Geschatte leestijd: 11 minutenThe most successful male bodybuilder in Dutch history, “The Flexing Dutchman” Berry de Mey, saw his career spiral downward after tearing his chest muscle while bench pressing. Although it’s not common to tear your chest muscle while bench pressing, it is one of the most common causes.
Recovering from a Chest Injury?
One of the dietary supplements known to contribute positively to the recovery of a chest injury is the amino acid L-Glutamine. Glutamine protects against muscle injuries and aging.
Inhoudsopgave
- Recovering from a Chest Injury?
- Anatomy of the Chest
- Pectoralis Major: Origin and Insertion
- Pectoralis Major: Functions
- Pectoralis Minor: Origin and Insertion
- Pectoralis Minor: Function
- Common Chest Injury: Pectoralis Major, the Large Chest Muscle
- Causes of Strained and Torn Large Chest Muscle
- Symptoms of Strained or Torn Large Chest Muscle
- Diagnosing Strained or Torn Large Chest Muscle
- Treatment/Recovery of Strained or Partially Torn Large Chest Muscle
- P.R.I.C.E: (P)rotection, (R)est, (I)ce, (C)ompression, (E)levation
- Treatment and Recovery of Completely Torn Large Chest Muscle
- Injuries to Pectoralis Minor, the Small Chest Muscle
- Preventing Chest Injuries
In this article, I will mainly focus on chest injuries caused or potentially caused by fitness and strength training, how they are caused, how they can be prevented, and how to recover from them. But first, as always in my articles about injuries, I will discuss the anatomy of the chest muscles. Understanding how a muscle is attached and what its normal function is often helps you understand more quickly where and how things can go wrong.
Check out this link if you want an overview of all chest exercises.
Anatomy of the Chest
The chest muscles consist of two different muscles, the pectoralis minor and the pectoralis major. The pectoralis major lies over the pectoralis minor. A skeletal muscle always has a point where it “originates” and a point where it ends, called the origin and insertion, respectively. The origin is usually attached to the least movable part. Both are the muscle’s connection to bone through an attachment.
Because most muscle injuries occur in this attachment, it may be useful to also read the general section on tendon injuries and attachment problems.
Pectoralis Major, Origin and Insertion
The pectoralis major is a so-called fan-shaped muscle. This means that the point of origin is much wider than the point of insertion. The pectoralis major is usually divided into the upper chest muscle and the lower chest muscle for training purposes. However, if you look at the point of origin, you can divide it into three or four parts (depending on the method and naming you choose). The upper chest muscle is the clavicular pectoralis major (pars clavicularis). Clavicularis refers to the collarbone from which this part of the pectoralis major originates. The lower chest muscle consists of the sternal pectoralis major, which originates from the sternum (breastbone, pars sternum), the costal pectoralis major, which originates from the cartilage of the ribs (2nd to 6th), and the pars abdominalis, which originates from the anterior lamina of the sheath of the rectus abdominis. The sternal and costal pectoralis major can be combined under the name pars sternocostalis.
All of them have the same insertion point, namely the humerus, the upper arm, forming the front of the armpit. However, there is a difference in how they are connected to the upper arm and at which exact location. The upper chest muscle, the clavicular pectoralis major, has its own insertion point that extends over that of the lower chest muscle. The lower chest muscle, with multiple points of origin, has one shared insertion point above that of the upper chest muscle.
Pectoralis major: functions
The pectoralis major has various functions, most of which contribute to movement in the shoulder joint:
- Protraction of the scapula. Pulling the shoulders forward as in pushing movements like bench presses.
- Anteflexion of the humerus. Bringing the upper arm forward and upward as in lifting a child.
- Adduction of the humerus. Bringing the upper arm inward as in pec deck flyes and cable crossovers.
- Endorotation of the humerus. Bringing the arm inward as in arm wrestling.
- Maintaining the attachment of the upper arm to the trunk.
The different parts of the chest muscle have (an emphasis on) different functions. The upper chest muscle, the pars clavicularis, is primarily responsible for flexion, horizontal adduction (bringing inward as in flyes), elevation (raising the shoulder girdle), and endorotation. The lower fibers (costal and abdominal) emphasize more on detracting/depressing, pulling the shoulder girdle downward.
