The pectoral muscles, while large and robust, are frequently targeted and highly sought-after in weightlifting circles. Despite their strength, these muscles are susceptible to overexertion when excessively burdened. At our Portland Physical Therapy clinics, we often treat chest strains resulting from lifting weights that are too heavy for the individual, particularly when the muscle is in an overly stretched state.
These strains can cause minute tears in the muscle fibers, leading to soreness and potential pain in the individual. If not correctly managed, this can lead to a series of posture adjustments and may result in tightness in the chest muscles. Over time, this can set the stage for issues such as rotator cuff impingement and neck pain. Early intervention with physical therapy is the best course of action for managing an acute strain in the pectoral muscles.
| Chest Injury | Therapy & Treatment |
|---|---|
| Pectoral Muscle Strain | Rest, Ice, Compression, Elevation, Physical Therapy, Pain Medication |
| Rib Fracture | Rest, Pain Management, Breathing Exercises, Physical Therapy |
| Costochondritis | Rest, Heat or Ice Therapy, Pain Medication, Physical Therapy |
| Sternum Fracture | Rest, Pain Management, Physical Therapy |
| Intercoastal Muscle Strain | Rest, Ice, Compression, Elevation, Physical Therapy, Pain Medication |
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 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 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 and 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, the 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 have 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 the use of dumbbells, elastic tubing and exercise machines for strengthening. Closed kinetic chain exercises involve pushups, planks, and use your body weight 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.
Do chest injuries heal on their own?
Some minor chest injuries may heal on their own with time and rest, but it largely depends on the severity and type of the injury.
For example, minor pectoral or intercostal muscle strains, where the muscle fibers have been slightly torn or overstretched, can often heal with rest, over-the-counter pain relievers, and light stretching once initial pain subsides.
However, more severe injuries, such as rib fractures, sternum fractures, or severe muscle strains, usually require medical intervention. This can involve pain management, physical therapy, and in some cases, surgery. Even in these cases, the body does the actual healing, but medical treatment can guide the healing process, alleviate symptoms, prevent complications, and help restore function.
Furthermore, chest injuries that involve internal organs, like the lungs or heart, are very serious and require immediate medical attention.
If you’ve suffered a chest injury, it’s important to consult with a healthcare provider to determine the severity of the injury and the appropriate course of treatment. Never ignore chest pain or injury, as it could indicate a serious condition requiring immediate medical attention.
How can I treat a chest injury at home?
Treating a chest injury at home should only be done for minor injuries, and only after you’ve seen a healthcare provider who has determined that home treatment is safe and appropriate. For severe chest injuries, especially those involving difficulty breathing, intense pain, or potential damage to internal organs, you should seek immediate medical attention.
For minor chest injuries, such as mild muscle strains, here are some steps you can take:
- Rest: Give your body time to heal by avoiding activities that cause pain or could potentially worsen the injury.
- Ice: Apply an ice pack to the injured area for 15-20 minutes at a time, several times a day, for the first 24-72 hours. This can help reduce inflammation and pain.
- Compression: Lightly wrap the injured area with an elastic bandage to reduce swelling. Be careful not to wrap it too tightly, which can cause more harm.
- Elevation: If possible, try to keep the injured area raised above the level of your heart to help decrease swelling.
- Pain Relievers: Over-the-counter pain medications, such as ibuprofen or acetaminophen, can help manage pain. Always follow the directions on the package.
- Gentle Stretching: Once the initial pain has decreased, gentle stretching exercises can help restore flexibility. These should be done under the guidance of a healthcare provider or physical therapist.
- Gradual Return to Activity: As your chest injury heals, gradually reintroduce physical activity. Avoid activities that cause pain.
Remember, these tips are for minor chest injuries. Always consult a healthcare provider if you’re experiencing chest pain or have suffered a chest injury.
