The pectoral muscles are one of the most isolated, and most-desired-for chest muscle group in the weightlifting world. Although a large and powerful muscle, it can still be overstrained when overloaded. Often the Chest strains we treat at our Portland Physical Therapy clinics happen when a load that is too heavy to handle is given to the muscle at an overstretched position. These muscle strains involve tiny tears in the muscle fiber on a microscopic level and would cause soreness and sometimes pain on the weightlifter. Several postural compensations ensue, and if the pectoral strain is not treated appropriately, tightness in the chest muscles may develop and can predispose the shoulder girdle for rotator cuff impingement and cervical pain down the road. Physical therapy is best prescribed in an acute chest muscle strain on the pectoral muscle.
Pectoralis Anatomy
The pectoral muscles comprise of the pectoralis major and the pectoralis minor – a pair on the left and a pair on the right. The pectoralis muscle fibers have a fan-like structure, fibers originate from the shoulder area anterior surface of the collarbone (clavicle), the breastbone (sternum), the top of the first 6 rib cartilages and the top of the external abdominal oblique aponeurosis. The pec major fibers then converge into its tendon, which inserts into the anterior top part of your arm above the bicep, Its action is to pull in the arm towards the chest and turn your arm inward. The pectoralis minor is a much smaller sister muscle underneath the pectoralis major and its fibers start on the cartilage of the third to fifth ribs and end at a bony prominence underneath the collarbone called the coracoid process. Its main action is to pull in the shoulder blade toward the rib cage.
Chest Strain Pain Relief
Physical therapy treatments can be quite effective in decreasing pain after injury and in reducing damaging postural effects. Ice is used on an acute strain that is still inflammatory, but eventually, moist heat can be used to increase blood flow to the muscle help the tightness relax. Electrical stimulation by way of a TENS machine can be used to deliver pain relief by way of the gate theory — an electric current is passed through your muscle and gives it a vibratory sensation. This vibration sensation travels to your brain faster than the pain signals and therefore masks the pain non-narcotically.
Physical Therapy for Range Of Motion
Because of the fibers of the pec muscles, range of motion in your shoulder may be compromised. Flexion, the ability to raise the arm overhead, may be reduced and because of the fibers of the pec minor, an injury there would cause a forward rotation of the arm and shoulder blade. Manual therapy and physical therapy exercises are performed in therapy to restore this motion. There are three main types of range of motion exercises in physical therapy: passive, active-assisted and active range of motion. Passive ROM exercises are performed with the patient being completely passive: the physical therapist moves your arm for you. Active-assisted ROM exercises use pulleys,sticks or your opposite hand to help assist the weight as you move the injured arm. Active ROM exercises require the patient to move their own arm. Physical Therapy exercises are usually prescribed in this order from passive to active, depending on the severity of the muscle strain/tear, and depending on the patient's ability to heal and progress.
Physical Therapy and Stretching The Chest
Your pectoral muscle is likely to tighten up after an injury. This is a protective reaction called muscle guarding whereby the patient may subconsciously tighten their muscle to protect it from overstraining again. The fibers of the muscle may also be scarred down from the tear causing further tightening of the structure. Pec stretches are performed to gently stretch the muscle to reduce this tightness and are prescribed to you by your physical therapist. These stretches should be done gradually so as to minimize re-tear and further injury. These exercises can be aided with manual therapy and massage along the fibers of the pectorals. Common pec stretches include the corner stretch, where you place both hands along the walls in a corner and having the patient lean in towards the corner. Another stretch uses a doorway, where the hand of the injured arm reaches to the side of a doorway, and the body of the patient leans in through the doorway. Stretches should be performed for 30 seconds, or however long tolerable and should not incite numbness or tingling in the arm or hand. Consult a physical therapist for details.
Pectoralis Strengthening
Once the muscle has recovered from its tear, it is time for the remodeling phase. Gradual strengthening exercises are performed and progressed during PT sessions as early as the symptoms of pain and tightness abate. Your physical therapist must strengthen you at all angles of the fibers of the pec muscle and must be able to challenge you through all modes of pressure. The main separations of exercises involve open kinetic chain and closed kinetic chain exercises. Open kinetic chains exercises involve use of dumbbells, elastic tubing and exercise machines for strengthening. Closed kinetic chain exercises involve pushups, planks, and use your bodyweight as resistance. Considering that your shoulder muscles have atrophied and gotten weak, it is also prudent to make sure to strengthen the rotator cuff and shoulder girdle as well.
Chest injuries and tightness causing secondary shoulder problems
As mentioned before, tightness in the pectoral muscles resulting from injury could cause damaging postural habits. The shoulder blade will tend to rotate around the rib cage – this is known as scapula abduction and protraction. This posture, combined with elevation of the arm, can cause subacromial impingement of the supraspinatus – a crucial rotator cuff muscle. The supraspinatus can suffer from tendonitis, inflammation and eventually tendon tear if pec deficits are not treated appropriately. These secondary problems are much more severe than the pec muscle strain that originated it. To prevent this from happening, your physical therapist should strengthen the scapular stabilizers like the middle trapezius, rhomboids, lower trapezius, and serratus anterior.
After Chest Injury Physical Therapy
Physical therapy is discontinued when you are able to return to all of our daily activities without pain, and have returned to sports activities with full participation.
Please keep in mind that severe pectoral muscle injuries may require further medical care – especially if the tear involves the pec tendon or is large enough to not be able to heal on its own. If your physical therapist does not feel that your chest is healing quickly enough in the usual timeline for soft tissue healing, then a visit to the physician or an orthopedic surgeon may be required.
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