Hence, to train the upper chest muscles, for example, you might perform an incline bench press instead of a flat bench press. With this angle, you now lift your shoulders more upward than forward. The opposite applies to the lower fibers of the chest muscles, for example, decline chest press. By lying on an inclined bench with the head lower than the legs, the shoulders must be pulled toward the legs (depression) instead of toward the head (elevation).
Pectoralis minor: origin and insertion
The pectoralis minor lies beneath the pectoralis major. It has 3 points of origin at the extreme point of ribs 3, 4, and 5, near the cartilage. The point of insertion is the coracoid process (raven’s beak prominence).
Pectoralis minor, function
The functions of the pectoralis minor are:
- Depression of the shoulder. Pulling the shoulder downward.
- Medial rotation: Turning the shoulder blade inward.
- Protraction: Pulling the shoulder blade forward.
Common Chest Injury: Pectoralis Major, Large Chest Muscle
The most common chest injury in fitness and bodybuilding is pectoral strain, the forced and/or torn chest muscle. Pectoral strain can be classified into 3 degrees of damage (classification based on pain is also used):
- Degree 1: A few muscle or tendon fibers are torn. Similar to a strained chest muscle. The loss of strength is minimal, and recovery is relatively easy/quick.
- Degree 2: A partial tear. More fibers are torn, there is more loss of strength, and recovery is less rapid.
- Degree 3: A complete tear. The connection to the upper arm bone is broken.
A complete tear can occur in both the attachment of the upper part of the muscle (pars clavicularis) and the attachment of the lower part of the chest muscle (pars sternocostalis), or both at the same time.
As mentioned, the grading is also indicated in other ways. Sometimes, pectoral strain refers only to straining or partial tearing, and complete tearing is not included.
Causes of Strained and Torn Large Chest Muscle
The (attachment of the) large chest muscle can tear in two ways. This usually happens acutely. Common causes are almost all chest exercises, especially bench presses. The fact that this occurs relatively often in bench presses is very likely due to the fact that it is often done relatively heavily. Other causes include traumas such as a hard blow to the chest or front of the shoulder, causing the chest muscle to strain. It can also occur in other sports, for example, in baseball, both in pitching and at bat.
A torn large chest muscle can also result from chronic overtraining. This leads to small tears that increase in number, increasing the likelihood of a larger tear.
Symptoms of Strained or Torn Large Chest Muscle
Symptoms of a strained or torn attachment of the chest muscle are:
- Pain in the chest region
- Inflammation: Swelling, burning sensation, and bruising. These can, in severe cases, radiate to the shoulder and upper arm.
- Loss of strength when lifting
- Difficulty moving the arm across the chest.
- In the case of a completely torn chest muscle, a “pop” sound may be heard during the tear. There may be a sudden, sharp pain in the chest, front shoulder, and top of the arm. Some describe this feeling as if they were having a heart attack (although they probably have no idea what a heart attack feels like). Because the muscle is no longer attached to the upper arm, it sags (similar to a Popeye arm) due to the thickening that occurs at the bottom of the chest, resembling a “bitch tit” (gynecomastia). There will be a significant loss of strength. Moving the arm, laughing, and coughing can be painful. After the tear itself, this may sometimes be less painful than a partially torn or strained attachment because the connection is broken.
Diagnosing a Strained or Torn Large Chest Muscle
Important: If you suspect that the chest muscle is torn, you should immobilize it as soon as possible (for example, with a sling/scarf) and cool the chest and front shoulder with a cold compress. Then have a doctor diagnose it as soon as possible because it is important to have any necessary surgery performed as soon as possible. The longer you wait for surgery, the less likely the chest will return to near its previous level after recovery.
During an examination of chest complaints, a doctor will inquire how they occurred and conduct a physical examination by, among other things, looking at the location of pain and reduced strength. This is often sufficient indication. An X-ray and/or MRI may be performed for confirmation or to indicate other damage.
