Dealing with a Torn Pectoral Tendon
August 15, 2008
by Nate
Update on November 9, 2009: Since this entry has proved to be a little bit sticky, my spotter has asked that I correct some factual inaccuracies in my account that became clear in the time after this entry. I’ve also added an update at the end on the current state of my injury.
Almost two weeks ago, in a late-night workout at home with HB spotting, I reached a new max on the bench press of 325 pounds. I’d been making rapid strides on the bench recently, partially by working out much closer to my max and partially, I suspect, because of creatine supplements. I warmed up, but not a whole lot: I remember wanting to preserve as much energy as possible for hitting a new max. I’d set my new goal on the bench at 400 pounds. I did 325 and, honestly, it felt easy. I wanted to do more: 330, or 335? Hell, I said: you only live once. We put 335 on. I brought the weight down and stalled. As I tended to do, I shifted the bar a bit higher to get a burst of strength from the shoulders. I started to push up and felt a moment of triumph—I thought I had it. Suddenly, something snapped in my right pectoral. The weight crashed down on my right side. HB grabbed the bar and I slid out from under it and fell to the floor, cradling my right side.
Update: The weight did not crash down on my right side. It’s amazing how significantly—and how incorrectly—I tried to reconstruct my memories of what happened to explain results that I didn’t understand. The dramatic black and blue strip that developed on my right bicep, for instance, was caused by the ripping of the tendon at the insertion point, and always (if I understand rightly) accompanies an injury of this sort. In actuality, I just let my right arm sag at the moment of injury—largely out of fear, as I had felt something happen—and was still supporting the bar as my spotter held the bar enough for me to slide out from under it.
The next day, it looked like my right pec was swollen, which was only to be expected. The injury didn’t hurt that much; there was a constant dull ache, but not the kind of burning pain I thought would accompany a tendon injury. I was pretty sure I’d just pulled a muscle. But after two days, Bek asked me for the fifth time or so if I was sure I didn’t want to have her take me to a doctor. I was pretty sure it wasn’t serious, but it was probably better to be safe than sorry, and if she’d help with the arrangements, I thought I might as well do it, if only as a precaution. I went to urgent care, and the doctor didn’t even examine me, but put me in a sling and sent me to an orthopaedist.
I had developed a rather ugly black and blue strip on my right bicep, but my bicep didn’t hurt and wasn’t that close to my pec, so I figured I’d dropped the bar on it.
At the orthopaedist, he took one look at me with my shirt off, laughed, and said, “Yeah, I can tell you exactly what you’ve done.” He explained that the pectoralis major tendon was a long, broad tendon, connected to the entire side of each tendon. “You see how it creates kind of a web across the side of your left pec and draws it out? See how that’s missing on your right side?” My right side wasn’t swollen, it had dramatically changed shape because most of it wasn’t connected anymore.
You can see a good example of what this looks like, if you wish. (It’s kind of an unpleasant image, so be warned. Also: the bruised area on my bicep was smaller than that shown here—mine was more like a strip.)
Monday, I got an MRI. Now I’m waiting with a sheaf of magnetic images of my insides to present to the doctor on this coming Monday. On the first visit, he indicated a strong preference for treating the injury “non-surgically” and just living with the “defect”. I don’t know if this will change based on the MRI, but I’m going to ask about the possibility of surgery anyway. With surgery, I’d have the possibility of returning to full strength, not to mention a more normal appearance. The problem is that the surgery sucks. 3-6 weeks in a sling, at least a week of sleeping in a chair, many months of painful physical therapy afterward. (Well, I get that even without surgery.)
It’s amazing how impossibly self-absorbed I feel right now: it’s hard to think about much beyond my injury and the possibility of surgery. I’m angry about the seeming arbitrariness of the injury (all my speculation about the causes of the injury may add up to nothing… descriptions of the injury online are all different), angry about losing my best lift, and generally quite filled with self-pity. It’s nice, on the one hand, to have an injury so widely acknowledged to be hell, and to have a horrible black and blue mark on my arm as proof that something serious has happened to me. On the other hand, I feel like it’s coming very close to the time that I need to get over myself and focus on living again.
