Physical Therapy for a Pectoralis Major Tear

Rehabbing a Torn Pec Muscle or Tendon

A torn or ruptured pectoralis muscle can limit your ability to engage in normal work and recreational activities. It can limit arm use, and may cause significant pain. If you have ruptured or torn your pectoralis major muscle in your chest, you may benefit from physical therapy (PT) to help you recover. You may experience pain, limited shoulder motion, and difficulty using your arm normally. Your physical therapist can assess your condition and offer the right strategies and treatments to help you fully recover.

Anatomy of the Pectoralis Major

Your pectoralis major is the large muscle in the front of your chest. It courses from your sternum (breastbone) and your collar bone to attach at the front of your upper arm bone. This large, fan-shaped muscle works to adduct your arm, which means that it pulls your upper arm across the front of your body. When you are pushing something, your pectoralis major is active to stabilize the front of your shoulder. The muscle also helps with respiration during heavy breathing.

How Your Pec May Tear

Your pectoralis major muscle may tear if it becomes overloaded, typically during activities where you are pushing something. The tear often occurs during a bench press exercise. When you are lifting heavy weights and the pec tendon becomes overloaded, it may tear. Other forceful encounters, such as a fall onto an outstretched arm or a sudden and violent pull on your arm may also tear your pectoralis major tendon.

Symptoms of a Pec Tear

There are certain signs and symptoms that may occur if you have ruptured your pectoralis major muscle. These may include:

  • An audible pop in your chest or shoulder during the traumatic event that caused your injury
  • Pain in the front of your shoulder
  • Difficulty lifting your shoulder and arm
  • Difficulty pushing things, like a door
  • Bruising in the front of your shoulder
  • Swelling in the front of your shoulder and chest
  • Distorted shape in the front of your chest on the affected side

If you have any of these symptoms and suspect you may have torn your pec, you should visit your physician right away. They will be able to examine your condition and diagnose your problem.

Diagnosis of a pectoralis tear relies largely on the clinical examination. Your doctor will ask you how your pain and limited motion started. Usually, your description of the mechanism of your injury and your symptoms will lead your physician to suspect your pec has torn. A specialized test called magnetic resonance imaging (MRI) may be done to confirm the suspected diagnosis.

There are three grades of muscle and tendon tears. Your pectoralis tear will likely be graded by your physician. The grades are numbered by severity. A grade I tear is simply an overstretching of the pec tendon. A grade II tear is a partial tendon tear; some of the tendon is torn and some is still intact. A full-thickness tear of your pectoralis muscle or tendon is a grade III and is the most severe. Grade III tears usually require surgery as an initial treatment to correct.

Initial Care for a Pectoralis Tear

Once a pec tear has been diagnosed you can start on the road to recovery. Initial care may include surgery to restore the proper position of your pectoralis muscle. Surgery involves sewing your pec tear back into place on your upper arm. After surgery, a period of six to eight weeks of immobilization in a sling may be required by your physician .

If you do not require surgery, your physician may still require that you wear a sling. The sling helps to keep your upper arm and shoulder still to allow your pec tendon to heal. Typically, a sling is worn for four to eight weeks.

During this initial time of immobilization, you may use ice to help control the pain and to decrease swelling around your shoulder and chest. Ice should be applied for 10 to 15 minutes several times each day. Be careful not to suffer a frost burn on your skin; placing the ice pack in a towel wrap is recommended.

When Should Physical Therapy Start?

You may be wondering how soon you can start PT after a pectoralis injury. Typically, people with a grade I pec tear can start therapy about seven days after the injury. Grade II pectoralis tears require a bit more rest and immobilization, so PT will likely start about three to four weeks after the injury. A grade III tear requires a bit more rest, so your physical therapy will start about six weeks after the injury. If you have had surgery, your PT may start about six weeks after surgery.

Everyone's injury is different, so be sure to talk with your physician to understand when the best time for you to start PT.

PT Evaluation for Pectoralis Tear

Your first session with a physical therapist is called an initial evaluation. During this session, your PT will interview you about your injury. They will ask how your injury occurred, how it is affecting your work and recreational activities, and if you have had surgery or not. Your PT will also ask about your past medical history.

During the PT evaluation for a pectoralis major tear, your therapist will perform specific tests. These help determine your functional baseline and guide your treatment. Tests commonly performed during an evaluation for a pectoralis tear include:

After your physical therapist has completed the evaluation, they will work with you to develop a plan of care and set goals for your rehab. Goals should be challenging, but attainable. Your PT can also tell you what to expect from therapy and what your overall prognosis is likely to be.

Physical Therapy Treatment for Pectoralis Tear

Various treatments may be used by your physical therapist during your pec major tear rehab. These may include physical modalities, exercise, or manual techniques. All treatments are designed to help you move better, decrease pain, and improve overall functional use of your arm.