Treatment/Recovery of a Strained or Partially Torn Large Chest Muscle
In case of strain or partial tear, follow the R.I.C.E principle. In this case, P.R.I.C.E. may still apply with (P).R.I.C.E. summarized as follows:
P.R.I.C.E: (P)rotection, (R)est, (I)ce, (C)ompression, (E)levation.
Protection: If you notice that you experience pain even with the slightest movement due to the strain or partial tear, it is useful to wear a sling. This prevents movements that further damage the muscle (attachment).
Rest: The muscle damage is caused by overloading, either chronic or acute. In both cases, it is important to stop this loading immediately. It is wise not to train your chest as long as you still feel pain in other activities in daily life. If normal activity still causes pain, do not further stress the damaged muscle. Light stretching and mobilization exercises without resistance can help once the pain has decreased. By mobilization, I mean moving the arm in all directions to prevent the joint from becoming stiffer and causing more complaints.
Also, be cautious with exercises for other muscle groups that also strain the chest, such as dips for the triceps and front raises for the shoulders. Be careful with picking up and putting down weights in other exercises as well. One wrong movement with heavy weights in your hands can ruin a few days of recovery. It may be helpful to temporarily perform more exercises on machines rather than with free weights. Take 6-8 weeks of rest in this way before starting to rehabilitate with light strength exercises again. After 3-4 months, you can then train the chest muscles at full strength again.
Ice: The English word for inflammation is inflammation, literally meaning inflammation or ignition. This is due to the heating associated with inflammation. By cooling the attachment, you limit this heating. Moreover, it also restricts blood flow and thus swelling and pain. For this, you can use a compress, ice packs, or, for example, frozen beans in a bag. Even running cold water can help. Be careful not to place the ice directly on the skin! This can cause damage similar to burns. Therefore, it is recommended to use a moist tea towel around (the bag of) ice unless you have a compress that already has a protective layer.
It is important to cool/ice as soon as possible after the first signs of inflammation, for example, immediately after the training in which the (first signs of) inflammation were noticed. Cool for at least the first 36 to 48 hours, 8 times a day, for a maximum of 20 minutes. After this, it is best to continue cooling for a few more days until the inflammation (recognizable by heating, swelling, and pain at rest) has decreased. The “I” in PRICE stands for Ice, but could also stand for Ibuprofen because this is often recommended as an anti-inflammatory.
Compression: With compression, you achieve two things. Firstly, it helps to reduce blood flow and swelling. Additionally, it provides support for the affected area (hence also protection). In the case of the chest, you can put a band around the entire chest. There are also shirts that provide compression for men who suffer from gynecomastia, making them suitable for this purpose.
Elevation: Raising the affected area limits blood flow and thus swelling. For example, lying on the other side.
Treatment and recovery of completely torn large chest muscle
As mentioned, a completely or largely torn chest muscle should be operated on as soon as possible. This does not always happen. Sometimes the treatment is conservative, i.e., without surgery, but the results are almost always worse. Therefore, be clear in explaining how important it is for you to recover as much as possible to your old level. Not every doctor will immediately suggest surgery. An orthopedic surgeon from the Boston University Medical Center Hospital conducted research on the outcomes of operative and conservative treatment:
We retrospectively studied 17 cases of distal pectoralis major muscle rupture to compare the results of repair in acute and chronic injuries and to compare operative and nonoperative treatment. Thirteen patients underwent surgery (six acute injuries [less than 2 weeks after injury] and seven chronic injuries) and four had nonoperative management. The mean age of the patients at injury was 29, and 10 of the 17 injuries were the result of weight lifting. Follow-up ranged from 18 months to 6 years (mean, 28 months). All patients subjectively rated strength, pain, motion, function with strenuous sporting activities, cosmesis, and overall satisfaction.
So, the patients were asked to give a score for their recovery based on strength, pain, mobility, function during sports, how the muscle looked, and overall satisfaction. In addition, strength was measured objectively. The results were:
- 96% for recovery from an acutely occurring injury, 93% for recovery from a chronically occurring injury, and 51% for conservative treatment.
- Strength testing compared to the other chest muscle: Acutely occurring injury = 102% (which is quite remarkable, stronger than the uninjured side); chronically occurring injury = 94%; conservative treatment = 71%.