I keep thinking about Amanda and Tania, both of whom (to different degrees) have had to come to terms with a constant life of difficulties like these. How hard it is to care about anything outside the psychologically consuming experience of one’s own pain! It reminds me of something I have often said, but not perhaps felt so dramatically as I do now: the primary problem with pain is that it makes one so tremendously particular, it drags one into being just me, just now.
At any rate: weight-lifters, beware. It looks like there are things one can do to reduce one’s risk of this type of injury. Use a narrower grip, don’t bring the bar down all the way to the chest, warm up extensively. Doing the press with dumbbells is apparently even better, as it strains the tendons less. Maybe someday I’ll have the chance to do it again, and take my own advice. I hope so.
Update from November 2009:
It’s been well over a year since the injury. The MRI showed that I had a 50% tear of the tendon, something that my orthopaedist said basically confirmed exactly what he thought based on a cursory examination. (In light of the current debate over health care reform, I have often thought about how unnecessary that expensive, insurance-covered MRI actually was.) The doctor claimed that I would experience 100% recovery of strength without surgery, so he recommended strongly against it. Six weeks of physical therapy restored me to 100% range of motion without pain. (It was also not particularly grueling, unlike many people’s experience with physical therapy. I say this to further emphasize how non-traumatic many aspects of my injury were.) My right pectoral muscle is shaped differently—due to being pulled in fewer spots—and will always look strange, though the truth is that it’s much more interesting than ugly as far as physical defects go. It’s dramatic enough that you can see it if I’m wearing a t-shirt. The most I’ve tried to lift since then is 205, at which I performed a couple sets of 8 reps. So I’m not as strong, but I’m also just not willing to try to push myself as far.
That muscle feels different than the other one—and probably always will—but it’s hard for me to imagine, looking back, that it ever could be worth it to surgically correct an injury like this for someone who doesn’t make his living from either the appearance or maximum functionality of his pectoral muscle. The main thing I got from it all was an interesting story to tell and a valuable lesson about my own limitations.
Comments
On August 15 at 1'01 PM
, Adrian Turner wrote:
WOW! Well I’m glad you are ok.
God Bless you on a speedy recovery.
On August 15 at 1'21 PM
, Amanda wrote:
Nate, I know how often others can sound like belittling or patronizing assholes when trying to console, sympathize, or encourage. I know there are times when I sound exactly this way too, despite disliking it in others so much. For someone who has dealt with so much illness and injury, I’m not good at responding appropriately when other people go through these things, so I’m sorry if any of my twitter responses to you have come across as insensitive. Know that above all I have been thinking about you and wishing the best for you through this or the emotional fortitude if the best doesn’t come, whatever different daft things I might wind up saying.
On August 15 at 1'31 PM
, Nate wrote:
Adrian: Thank you!
Amanda: Not at all! Sorry: it looks like I actually missed a couple of your twitters. I need to check the replies thing more often. Or, actually… I bet I could get a feed of just those, couldn’t I? No, your well-wishes are welcome and appreciated.
On August 15 at 2'20 PM
, Tania wrote:
Hope there are good options for your recovery, Nate.
Also, for the future… there’s a difference between enjoying your body and, well, trying to conquer it. I hope that’s become clear to you and you won’t make the same mistake twice. Living with my body keeps trying to drill that into my head. It’s a hard lesson. (Even yesterday, I “re-organized” in the bathroom and over-used my brand spanking new, not-yet-fully-recovered wrist.)
(Also, 335 pounds? Holy shit!)
On August 15 at 7'20 PM
, Amanda wrote:
I want to respond a little more thoroughly now that I have time to do so.