Exercise

Exercise for your pec tear should be your main treatment in physical therapy. Why? Because exercise helps you regain range of motion, strength, and functional use of your arm. Your physical therapist may also have you perform a daily home exercise program to augment the things you are doing in the PT clinic. Various types of exercises may be done, including:

  • Range of motion. Range of motion exercises help to improve the way your shoulder moves. Exercises may include passive ROM, where your PT moves your arm, or active motion where you are moving your arm. Pulley systems may be used to help you gain movement through your shoulder joint and chest.
  • Strengthening exercise. Strengthening exercises may be done to help improve the way your shoulder and pectoralis muscles work. Exercises may start with simple isometrics; you push against something sturdy while no motion occurs at your shoulder. You may then progress to strengthening for your shoulder, rotator cuff, and pectoral muscles with free weights, resistance bands, or with weight machines. Exercises should be challenging and should not cause pain.
  • Endurance exercise. Exercises to improve muscular endurance may be done during your pec tear rehab. Your physical therapist may have you use an upper body ergometer (UBE) to improve upper extremity muscular endurance. (A UBE is a bicycle that you pedal with your arms.) A rowing machine may also be used. These exercises may place significant stress through your pec and upper arm, and therefore should be reserved for the later stages of your recovery.
  • Plyometrics. Once significant progress has been made with your rehab, your PT may prescribe upper extremity plyometrics. These exercises place rapid force through your arm and require that you return the force. Plyometric exercise may include weighted ball catching or throwing and catching a ball against a plyo-back trampoline. These exercises are especially important if you are planning on returning to high-level athletics.

Keep in mind that your exercises may cause slight discomfort; your exercises should not cause severe or lasting pain in your chest, shoulder, or upper arm. If any exercise causes pain, check in with your physical therapist.

Scar Tissue Massage

If you have had surgery, your PT may perform scar tissue massage over the surgical scar. The massage and mobilization helps to create a mobile scar in the skin and fascia surrounding your surgical incision. Keep in mind that scar tissue massage has not been proven to improve functional use of your arm after a pectoralis major tear.

Heat

Your physical therapist may apply heat to your upper arm and shoulder during your pectoralis major rehab. Heat is used to increase local circulation, decrease pain, and improve tissue mobility. Care should be taken when using hot packs, as they can burn your skin. Be sure to tell your PT if the heat application is too hot.

Ice

Ice is often used at the end of physical therapy to help decrease pain and inflammation around your shoulder and pec. Ice decreases local blood flow to the tissues where it is applied. Care should be used when applying ice, as it may cause a frost burn to your skin. Inform your PT if the ice application is painful or uncomfortable.

Ultrasound

Ultrasound is a therapeutic modality used in physical therapy. The goal of ultrasound application is to improve circulation to the tissues deep in the body. Application of ultrasound is done by your physical therapist, who uses an ultrasound wand and a coupling gel over your injured arm and shoulder. Ultrasonic waves are passed into your body, heating the tissues and increasing circulation. Typically, ultrasound is painless, but if it is not applied properly, it may cause a deep burning sensation. Tell your therapist if you feel any discomfort during ultrasound for your pectoralis major tear.

A word of caution: scientific studies have not proven that ultrasound adds anything of value to a physical therapy program. The use of ultrasound after a pec tear does not offer superior functional improvement when compared to rehab programs that do not include ultrasound. Still, some physical therapists use it, so you should have a basic understanding of it and how it is used during rehab for your pectoralis tear.

Electrical Stimulation

Your physical therapist may use electrical stimulation as part of your pectoralis major rehab. Electrical stimulation, or e-stim, is used to help decrease pain, improve circulation, or improve the way your muscles contract around your chest and shoulder. Care should be taken when using e-stim near your pectoralis major as it is near the heart. Applying e-stim over your heart has the potential to interfere with cardiac function.

Kinesiology Taping

A recent advancement in injury rehab is the use of kinesiology taping. Kinesiology tape, or K-tape is applied by your physical therapist to help decrease pain, decrease muscle spasm, or facilitate muscle function. Kinesiology tape may also be used to decrease bruising during the initial phases of your recovery. Keep in mind that K-tape is a newer treatment and has not passed rigorous scientific testing. Therefore, it may not add much to your overall functional improvement with your pectoralis major.

How Long Should PT Take?

You can expect to attend physical therapy for four to eight weeks after a pectoralis major tear. If you have had surgery or have a grade III tear, you can expect to attend physical therapy a bit longer than if you have a grade I pec tear. Everyone heals at different rates and everyone's injury is unique, so keep in mind that your specific situation may take longer to heal, or your rehab may be done quite quickly. Working closely with your physical therapist and physician can help you understand what to expect with your specific situation.

A Word From Verywell

A pectoralis major tear is a rare occurrence, but if it happens, you may experience significant pain and functional mobility loss. Your normal work and recreational activities may be affected as well. Working with a physical therapist after a pectoralis tear can help you regain range of motion, strength, and functional use of your arm. That way, you can quickly and safely get back to your normal activity.

Was this page helpful?

Article Sources

  1. Cordova A.J., Azizi H.F., Rand S. (2017) Pectoralis Major and Minor Strains and Tears. In: Kahn S., Xu R. (eds) Musculoskeletal Sports and Spine Disorders. Springer, Cham


  2. Mooers BR, Westermann RW, Wolf BR. Outcomes Following Suture-Anchor Repair of Pectoralis Major Tears: A Case Series and Review of the Literature. Iowa Orthop J. 2015;35:8-12.