Non-operative treatment thus leads to considerable loss of strength, but also to a significant difference in appearance.
Other studies also showed a clear difference in the results of operative and non-operative treatment:
- 88% excellent/good results for operative repair compared to 27% excellent/good results for non-operative repair.
- 99% peak load, 97% work capacity after operative repair; 56% peak load, 56% work capacity after conservative treatment.
Surgery always has risks such as general infection risk and risk of anesthesia (heart attack, stroke, risk of death). More specifically for the surgery on the torn pectoralis major, risks include:
- Persistent weakness of the muscle
- Myositis ossificans traumatica (Connective tissue turning into bone)
- Stiffness of the shoulder
- Re-tearing
Injuries to the pectoralis minor, the small chest muscle
Injuries to the pectoralis minor occur less frequently, especially if not combined with a torn pectoralis major. They sometimes have the same cause as the above-mentioned causes of injuries to the pectoralis major, but are more often caused by a blow to the chest than, for example, overloading through strength exercises. The symptoms also resemble each other, although with the pectoralis minor, the pain can also be felt in the forearm and radiate to the fingers. Other symptoms include sensitivity when touching the coracoid process (described above). The diagnosis can be made by MRI in addition to examining the symptoms. Since these injuries do not often occur in bodybuilding, I will not go into further detail here.
Prevention of chest injuries
- As with most muscle injuries, a good warm-up is one of the most important things to prevent injury. Do a warm-up to increase temperature, improve blood circulation, and produce synovial fluid that lubricates the joints. For a warm-up, do 8-10 minutes of cardio at 60%-70% of your maximum heart rate (220-age).
- Stay warm! If you spend fifteen minutes chatting between each set, your body cools down, increasing the risk of injury (and of course wasting valuable training time). Depending on your training goal (muscle strength, building muscle mass, maximum strength), rest for 1 to a maximum of 3 minutes in between. Wear clothing that keeps you warm during breaks. We don’t always train at Venice Beach, and it’s not summer all year round. So, sometimes we have to accept that we can’t enjoy the pumped muscles in the mirror during training.
- In addition, a muscle-specific warm-up is important. So, don’t try to impress immediately by bench pressing 140kg, but start with light weights and many repetitions (at least 15), minimum 2 sets. Do not make too big jumps in weight from set to set after warming up. So, don’t go straight from the light weights after the warm-up to that 140kg just because there happens to be a cute girl walking by.
- Light stretching: Grab a door frame or pole, for example, from a squat rack, with your arm outstretched, thumb up, and hand at chest height. Now turn away from the stretching arm until you feel a slight stretch and hold it for about 15 seconds. Then do the same for the other arm.
- Execution of chest exercises: “Real men let the barbell come to their chest when bench pressing.” This trains the muscle over a larger range and therefore better. However, it also carries a higher risk of chest and shoulder injuries. Personally, I won’t bench press differently because of this, but this is a conscious decision between results and risk. More importantly is the next point.
- Always perform the eccentric (negative) part of exercises calmly and controlled. For example, in bench press and flyes, you can raise the weight explosively, but do not let it drop and then lift it up again. Lower the weight calmly and come to a stop in 2-3 seconds. If you lift the weight while it is still moving downwards, a lot of tension is put on the chest muscles. Just like when your car is still rolling backward and you start driving forward.
References
- A.A. Schepsis et al. Expand. Rupture of the Pectoralis Major Muscle. Outcome After Repair of Acute and Chronic Injuries. J Sports Med January 2000 vol. 28 no. 1 9-15
- A. Bak et al. Rupture of the pectoralis major: a meta-analysis of 112 cases. Knee Surg Sports Traumatol Arthrosc. 2000;8(2):113-9.
- C.M. Hanna et al.Pectoralis major tears: comparison of surgical and conservative treatment. Br J Sports Med 2001;35:202-206 doi:10.1136/bjsm.35.3.202
Other sources
- Xinning L. et al.Isolated Tear of the Pectoralis Minor Tendon in a High School Football Player. Orthopedics, August 2012 – Volume 35 · Issue 8: e1272-e1275
