Pectoralis Major Repair Post-Surgical Rehabilitation Protocol

POST-OP DAYS 1-14

  • Shoulder Immobilizer x6 weeks – Even while sleeping
    • Place pillow under shoulder / arm while sleeping for comfort
  • Hand squeezing exercises
  • Elbow and wrist active motion (AROM) with shoulder in neutral position at side
  • Stationary bike (must wear immobilizer)

GOALS

  • Pain control
  • Protection

WEEKS 2 – 4

  • Continue immobilizer x6 weeks
  • Continue appropriate previous exercises
  • Supported pendulum exercises
  • Resisted elbow / wrist exercises with light dumbbell (<5#), shoulder in neutral

GOALS

  • Pain control
  • Protection

WEEKS 4 - 6

  • Continue immobilizer x6 weeks
  • Continue appropriate previous exercises
  • Shoulder shrugs, scapular retraction without resistance
  • Active assisted motion (AAROM) supine with wand – Flexion to 90 degrees
  • 1-2 Finger Isometrics x6 (fist in box)

GOAL

  • Supine AAROM Flexion to 90 degrees

WEEKS 6 - 8

  • D/C immobilizer
  • Continue appropriate previous exercises
  • AROM in pain-free range as tolerated, No PROM
  • AAROM (pulleys, supine wand, wall climb)
    • Flexion > 90 degrees
    • Abduction and ER to tolerance
    • IR and extension (wand behind back)
  • Submaximal isometrics (continue 1-2 fingers for IR)
  • Elliptical trainer – Lower extremity only
  • Treadmill – Walking progression program

GOAL

  • AROM Flexion to 120 degrees, abduction to 90 degrees

WEEKS 8 - 12

  • Continue appropriate previous exercises
  • AROM, AAROM through full range, No PROM
  • Light Theraband ex – ER, Abduction, Extension
  • Biceps and Triceps PREs
  • Prone scapular retraction exercises (without weights)
  • Push-up plus on wall – no elbow flexion > 90 degrees
  • Body blade
  • BAPS on hands
  • Ball on wall (arcs, alphabet)
  • Elliptical trainer (upper and lower extremities)
  • Pool walking / running – No UE resistive exercises

GOALS

  • Full AROM
  • 30 wall push-ups

MONTHS 3 - 4

  • Continue appropriate previous exercises
  • PROM / mobilization as needed to regain full ROM
  • Light Theraband ex – IR, Adduction, Flexion, Scaption
    • Continue ER, Abduction, Extension with increased resistance
  • Push-up progression – Wall to table to chair (no elbow flexion > 90 degrees)
  • Weight training with VERY LIGHT resistance (no flies or pull downs)
    • No elbow flexion > 90 degrees
    • Bench press
    • Seated row weight machine
    • Cable column
  • Ball toss with arm at side using light ball
  • UBE forwards and backwards a low resistance
  • Stairmaster
  • Treadmill – Running progression program
  • Pool walking / running – With UE resistance (no swimming)

GOALS

  • 30 table push-ups
  • Run 2 miles at easy pace

MONTHS 4 - 6

  • Continue appropriate previous exercises with increased resistance
  • Fitter on hands
  • Ball toss overhead
  • Push-up progression – Chair to regular
  • Sit-ups
  • Weight training with increasing resistance
    • No elbow flexion > 90 degrees
    • Military press, lat pull downs, flies
    • Gravitron for pull-ups and dips
  • Swimming
  • Running progression to track
  • Transition to home / gym program

GOALS

  • Normal Pectoralis Major strength
  • Resume all activities

*NO CONTACT SPORTS UNTIL AFTER 6 MONTHS POST-OP*