We have two pectoralis majors, one on each side of our chest. These large muscles help you move your shoulder. The pectoralis major is a fan-shaped muscle in the front of your chest wall. The muscle also includes two heads, which are the clavicular head and the sternocostal head:
- Clavicular head – This originates from the front of your collar bone (medial clavicle), then continues down to your upper arm bone (humerus) where it attaches at the intertubercular sulcus.
- Sternocostal head – The sternocostal head originates from your breast bone, the upper six costal cartilages of your ribs, and your external oblique muscle. The sternocostal head attaches to the humerus with the clavicular head.
A pectoralis major strain may be caused by a sharp blow to the upper body or by the repetitive movement that puts heavy weight on it, such as a bench press. Although this type of injury is rare, it can affect the movement of the shoulder, arm, and chest. There are also 3 different areas that a pectoralis strain can occur:
- A strain within the pectoral muscle itself.
- A strain between the tendon and muscle itself (musculotendinous junction strain).
- A tendon strain at the attachment to the bone.
Causes & Symptoms of a Pectoralis Major Strain
Similar to any other muscle strain, a pectoralis major strain is classified by the level of damage done to the muscle or tendon. The damage may vary from a small discomfort with overstretching the muscle to a complete rupture. The following grades of a pectoralis major strain include:
Grade 1 pectoralis major strain
A grade 1 strain feel more like a discomfort within the pectoral muscle rather than acute pain because it is usually a stretch of the muscle and / or tendon. Small tears may occur, however, there is no obvious area that is torn. If the pectoralis muscle isn’t tested properly, pain and inflammation will worsen.
Grade 2 pectoralis major strain
A grade 2 strain is an actual tear in the muscle or tendon. It would feel like a sharp pain within the pectoral muscle or tendon, perhaps even accompanied by a tearing sound. A grade 2 pectoralis major strain occurs when a tendon or muscle is partially torn but still currently intact, leaving the pectoral area noticeably weaker.
Grade 3 pectoralis major strain
A grade 3 strain is considered a complete tear in the tendon either at the attachment to the muscle or to the bone. A tendon rupture causes an extreme amount of pain within the pectoralis major muscle or tendon at the time of the injury.
There may even be a popping or tearing sound. This specific grade will require surgery in order to rejoin the tendon back to the muscle or bone where it has become severed.
Half of all patients who injure their pectoralis major muscle happen when overloading the muscle while bench pressing. Furthermore, the use of steroids is heavily known to cause a considerable amount of weakness in the pectoralis major which makes it more prone to a tear or rupture.
In cases of symptoms linked to a pectoralis major strain, the very first sensation you will feel when the pectoral muscle is torn is sudden pain felt in the chest or more commonly, at the front of the armpit. At the same time, you may also have a sensation of something tearing. In grade 1 strains you may be able to continue participating with minimal strength.
However, as the muscle begins to recover following participation, pain may gradually increase as bleeding and swelling around the injured muscle takes place. This may be associated with progressive tightening and stiffening of the pectoralis muscle.
In grade 3 ruptures, these sensations may be exaggerated such that you’re unable to continue participating immediately following an injury due to excessive pain and muscle tightness, weakness, and spasm. In complete tears of the pectoralis major muscle, you may have instant pain which quickly subsides. But as the muscle is completely torn, you’re unable to produce any force and the arm is substantially weakened.
Who gets a Pectoralis Major Strain?
Not only do athletes and weightlifters have the susceptibility to straining their pec major muscle, but many other people can also strain it as well. For instance, older adults who are vulnerable to falling injuries have a higher risk of straining their pectoralis major muscle.
In addition, those involved in vehicle accidents also have a higher rate of chest muscle injury, sometimes from the safety devices involved in a motor vehicle (such as seatbelts and airbags in cars).
Lastly, children have the lowest risk of experiencing a pectorpectoralis major strain because of their higher flexibility, which is the reason why it is always important for young adults and older adults to stretch properly not just before a sports event, but before any strenuous activity.
How Does a Pectoralis Major Strain Affect You? How Serious is it?
Straining your pectoralis major muscle may feel very similar to a more serious problem with the heart or lungs since the pain can radiate throughout your entire chest depending on its severity.
Understanding the difference between these types of pain can help you seek emergency treatment when necessary. Here are some causes and complications of chest pain, including:
The pain of a heart attack differs from that of a strained chest muscle. A heart attack may cause dull pain or an uncomfortable feeling of pressure in the chest. Usually, the pain begins in the center of the chest, and it may radiate outward to one or both arms, the back, neck, jaw, or stomach. The pain may last for several minutes, and it may disappear and return in some cases.