How hard it is to care about anything outside the psychologically consuming experience of one’s own pain! It reminds me of something I have often said, but not perhaps felt so dramatically as I do now: the primary problem with pain is that it makes one so tremendously particular, it drags one into being just me, just now.
This reminds me of some passages from Elaine Scarry’s The Body in Pain that I feel like you might appreciate:
“As the body breaks down, it becomes increasingly the object of attention, usurping the place of all other objects, so that finally, in very very old and sick people, the world may exist only in a circle two feet out from themselves; the exclusive content of perception and speech may become what was eaten, the problems of excreting, the progress of pains, the comfort or discomfort of a particular chair or bed.”
“As in dying and death, so in serious pain the claims of the body utterly nullify the claims of the world.”
You’ve described the way you feel as self-absorbed, but to me this isn’t an adequate description. Self-absorbed has the connotation of choosing to be utterly involved in your own thoughts. When you’re in so much pain there’s often not that level of choice involved. I wish I knew a better way to describe this because it’s something I often try to explain to people. In any case, I wouldn’t worry much about being too self-pitying. It can help a lot to give in to those feelings at times. You needn’t “get over yourself” since focusing on living doesn’t involve the exclusion of self-pity or other “negative” feelings, but the willingness to permit yourself to experience whatever breadth of feeling this injury and the situations arising entail. Of course, I’m terrible at permitting myself to feel anything, so consider that advice as coming from someone who is usually incapable of following it herself.
On August 15 at 7'41 PM
, Martin G wrote:
This topic of conversation deals in why I am entering medicine. When a very good friend recently asked me why I was enlivened by medicine this is what I had to say:
“If I have a thesis it consists of two parts: 1) there is a best life to be lived and 2) humanity is eminently distractable from living the best life. One of the chief sources of distraction to people are their bodies and disease is one of the large reasons for it. If I can alleviate disease then there is the chance that I free someone of one of the chief encumbrances toward living the best life.”
I hope it works out. I should also say that many folk have seen their pain as an orientation to something beyond their body and in that way are blessed to turn their suffering into something truly enlightening. That said, I admit myself to think that charism a rarity but a very noble rarity.
On August 16 at 6'00 PM
, Rachel Sullivan wrote:
I completely agree with your instinct to go for the surgery. With laprascopic tendon repair these days, it’s not even very risky at all, though I’m by no means an expert. If the surgeon says you’re a good candidate, which I think he will, then you should go for it.
Also, be careful with the creatine, we see a lot of sport supplement related injuries in the Active Duty population, especially in the kidneys. You need to drink a LOT of water to make sure that you don’t go into kidney failure one of these days. Just the other month I treated someone taking “N.O. EXPLODE” which is creatine and caffeine, and after a particularly intense workout he went into rhabdomyolysis and is now on the list for transplant, with no hope of his kidneys ever returning. I’m a big fan of Whey protein, but anything else makes me really nervous.
And I agree with Martin: much of the things you express are why I decided medicine was such a noble profession: my job is to help people get back to living, and it’s an amazing feeling when I actually do something that helps to do just that.
