I can remember it like it was yesterday. It was the second rep of a heavy set, not my working weight, but a heavy set on the bench press nonetheless. Lowering the bar to my chest, I started to feel a searing pain across the upper portion of my chest, like someone had jabbed something hot into the muscle. My ears were filled with what could only be described as the sound of the world’s largest velcro shoe tearing apart. I yelled for my spotter to take the bar, and he quickly helped me get the bar back to the rack, falling in just above the bottom pin of the bench. As I rose from the bench, not fully realizing what happened, I asked if he heard the same noise. He looked at me strangely; obviously he hadn’t.
Looking down, I could see an immediate shift in the colour of my skin, which was switching from a strangely orange hue (yes, I had a self tanning phase in high school) to a sickly purple. It eventually sunk in. It wasn’t someone slapping on a pair of the loudest velcro sneakers ever made, it was my pec tearing.
Being 18 at the time, I wasn’t prepared for the gravity of the situation. Despite delaying medical treatment, I did eventually learn, thanks to a lengthy late Friday night MRI, that I had partial muscultendinous tears in both pecs that could not be repaired surgically. Certainly not the worst outcome, but still something I’d rather do without. To compound the injury, my teenaged understanding of exercise physiology and strength training lead me astray in my recovery efforts. Over the course of the year I suffered many setbacks, mainly due to my inability to put my ego aside and create an effective rehabilitation program. Ten years later, my understanding of muscle function and tissue regeneration have improved quite a bit, and if I could go back in time, here are 11 things I would have done differently:
1. Iced more
By the time most of us have reached adulthood, we’ve had enough first aid courses ingrain RICE (Rest, Ice, Compression, Elevation) into our heads that it is second nature whenever a musculoskeletal injury occurs. Despite the steadfast belief that ice is the be all and end all for musculoskeletal injuries, the scientific literature suggests that while it may be effective in pain reduction, the purported effects on tissue swelling and inflammation are not as consistent (1,2). Science aside, since ice is one of the least expensive treatments around, extending the icing could have potentially reduced the initial swelling and inflammation of the injury, or at least provided a degree of pain relief that would have been much appreciated. While I chose to put the ice pack on until it warmed up only once, a more aggressive icing strategy could have reduced my pain at the time. You won’t find consistent, scientifically based recommendations on how to ice tissue, but I’d favour aggressive protocols with at least 10-20 minutes every two hours on the first day, and similar durations two to four times the following day (3).
2. Rested more
Sure I was familiar with the RICE protocol, but that first ‘R’, or rest, didn’t seem to sink in. I’m sure I’m not the only one who has the compulsive need to constantly test an injured area to see if it’s improved over the last five minutes. If it’s only been a day or two, and you’ve sustained a pretty serious injury like I did, a few days of rest won’t hurt you. That’s not to say you need to spend those days at home crying into your pillow, there’s nothing to stop you from training around the injury. You can certainly address other uninjured areas of the body, identifying exercises that don’t exacerbate the injury while still protecting the injured area.
Mainly, you just need to resist the urge to test the injured area during the initial few days following the injury, a mistake I made too many times. The early stages of muscle injury are associated with the formation of a collagen matrix which serves as a scaffold for muscle repair (4). Stress these fragile collagen structures too soon when they are improperly formed and you’ll damage them, ultimately increasing collagen proliferation from the injury site (larger scar tissue) (5) , and decreasing the likelihood of efficient muscle repair (6,7).
3. Increased the frequency of training (after I rested)
Much to my detriment, my main training influence at the time was the popular bodybuilding mags, and as such, I followed the standard body part per day split. This meant that my pec rehab (if you could call it that), happened once per week, on chest day and not a day more. With the inverse relationship of volume and intensity, given the limits the injury put on training intensity, it’s sufficient to reason I could have tolerated a greater volume that would be easily achieved by increasing the frequency of my training. There’s a reason some of the original strength training rehabilitation protocols had the word ‘daily’ right in the title (8,9). While frequent loading can be contraindicated immediately following the injury (5), in the subsequent repair and regenerative phases this frequent loading is essential to the formation of new tissue (6,7).
4. Used isometrics at varying angles
After the initial few days, with the swelling and my purple bruising subsiding (shifting to a rather sickly looking yellowish brown), I found myself tempted to start bench pressing. I started with the bar and even that was painful, but I continued despite the pain. What this should have told me was that I wasn’t ready for dynamic exercise through a full range of motion, and had I thought that, I would have saved myself some pain in the process.
Isometric contractions, where a muscle contracts without changing length, are essential to recovery from a muscle strain. In my case, a full range of motion was painful, but I could’ve tried isometric contractions, holding static contractions at various joint angles that were pain free. This may not be an ideal strategy to increase overall strength as strength gains can be position specific (10), but under these conditions any pain-free loading of the tissue would have been advantageous, at least until dynamic exercise could have been added back.
5. Performed more pushups
I don’t want to make this a debate about the superiority of the bench press or push-ups, they’re different exercises (despite exercising similar muscles) and both have their places in effective training programs. Unfortunately, my teenaged self didn’t share the same belief. If you can lift weight on a bar, why would you bother with just bodyweight? Thankfully I’ve come around to the benefits of not fixing your scapula in place by squishing it between a barbell, your body, and a padded bench. With the ability to create various progressions by altering hand position, foot contact points and height, and suspended versions with the TRX (or Blast Straps), pushups would have been an excellent component of the rehabilitation program once loaded, full range of motion contractions were possible.
