Postoperative Physiotherapy for Pectoralis Major Tendon Repair

Introduction

The pectoralis major muscle, also known as the "pecs," is a big, fan-shaped muscle in the chest. It is essential for moving the upper body, like bending the arm, bringing it in towards the body, and twisting it inward.

The pectoralis major muscle injuries usually happen when the tendon tears or ruptures. This often occurs during activities like lifting heavy weights, playing contact sports, or suddenly putting too much force on the muscle. These injuries can cause a lot of pain, make a person feel weak, and make it hard for them to do things. Pectoralis major tendon tears are categorized by how bad they are. This can go from a small tear to a complete break.

Surgery is often needed to fix and make the pectoralis major tendon work properly again. However, getting better after surgery relies on a carefully planned exercise program that helps the body heal, regain strength, and improve everyday activities.

What Are the Goals of Postoperative Physiotherapy for Pectoralis Major Repair?

The main aim of physiotherapy and rehabilitation is to help the patient get back to their usual activity level as fast and safely as possible. This includes the following goals

• Keeping the repaired soft tissues strong and healthy.

• Slowly regaining full movement ability.

• Fully controlling and stabilizing muscles.

• Being able to do normal daily activities and sports without any limitations in the upper body.

What Are the Phases of Pec Major Repair Protocol?

• Immediate postoperative phase - 0 to 2 weeks.

• Intermediate postoperative phase - 3 to 6 weeks.

• Late strengthening phase - 6 to 12 weeks.

• Advanced strengthening phase - 12 to 16 more weeks.

What Is Done in Phase One of Rehabilitation After Pec Surgery?

Phase 1 is in the immediate postoperative phase. The time right after surgery is significant for taking care of pain, reducing swelling, and keeping the healing area safe. This phase aims to help the body heal, maintain joint mobility, and avoid complications. During this phase, the treatment for physical therapy includes:

1. Pain Management:

   • Ice and cold therapy to reduce pain and swelling.
   • Transcutaneous electrical nerve stimulation (TENS) can help with the pain.
   • Gentle manual techniques like soft tissue mobilization or massage.

2. Swelling Control:

   • Elevation of the arm to reduce swelling.
   • Compression bandages or garments.
   • Gentle active and passive range of motion (ROM) exercises to promote lymphatic drainage.

3. Joint Mobility:

   • Pendulum exercises to promote shoulder joint mobility.

   • Passive ROM exercises within the pain-free range to prevent joint stiffness.

   • Gentle stretching of the pectoralis major muscle.

4. Protection of the Repair:

   • Immobilization with a sling or brace to protect the repair.
   • Educating the patient on proper body mechanics and precautions to avoid excessive stress on the healing tendon.

What Is Done in Phase Two of Rehabilitation After Pec Surgery?

Phase 2 is the intermediate phase, in which the focus shifts towards gradually increasing the range of motion, strengthening the shoulder, and restoring functional abilities. This phase includes the following.

1. Active-Assisted Range of Motion (AAROM):

   • Utilizing pulleys, dowels, or wand exercises to increase shoulder ROM.
   • Gentle stretching exercises for the pectoralis major and surrounding muscles.

2. Strengthening Exercises:

   • Isometric exercises for the pectoralis major and scapular stabilizers.

   • Progressing to isotonic exercises using resistance bands or weights.

   • Gradually introducing closed-chain exercises and push-up variations.

3. Scapular Stabilization:

   • Retraining scapular control and stability through scapular squeezes, rowing motions, and wall push-ups.
   • Incorporating scapular stabilization exercises into functional movements.

4. Proprioception and Neuromuscular Control:

   • Balance and coordination exercises to improve proprioception and regain control of the shoulder joint.
   • Unstable surface training and perturbation exercises challenge the muscles and enhance stability.

What Is Done in Phase Three of Rehabilitation After Pec Surgery?

The late strengthening phase is critical for advancing strength, improving muscle power, and enhancing functional capacity. The primary goals and physiotherapy techniques during this phase include the following.

1. Progressive Resistance Training - Introducing higher resistance and intensity to challenge the muscles further is done, and incorporating exercises such as dumbbell presses, bench presses, and cable fly is also done in this phase. Techniques like supersets, drop sets, and pyramids to stimulate muscle adaptation are implemented.
2. Power and Explosiveness Training - Power training incorporates exercises with explosive movements, such as medicine ball throws, plyometric push-ups, and chest passes. Resistance bands or cable machines are utilized to accommodate resistance during power exercises.
3. Functional Strength and Endurance - Functional movements and activities closely resemble the patient's specific sport or daily activities integrated into the exercise. Circuit training or interval training is incorporated to improve muscular endurance and cardiovascular fitness. Unstable surfaces, such as BOSU balls or balance boards, challenge stability and core strength.
4. Flexibility and Mobility - Regular stretching exercises are done to maintain and improve flexibility.

What Is Done in Phase Four of Rehabilitation After Pec Surgery?

Phase four is the advanced strengthening phase. This focuses on further optimizing strength, power, and performance for individuals aiming to return to high-level sports or activities. This phase includes

Sport-Specific Performance Training:

The following is done

• Sport-specific drills, movements, and exercises that closely mimic the demands of the patient's particular sport.

• Agility drills, sport-specific resistance exercises, and simulated game situations.

Progressive Overload:

• Continually challenging the muscles through progressive overloads, such as increasing resistance, repetitions, or intensity, is done, and advanced techniques like eccentric training, isometric holds, or cluster sets are also included.

Injury Prevention Strategies:

• Focusing on neuromuscular control, proprioception, and dynamic stability exercises to reduce the risk of re-injury.

• Incorporating balance and coordination drills, single-leg exercises, and perturbation training.

Maintenance and Long-Term Conditioning:

• Developing a maintenance program to sustain the achieved strength and fitness levels.

• Periodic re-evaluation of goals, addressing weaknesses or imbalances, and adjusting the training program accordingly.

Conclusion

After surgery to repair the pectoralis major tendon, the guidelines for returning to physical activity involve taking it slow and tailoring the approach to each person's needs. Things considered include the tendon being fully healed, the pain and symptoms going away, strength and flexibility being restored, and receiving training specific to the sport. It is crucial to stay in touch with the healthcare team during the whole process to ensure the individual can safely return to playing sports without getting injured again.