On August 21 at 3'32 PM
, Joann Walling wrote:
Hello there, I worked with you at Safeway. I asked youre Mother about you and she gave me this websight. I havent had alot of chance to read much, but I will be back when more time is at hand. I hope all is well for you and all youre doing… graham sends a cheery greeting
On December 2 at 1'20 PM
, Joe wrote:
Nate, Seeing your blog for the first time early December, I’m curious to know if you did have the surgery done and how you’re doing now. I had the exact injury 3 years ago to this day. I was bench pressing towards my personal goal of 400lbs. I was at 365, but my injury occurred while warming up with 225. It felt like a bolt of lightening had shot down my arm as I was going up with the weight. I had no spotters, so I am thankful that I was using relatively light weight and was able to throw it to the floor. I because of the tremendous pain in my chest and the pain in my left arm, I decided to drive myself to the emergency room. My KP doctors did not want to acknowledge what I had already known - that my pec major was mostly if not completely torn. They sent me home with a prescription for pain killers and scheduled for me to start physical therapy 3 weeks later. I had the same bruising as you and I could see after the swelling had gone down that the connecting tissue from my chest to arm were gone and a crater just above my arm pit was my new look. The physical therapist thought I my have torn it - but wasn’t sure. She sent me home with a rubber cord to do some exercises with. I was angry at how this type of injury was literally dismissed by my HMO, but I thought I would try to live with it. A year later, working as a contractor, pain in my left should developed, so I demanded that my doctor refer my to an ortho to get an MRI. 12 months and 3 botched MRI’s later, the orthopedic surgeon confirms that my pec major is torn, but surgery at this point may do little if nothing to improve things strenght wise or appearance. Due to the long recovery period, I decided to just live with it. My strenght is not near what it used to be, in fact I don’t even bench anymore. I do however do sets of push ups daily for a total of 500. I have to say that I can still push out a set of 100 or more and my chest has regained much of its form. The crater is mostly noticeable only when my arm is raised. So, if you have decided not to have surgery, I’m here to tell you that living with the damage is not all that bad.
On December 22 at 2'28 PM
, Nate wrote:
Joe,
I’m sorry to take so long to reply to your comment; I think I have some kind of subconscious aversion to dealing with this topic.
Your injury was worse than mine. One of the reasons I delayed going to the doctor’s was, in fact, that after the first hour, there was much less pain than I thought should accompany a tendon injury. Even the first hour is hard for me to judge accurately: I think I may have been more shocked by what had happened than I was in pain.
I was told to get an MRI, and the MRI showed a 50% tear of the pectoralis major. It looks like it tore about 50% of the area over the whole range of its attachment, not as if the lower half was torn. The doctor claimed that it will ultimately fully regrow, though I’m a bit skeptical. The muscle is shaped differently than it was (it forms a definite peak when clenched, whereas the left muscle forms a flatter plane). It’s still painful to lift more than about 80lbs on the bench, and if I clench the muscle unexpectedly it feels like someone is poking me sharply in the armpit.
Frankly, though, your testimony is yet further incentive to suck it up and get on with having a mark of character and just living with it. It sounds like you’re still kicking ass and taking names while having an interesting story to tell to go along with it.
On September 10 at 4'09 PM
, Casey wrote:
I went to the dr. today and they think that I have torn pectoral tendon. I will be seeing an orthopedic soon. I had the same bruising from my bicep to my nipple which didnt show up till a couple days after the injury. When I flex my pec muscle there is a hole/gap above my nipple to the left side. I have not noticed any mobility issues or pain at all. Just a deformed looking peck. Thanks for your post.
On October 27 at 2'29 PM
, Torrey wrote:
I am now a few months from 40 years old and I had this type of injury in 1989.I was only 19 years old at the time and didnt know much about the injury.there was no internet at the time.This type of injury takes time to heal but will never get to full strength again.The appearance doesnt bother me as much as the strength issue,suudden unexpected movements bother me even right now.You can live a very productive life with this injury without having surgery.The thing to do for a real young person is to have surgery and let it get back to normal.For an older person I would advise to let it heal naturally and then lift with dumbells and machine weihgts unless you can afford to be out of work for a good while .
On October 27 at 2'29 PM
, Torrey wrote:
I am now a few months from 40 years old and I had this type of injury in 1989.I was only 19 years old at the time and didnt know much about the injury.there was no internet at the time.This type of injury takes time to heal but will never get to full strength again.The appearance doesnt bother me as much as the strength issue,suudden unexpected movements bother me even right now.You can live a very productive life with this injury without having surgery.The thing to do for a real young person is to have surgery and let it get back to normal.For an older person I would advise to let it heal naturally and then lift with dumbells and machine weihgts unless you can afford to be out of work for a good while .