6. Incorporated board presses
In the bottom position of the bench press, the pectoral muscles are at their longest, and this degree of stretch can be a dangerous position, especially on recovering tissue. Board presses would have allowed me to achieve heavier loading earlier into my recovery, and allow me to do so while avoiding the painful regions of the bench press range of motion. As an added bonus, this increased loading would have benefitted my deltoids and triceps that weren’t quite receiving the loading they once were when I was fully capable of benching. Watch the EliteFTS definitive guide to board pressing here
7. Increased my volume of rowing and rotator cuff work
Muscle strains are a perplexing problem with a variety of potential causes, including strength imbalances across joints coupled with dysfunctional activation patterns of stabilizing muscles. Or we’re over-thinking, and it’s usually just mechanical; momentary poor technique coupled with a weight too heavy often spells disaster. Either way, given that the average person spends hours a day slumped at a desk over a keyboard, it wouldn’t be surprising that in addition to poor tissue quality and muscle length in the pectoral region, we might also have some issues on the other side. Couple this chronic slumped posture with a training program that overemphasized the large internal rotators (Pec Major, Lattisimus Dorsi) and you have a recipe for some serious weakness of the upper back and external rotators. Balancing strength across a joint is a complex issue, not simply equating the number of sets one for one like you often see on the net. Despite this, had I increased my upper back work, including specific external rotator work both pre and post injury, I may have had a significant impact on my return to pressing and may not have ended up in my torn pec predicament in the first place.
8. Addressed tissue quality
This one speaks to the point above. Over time, increased loading of the internal rotators along with poor posture results in poor tissue quality and tightness in the pectoral region. This could have easily been addressed with regular massage of the area, coupled with a mobilization program to address tissue length. Not everyone has the cash or the extended health benefits to get regular massages, but the quick and dirty treatment in the video below, from the guys at Cressey Performance, will get you on the right track.
9. Avoided overhead pressing (temporarily)
In the early stages, I could overhead press, not as heavy as pre-injury, but heavier than I could bench after the injury and enough to satisfy my need for heavy training (read: 18-year old ego). But just like in the bench press, there were signs of my injury, namely pain that increased into the depths of the range of motion and with increased load. Sure enough, after a few weeks, I felt the sign of re-injury during a particularly heavy overhead press, and yet another setback. While the overhead press is largely considered a shoulder and tricep exercise, the pectorals are active and contribute to the movement (11,12). You may need to find alternate ways to load your shoulders, even using ‘blasphemous’ isolation based exercises, until heavier compound exercises are possible.
10. Swallowed my pride
At the time, nothing was more painful than the injury itself than the simple fact that I couldn’t bench press what I had in the past, and this blow to my fragile teenage ego was a setback. Instead of focusing on the signs my injury was giving me, namely the pain, I focused more on the weight on the bar, desperate to return to my pre-injury strength. This constant drive lead to many physical setbacks, minor tears of the already damaged tissue, and ultimately a much longer recovery. Next time around, my focus will be on maintaining a pain free, complete range of motion while GRADUALLY adding weight back to the bar.
11. Actually listened to the warning
As I mentioned above, it’s possible that my pec tear could have been the consequence of a momentary slip in technique, where a disadvantageous mechanical position with a loaded barbell overcame the strength of the soft tissue. Or, more likely, it was a combination of poor program design, too much loading, and piss poor periodization (or lack thereof). It’s unfortunate that I didn’t see this as a warning sign, and my program design lagged until quite a while later. Fortunately, thanks to a growing interest in strength and conditioning and the teachings and writings of many great professors and strength coaches along the way, my programming gradually improved, albeit at a slower rate than it should have. My training now includes sufficient balance between pressing and rowing movements, periodization of loading and training volume, and a healthy selection of variations for all the basic exercises.
If I only knew then what I know now…
Obviously my knowledge on the rehabilitation of musculoskeletal injuries has increased since I was an 18 year old meathead. Ten years ago the internet was a different place, and the sheer amount of training information was significantly less than what gets posted on a daily basis today. These 11 changes would have made a substantial difference to my lifting then, and hopefully, if someone finds themselves in the same position I was in, these will help them avoid the same mistakes that I made.
I’d love to hear what mistakes you’ve made or what you’d do differently following any injuries you have sustained while training. Let me know in the comments.
- Hubbard, TJ & Denegar, CR (2004). Journal of athletic training, 39(3), 278–279.
- Bleakley, C et al (2004). American journal of Sports Medicine, 32(1), 251–261.
- Swenson, C et al (1996). Scandinavian journal of medicine & science in sports, 6(4), 193–200.
- Lehto, M et al (1985). Journal of bone and joint surgery. British volume, 67(5), 820–828.
- Järvinen, M J & Lehto, MU (1993). Sports medicine (Auckland, NZ), 15(2), 78–89.
- Kannus, P (2000). The Physician and sportsmedicine, 28(3), 55–63.
- Kannus, P et al (2003). Scandinavian journal of medicine & science in sports, 13(3), 150–154.
- Knight, KL (1979). American journal of sports medicine, 7(6), 336–337.
- Knight, KL (1985). Med Sci Sport Exerc, 17(6), 646–650.
- Kitai, TA & Sale, DG (1989). European journal of applied physiology and occupational physiology, 58(7), 744–748.
- Paoli, A et al (2010). JSCR, 24(6), 1578–1583.
- Uribe, BP et al (2010). JSCR. 24(4), 1028–1033.