Also known as stable angina, is chest pain resulting from coronary heart disease. Angina pectoris occurs when there is not good enough blood getting to the heart due to the narrowing or blockage of the arteries.
The symptoms of stable angina are similar to those of a heart attack but may be much shorter in duration, typically disappearing within 5 minutes. These symptoms normally occur after physical exertion and go away after resting or taking medication.
This is an infection that causes the air sacs within the lungs to fill with fluid or pus. Viruses, bacteria, and fungi can all cause pneumonia. A patient living with this condition may experience a sharp or stabbing pain in the chest, which worsens when coughing or breathing deeply.
Recommended Treatment & Rehabilitation for a Pectoralis Major Strain
General chest pain does not always signal serious complications like a heart attack. But an accurate diagnosis is recommended to check for what condition is present prior to your injury.
Therefore, your doctor will begin a regular three-step diagnostic process involving a physical examination, asking you about your medical history, and finally, perform a set of imaging tests in order to rule out other possible conditions.
After your doctor has done the first two steps during the process, he or she will order a set of imaging tests. Imaging is generally used to help differentiate a pectorpectoralis muscle injury from other types of disorders and to determine its extent:
- X-ray – X-rays should be taken to look for any possible bone fragment on the tendon or other associated fracture or dislocation.
- Computed Tomography (CT) scan – This can be used to evaluate fractures identified on X-rays for surgical fixation.
- Ultrasound / Magnetic Resonance Imaging (MRI) – is an inexpensive modality that can be used to assess the presence of a tear or retraction of the tendon while an MRI can be performed to determine the size and extent of the injury.
After a diagnosis has been done, physiotherapy may be further advised. A physiotherapist will be able to work with you by designing a special treatment program specific to your condition and goals. Here are some of the treatments he or she may include:
Rest from your physical activities. Additionally, limit the use of your chest and shoulder muscles. No pulling, pushing, lifting, or activity requiring heavy breathing. To initiate the pain relief, hold crushed ice in a plastic bag against the pectoralis major muscle. Hold the ice, cycling 20-30 minutes on and off, for the first 24-72 hours.
Range of motion
To help combat chest stiffness and re-instate proper respiratory function, practice slow and controlled breathing. This will expand the chest, stretch the tissue surrounding the pec major, and re-establish the range of motion.
Complete 8-10 slow, deep breaths. To stretch the muscles of the chest, begin a comfortable standing position with your arms by your sides. Raise both arms in front of you, at 90 degrees. Move one arm at a time out to the side and as far back as you can without pain. Hold for 30 seconds, then complete 3-5 repetitions for each arm.
Even though rest is necessary initially for the chest muscles, they need to be strengthened later in the rehabilitation process. Begin by standing facing a wall. Then, plant your hands on the wall, directly in front of your shoulders, and perform small push-up movements against the wall. Progress doing push-ups on the floor, but from your knees.
Progress further to a regular push-up from your feet. Repeat this training 10-12 repetitions for 3 sets a day.
Other exercises can help you boost your recovery from a pectorpectoralis major strain after recovery has been done. Some exercise examples are targeted directly to your chest, such as:
Wrap the band around your feet, then hold the band with your thumbs facing upwards. Next, keep your arms at your side with your shoulders down and relaxed. Pull your elbows back squeezing the shoulder blades together toward the back. Perform this stretch 10 times a day with 25 repetitions.
Foam rollers are light foam tubes that can be used to improve flexibility as well as for self-massage. They can be used to roll out thighs muscles, which relieves tension and speeds up muscle recovery.
Doorway pectoral stretch
To perform this stretch, stand facing an open doorway. Then, raise your arm with your elbow bent 90 degrees. Rest your forearm against the wall with your elbows at shoulder height. Lastly, lean forward to gently stretch your chest muscles. Perform this stretch 2-3 times a day.
Alternative & Homeopathic Treatment for a Pectoralis Major Strain
One of the most common at-home treatments for mild chest muscle strains involves rest, ice, compression, and elevation (RICE), as described below:
- Rest – Stop activity as soon as you notice pain and rest for a few days before resuming to light activities two days after resting.
- Ice application – Apply ice or a cold pack to the affected area for 20 minutes up to 3 times a day.
- Compression – Wrap any areas of inflammation with an elastic bandage but do not wrap too tightly as it may impair circulation.
- Elevation – Keep your chest evaluated, especially at night time.
With home treatment, your symptoms from a mild pectorpectoralis major strain should subside in a few weeks. While you wait for a full recovery, you may take pain relievers to reduce discomfort and inflammation, such as ibuprofen or acetaminophen.