Pectoralis Major Repair Protocol

This rehabilitation protocol is designed to guide patients and physical therapists through the recovery process following a surgical pectoralis major tendon repair. The primary focus of the early recovery phases is protecting the repaired tendon while gradually restoring joint mobility, followed by a progressive strengthening program to restore full function, strength, and sport or work capacity.

Phase I: Protection & Passive Range of Motion (Weeks 0-6)

The primary goal of this phase is to protect the healing tendon repair, control pain, and prevent joint stiffness through limited passive motion.

• Goals: Protect the surgical repair; minimize pain and inflammation; maintain elbow, wrist, and hand mobility; gradually increase passive shoulder motion within safe limits.
• Precautions & Restrictions: Sling must be worn at all times (including sleep) except for hygiene and physical therapy; no active shoulder internal rotation or horizontal adduction; no reaching behind the back; passive range of motion limits: flexion to 120 degrees, external rotation to 0 degrees (neutral) with the arm at the side, and abduction to 45 degrees.
• Suggested Exercises: Pendulum exercises; passive shoulder flexion (assisted by therapist or pulley) up to 120 degrees; passive external rotation up to neutral (0 degrees); elbow, wrist, and hand range of motion; grip strengthening exercises; submaximal isometric shoulder external rotation and abduction (neutral arm position).
• Criteria to Progress: Minimal rest pain; clean, healing surgical incisions; achieved passive range of motion targets (flexion to 120 degrees, external rotation to 0 degrees).

Phase II: Active-Assisted & Active Range of Motion (Weeks 6-12)

During this phase, the patient is gradually weaned from the sling, and active-assisted/active movements are introduced to restore full mobility.

• Goals: Wean from the sling; restore full shoulder passive range of motion; initiate active-assisted and active range of motion; establish stable scapular control.
• Precautions & Restrictions: Wean from the sling by week 6 to 8 as tolerated; avoid sudden jerking or heavy lifting; no resistance training for the chest muscles; limit external rotation to 30-45 degrees at 90 degrees of abduction until week 8, then progress as tolerated.
• Suggested Exercises: Active-assisted range of motion (using a cane or pulley) for flexion, abduction, and external rotation; progress to active range of motion in all planes as muscle control improves; scapular shrugs, retraction, and depression; prone scapular stabilization (I, Y, T positions); gentle posterior capsule stretching.
• Criteria to Progress: Full active shoulder flexion and external rotation (at side) equal to the uninjured side; normal scapulohumeral rhythm; pain-free active movement without shoulder hiking.

Phase III: Early Strengthening & Core Stabilization (Weeks 12-18)

Strengthening of the rotator cuff and periscapular muscles is emphasized, and light activation of the pectoralis major begins under controlled conditions.

• Goals: Restore full active range of motion in all planes; strengthen the rotator cuff and shoulder girdle stabilizers; initiate gentle, progressive loading of the pectoralis major.
• Precautions & Restrictions: No heavy bench press, dumbbell flyes, or chest dips; monitor for anterior shoulder pain; proceed slowly with resistance progressions.
• Suggested Exercises: Rotator cuff strengthening (internal and external rotation) using resistance bands or light dumbbells; scapular stabilization (rows, lat pull-downs, scaption); very light pectoralis major loading, starting with submaximal isometrics (squeezing a ball between hands at chest height) and progressing to light resistance band chest press; closed-chain exercises (tabletop weight shifts, quadruped stabilization).
• Criteria to Progress: Full, pain-free active range of motion; rotator cuff and periscapular strength at least 4+/5; ability to perform light resistance training without pain or instability.

Phase IV: Advanced Strengthening & Return to Activity (Weeks 18-24+)

This phase focuses on rebuilding peak muscular power, speed, and endurance, and preparing the patient to return to sports or heavy manual labor.

• Goals: Restore pre-injury strength and muscular endurance; introduce dynamic, high-velocity movements; safely transition back to full athletic or work activities.
• Precautions & Restrictions: Avoid maximal lifting or high-impact chest exercises (maximal bench press, heavy flyes) until at least 6 months post-surgery; always perform a thorough warm-up before lifting.
• Suggested Exercises: Progressive resistance training for the chest (incline push-ups progressing to standard push-ups, light to moderate barbell/dumbbell bench press with controlled depth); cable crossovers; medicine ball chest passes and deceleration drills; plyometric push-ups; sport-specific or work-specific simulated tasks.
• Criteria to Progress: Shoulder strength at least 90% of the contralateral side; pain-free performance of all functional activities; clearance from the orthopedic surgeon.

These guidelines represent a standard rehabilitation protocol. Individual recovery rates vary significantly depending on the size of the repair, bone/tissue quality, and general patient health. Your surgeon may modify this protocol specifically for you.

Disclaimer: This protocol is for educational purposes and is not a substitute for professional medical advice. Always consult your surgeon or physical therapist before performing any exercises or modifying activity restrictions.