On November 22 at 1'09 AM
, Colt wrote:
I just wanted to comment on your excellent outlook about your injury. I partially tore my pectoral muscle away from the tendon about two years ago. I could not find a surgeon who would reattach it since it was not a complete tear, involved suturing muscle which doesn’t hold the best, and I waited too late to ask for surgical intervention. I do not earn a living bodybuilding or power lifting either so that didn’t help my cause. It killed me that I could not workout at the same level that I previously could and the cramping and awkward feeling in my pec drove me absolutely insane. It is still something I struggle with today, not only physically, but most importantly psychologically. Reading this was inspiring, since you have such a positive outlook.
On January 16 at 1'06 AM
, henry wrote:
hi. same thing happend to me with bench press. except my spotter goofed up. he did not spot. i told him i can do the lift off and he waited and after that he forgot to hold the weight. so it dropped on me. my left pectoral and my tendent look funny. i dont know what i am going to do. i hope i can get the same strenght again. my shoulder is fine. i went to physical therapy. and she think i am fine. but she said i should see a orthpedic. there might be a tear muscle. i was lifting 405lb. i am 160 lb. it was a mistake. i wished i had not done it. how ever i did it many times before. but never brought it down all the way. and with a dumb spotter who was like a military guy about 6 foot 7. who could not do anything. was a real lost for me.
On January 24 at 8'18 PM
, Augie Priore wrote:
I ripped my left pec 9 years ago and just ripped my right one 2 weeks ago. I’m a knuckle head. Did everything wrong. Slightly dehydrated, didn’t stretch out enough, gym was could, blah, blah, blah. My black and blue mark came down over my biceps and even went into my forearm a little. I believe it to be blood internally pooling, just like last time. The muscle ripps then bleeds internally. I’m waiting for benefits since I don’t have them now and will be getting an mri and surgery asap. I had surgery last time. 365lbs on the second rep. I felt like a million bucks. My body gave out on the second rep. Then I felt like 5 bucks. This time it was the first rep with 325. Did 275, 315, didn’t wait long enought, bit off more than I can chew, Lousy form brought the weight down to fast. I’m going to get the surgery though. I’m hoping it was a clean tear off the bone. Looks like yours might have been slightly down the tendon or maybe that’s your biceps natural curves. Hope all is well and good luck a year out.
On September 13 at 10'08 PM
, ross wrote:
Hi, I believe I have a partialy torn left pec. I had bruising and broken blood vessels under the skin.The swelling doesn’t go down much even with icing.I’m sure its do to the fact I still try to exercise it.I feel no major pain or lose of range of motion.I have tried to lift heavier weights since it didn’t hurt much and about 2 monthes went by, but that lead to some more bruising.I would love to ask you some questions if you had time like how did you know when it was ok to lift again? Anyway thanks for shareing your progress and I hope all is still well with you.
On September 16 at 1'44 PM
, Cris wrote:
Hi, I’d like to thank you for posting about your injury, your feelings and updating with your recovery. My son is playing D3 football and has just been told he requires surgery for a pec tear and he is devastated. Your post has given me insight as to his feelings and some questions that I need to be asking the doctors. Thanks!
On October 6 at 1'19 PM
, Joe wrote:
I ripped my right pectoral major tendon. It’s been 2 weeks. When does the poke in the armpit feeling go away?
On October 6 at 1'46 PM
, Alan King wrote:
I tore my left pec two weeks ago. No sure yet how severe. Bruising down to forearm but pain has reduced alot over the few weeks. However the sensation of someone poking my armpit / muscle too short is a real bother. Does this stay forever or will I notice an improvment over time
On October 13 at 4'28 PM
, Nate Eagle wrote:
Joe & Alan: I hate to be the bearer of bad news, but for me the “poke in the armpit” feeling has never gone away. It’s gotten better than it was at first, but whenever I flex that muscle reflexively I have the same sensation. It doesn’t happen during the course of a normal day — I noticed it, though, when riding a roller coaster this weekend when I’d grip my seat restraint during turns.