The most crucial muscle group involved in a powerful Bench Press is the “pec”—the pectoralis major. It is a large muscle group composed of two to three muscle “bellies”—the bulging, central part of a muscle. These originate on the anterior clavicle, sternum and a portion of the lower ribs.

As such a large muscle group, the pecs are capable of pressing massive amounts of weight. But with this comes a high risk of injury, the most common of which is a pectoral tendon rupture—literally, the tendon separating from the bone.

These muscle fibers are at maximal stretch during the final portion of the Bench Press, when the lifter lowers the bar onto his or her chest wall. A common scenario for this injury is a male weightlifter completing a heavy set of Bench Presses and feeling a “pop” or tearing sensation while lowering the bar to his chest. This is usually followed by pain, swelling and significant bruising into the armpit, upper arm and chest region. A visible or palpable defect is often detected upon examination. Often only one of the heads of the muscle is torn.

Pectoral tendon injuries can be devastating, but with proper evaluation, treatment and rehabilitation, an athlete has a fighting chance to regain most functional strength and muscle mass.

Pectoral Tendon Injury Prevention

• Warm up to increase the pliability of the soft tissues and prepare your muscles and nerves for heavier weights. Start with lighter weights and pyramid up.
• Make sure you’re getting adequate protein for your height/weight and activity. This can range from 1 gram of protein per pound to 1 gram per kilogram of bodyweight.
• Get at least 7 to 8 hours of sleep per night.
• Rest for 48 hours between Bench Press sessions.
• Lower the eccentric portion of the repetition in a slow and controlled manner, as the muscle is contracting and stretching at the same time and is predisposed to injury at this point.

Diagnosis

Typically, an orthopedic surgeon will use an X-ray and/or an MRI to make a diagnosis. An MRI is better at defining soft tissue structures (i.e., tendon/muscle) and often helps to define the diagnosis if it is not apparent on the history and examination.

Treatment

Non-operative measures include a sling for comfort, rest, ice and anti-inflammatory meds. However, this is reserved for only those who are low-demand, and small partial tears or muscle belly tears. For a complete tendon tear, surgical repair is usually recommended due to the resulting improvements in strength/endurance and cosmetic restoration.

Rehabilitation

Postoperative rehabilitation is a balancing act between initial restriction of motion to allow the repaired soft tissues time to heal in a low strain (stretch) environment and enough motion to prevent any residual stiffness or loss of motion.

It is important to return to functional strength gradually. As with any recovery situation, the timing varies significantly from patient to patient based on biologic and sport-specific factors. Some experts recommend that an athlete lift no more than 50% of his/her 1 Rep Max (RM) within the first six months of recovery. Heavy lifts requiring large stretches of the pec tendon, such as Cable/Dumbbell Flies or Pec Dec Apparatus, should be avoided within the first six months.

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