Pectoralis Major Repair

Orthopedic & Sports Medicine Specialists (OSMS)

Weight-Bearing

Sling for soft-tissue healing x6-8 wks total (limited removal in safe environments at 4 wks); sling discontinued at 6-8 wks Phase II-III

Key Restrictions

Avoid active shoulder movement all planes Phase I; avoid shoulder ER beyond 40 deg and horizontal abduction Phase II; no swimming/throwing/overhead serves Phase II-III; avoid wide-grasp bench press, push-ups with humeral abduction beyond frontal plane, 1-rep-max bench press, and IR strengthening until 12 wks Phase IV

Timeline & Phases

Phase I (surgery-4 wks): protect muscular repair, cryotherapy 20 min q2h, sling x6-8 wks total, avoid active shoulder movement all planes, hand gripping, elbow/forearm/wrist ROM, cervical/scapular AROM, axillary nerve desensitization, postural exercises, shoulder pendulums, walking with sling on; progress to Phase II with negative impingement pain/apprehension; Phase II (4-6 wks): begin PROM all planes with eventual normal scapulothoracic movement, begin proprioceptive/dynamic neuromuscular control training, strengthen shoulder/scap stabilizers, sling discontinuation at 6-8 wks, avoid ER beyond 40 deg and horizontal abduction, no swimming/throwing/overhead serves, avoid fall-risk activities, resisted forward flexion, scapular mobility/stabilization exercises (shrugs, rows) and neuromuscular control, scapular PNF patterns, table weight shifts progressing to UE weight-bearing, gentle shoulder mobilizations, PROM all planes assessing scapular rhythm, grade 1-2 oscillatory joint mobilizations (anterior/posterior distraction), core strengthening, walking/stationary bike, impact exercises only once full RTC strength in neutral achieved; progress to Phase III with 75-100% PROM; Phase III (6-8 wks): begin AAROM all planes with normal scapulothoracic movement, continue proprioceptive/neuromuscular training, strengthen shoulder/scap stabilizers, sling discontinuation at 6-8 wks, ER allowed beyond 40 deg, no swimming/throwing/overhead serves, progress to AROM at wk8 with T-bars/pulleys, submaximal pain-free isometrics (flexion/ext/abduction/ER/horizontal abduction), PROM all planes assessing scapular rhythm, grade 3 sustained joint mobilizations, progress weight-bearing to quadruped/tripod (1UE+2LE), core strengthening; progress to Phase IV with 75-100% AAROM pain-free, PRE tolerance for scapular stabilizers/shoulder complex, no reactive effusion; Phase IV (8-24 wks): full shoulder/scapular ROM all planes, 5/5 RTC strength at 90 deg, 5/5 peri-scapular strength, avoid wide-grasp bench press/push-ups with abduction beyond frontal plane/1-rep-max bench press/IR strengthening until 12 wks, progress to FROM via stretching and grade 3 mobilizations, begin submaximal pec strengthening, wall push-ups progressing to table push-ups/uneven surfaces, dynamic stabilization, perturbations, weight-bearing planks on hands, closed chain stabilization narrow base; after 12 wks theraband pec major strengthening then dumbbell, UE plyometric wall taps and chest pass; after 18 wks throwing/overhead athletic movements; after 24 wks bench press and push-up goals as tolerated

Notes

OSMS Rehabilitation Guidelines; mainly open repairs progressed slowly to avoid catastrophic failure; individual variation depends on surgeon input and patient response; references Cools et al. (2007), Reinold/Escamilla/Wilk (2009), and Wilk et al. (2002/2011) on scapular rehabilitation and overhead throwing athletes