Physiotherapy Management of Pectoralis Major Strains- Strategies for Optimal Recovery

Introduction

Pectoralis major is a large fan-shaped muscle that is located in the chest area. These muscles play an important role in shoulder movement and movement of the upper extremities. It also helps in shoulder flexion, internal rotation, or adduction. Trauma or injuries in these muscles leads to immense pain and requires treatment and management. Physiotherapy significantly impacts success rates in managing these conditions and pain.

What Is Pectoralis Major Strain?

Pectoralis major strain involves stretching or tearing of the major muscle. These play a major role in arm movement and arms flexing. This occurs due to sudden, forceful stretching and contraction of muscle beyond normal limits. These types of strain are mainly impacted by rapid movements that directly affect the chest area. The severity of a pectoralis major strain can vary, ranging from a mild stretching of muscle fibers to partial or complete tears. Clinically the pectoralis tears are not elusive. The individuals always have a history of doing a lift or feel like the shoulder is ripping off; these types of injuries are often accompanied by a “snap” or pop sound.

• Pain is generally not more intense.

• Mild swelling occurs, followed by ecchymosis (discoloration of the skin due to bleeding underneath the skin).

• On physical examination, loss of the anterior axillary fold and normal pectoralis contour is seen.

• Bruising is often evident on the anterior chest wall or in the proximal arm.

• Loss of strength is most noticeable in such strains, and notable internal rotation is affected and neural on testing.

Most of the pectoralis major strains are classified into three grades based on severity:

• Grade 1: Mild strain with minimal tearing of muscle and no loss of strength. For grade 1, physiotherapy mostly started seven days after injury.

• Grade 2: Moderate strain with partial muscle tearing and some strength loss. Physiotherapy is provided three to four weeks after the injury.

• Grade 3: Severe strain or complete muscle tear leading to significant loss of strength. The therapy in such cases is provided about six weeks after the injury.

Each type of injury is different and requires healthcare professional guidance to understand the best time to start with a physiotherapy approach. The common symptoms of a pectoralis major strain include sudden onset of pain in the chest or front shoulder during the injury. The pain may be accompanied by tenderness, weakness, swelling, bruising, and difficulty with arm movements. The primary diagnosis is made by clinical presentation and physical examination, followed by a radiographic examination or MRI (magnetic resonance imaging), especially in partial tear cases.

In Which Pectoralis Major Strained Condition Physiotherapy Interventions Are Required?

The conditions where physiotherapy interventions are required in pectoralis major strains are:

• Muscle Weakness - Pectoralis major injuries can result in muscle weakness or imbalances.

• Pain and Swelling - Conditions that result in pain, swelling, and disturbing movement.

• Decreased Range of Motion - Incidence where there is a significant loss of range of motion in the shoulder or chest due to a pectoralis major injury.

• Pectoralis Major Strains or Tears - Pectoralis major strains involve stretching or tearing of the pectoralis muscles. These strains include sudden overload and excessive stretching of muscle fibers. They are commonly seen in athletes and weightlifters.

• Post-Surgical Rehabilitation - Severe pectoralis injury requires post-operative care and rehabilitation. This helps in optimizing the healing process and range of motion, regaining strength, and facilitating a return back to normal activities.

• Preventing a Reinjury - Proper techniques for doing activities can reduce the risk of re-injury and help in preventing any further injuries.

• Functional Limitations - Injuries in these muscles can affect daily activities and sports performance. In such cases, physiotherapy interventions are required.

How Are Pectoralis Major Strains Managed?

The management is mainly based on severity and involves a combination of conservative treatment and surgical intervention in some cases. Common management approaches include:

• Rest - Resting the affected muscles and avoiding straining activities that can increase pain in injured areas.

• Modifying Activities - Altering the body movements that involve using the pectoralis major muscle until healing progresses.

• Inflammation and Pain Management - Inflammation and pain can be managed by methods like

1. Ice Therapy: Also called cryotherapy, a therapeutic modality that involves the application of cold temperatures to the body for therapeutic purposes.

2. Massage Therapy: A manual therapy technique that involves the manipulation of soft tissues in the body, including muscles, tendons, ligaments, and connective tissues

3. Heat Therapy: Also called thermotherapy, is a therapeutic modality that involves the application of heat to the body.

4. Electrical Stimulation: Electrotherapy is a therapeutic modality that involves the application of electrical currents to the body for various therapeutic purposes. Different types like TENS (transcutaneous electrical nerve stimulation ), NMES (neuromuscular electrical stimulation), and FES (functional electrical stimulation) are used.

5. Kinesiology Taping: Kinesiology tape, or K-tape, is applied to decrease and reduce muscle spasms and pain and facilitate muscle function.

6. Anti-inflammatory Drugs (NSAIDs): Medications like Naproxen and Ibuprofen over-the-counter help alleviate pain and inflammation.

These therapies can be employed to manage pain, reduce swelling, and facilitate the healing process.

• Role of Physiotherapy in Management: Physiotherapy plays a crucial role and great impact in successfully treating pectoralis major strains. These approaches include:

1. Strengthening Exercises: Targeted exercises to strengthen the pectoralis major muscle and the surrounding muscles are done. These exercises include push-ups, chest presses, and resistance band exercises.

2. Functional Training: Specific exercises that mimic daily activities and sports movements help in restoring function and improve performance.

3. Manual Therapy: A professional may employ techniques like myofascial release, soft tissue massage, and joint mobilization, which help in alleviating pain and tightness and restores normal function.

4. Plyometrics: These exercises use rapid force through the arm and require a forced return. Plyometric exercise includes a weighted ball catching or throwing and catching a ball against a plyo-back trampoline. These exercises are mainly important if individuals plan to return to high-level athletics.

5. Range of Motion: Controlled gradual exercises are done to restore and maintain shoulder and chest range of motion. This involves gentle stretching and mobility exercises.

• Surgical Approach- Extreme tears and severe strains require surgical intervention. This typically includes cases like prolonged, persistent pain, loss of function, and when the conservative approach is not effective.

Conclusion:

The recovery time for a pectoralis major strain can vary depending on the severity of the injury, adherence to the rehabilitation program, and individual factors. Always consult a physiotherapist for an accurate diagnosis and appropriate planned management of the strains keeping one's medical condition in mind. Proper guidance through the recovery process may help in a safe return to sports and normal day-to-day activities.