Tendon tears (Bicep and Pec)

[Hurlburt]

Hello all, long time follower on this site, first post. I've been following starting strength and the Texas Method on and off for a couple of years now with absolutely amazing gains for my age (late 40's).

First I'll share a story that may help someone and then ask a question.

January 11, 2020, shoveling wet snow, I go to pitch a heavy shovel full and POP! Left bicep tendon exploded off the bone of my forearm. Pain was blinding initially, heavy bruising and one of the heads of the muscle bunched up in my upper arm. I had surgery to reattach it on 1/20, the endo button procedure. Incredibly, after the initial injury I never experienced what I call pain, just discomfort, as related to the surgery. By may i was starting to get strength back and by June I could do pullups. Today I'm near full strength, but it doesn't have endurance and tires quickly.

Late June I began a round of Texas Method. By late July I was getting my numbers back up pretty decent. July 29 I was benching at 90% of my 5RM, first set on rep number 2 and felt a massive and extraordinarily painful POP in my right pec, I may have had my elbows in a bad position. After an MRI and trip to the same surgeon, he told me I had a partial tear (grade 2 I think). The tendon tore away from the muscle as opposed to tendon tearing away from the bone and therefore inoperable. I began physical therapy last week, PT said i should have about 4 visits, once a week. Mostly stretching and some digging at the scar tissue to get it in line with the grain of the muscle.

Can anyone who has had such a pec tear offer advice and or how well they came back from it, how they rehab'd it, particularly at middle age? I'm afraid I'm going to have to stop pressing heavy, at my age. If that's the future, so be it, I'll do lighter weights after I heal, but that would suck.

Thanks all!

[Nick D'Agostino]

Hey Hurlburt,

It's great to hear that you made a full recovery after the bicep surgery.

For pec rehab, I would bench 2x/week separated at least 48 hours apart. Continue overhead pressing at least once per week if you can. If you can't press bench 3x/week until you can press. Start the rehab process at high reps and gradually decrease to low reps over a month or two. Every 2-3 sessions, reduce the rep count by 2-3 reps. Start at 15 reps, then go to 12, then 10, then 8, then 5 or 6. Once you get to 5, get back into an LP or intermediate program.

Counting the empty bar set complete 3-5 total sets each session. Gradually increase the weight each set. If the bounce is the thing that is aggravating the injury, I would pause for the first two weeks to let things calm down and start to rebound again around 10 reps. You can take bigger weight jumps initially, but once you get below 10 reps, I would not make the jump bigger than 10% each session.

As you are doing the sets, the pain should start to blur and become more diffuse. If you feel the pain becoming sharper or more localized, I would shut things down that day and try again within 48 hours. Good luck!

[Hurlburt]

WOW, that was an awesome reply, thank you very much for taking the time!

I hit the gym today and tried what you said, but first I re-watched a number of Rip's videos on the bench press. I only used an empty bar and focused on form and it felt fine with no discomfort at all. I'll start adding a few pounds at a time and feel it out.

I had been avoiding pressing since the injury, thinking that would activate the pectoral as well, but did 5 sets with an empty bar today, also with no discomfort.

Questions:
1) Do I need to be so concerned pressing as I was? Is it safe to start adding weight just a little more aggressively than I will be on the bench?
2) At what point, if any, should I get comfortable putting pre-injury weights back on the bench and risk re-injury for a less functional exercise at my age?
and 3) Is it possible there is some nutritional or medical aspect to this that weakens the tendons? I have two similar injuries which I've never before experienced within 7 months.

Again, I REALLY appreciate the feedback and hopefully my experiences can help someone else out. I'm happy to discuss the surgery and rehab offline if it would help anyone out, I certainly looked everywhere for information before I got cut open.

[Nick D'Agostino]

1) Probably not. It is safe to add weight a little more aggressively on the press than the bench.
2) This is a personal question. If you don't have shoulder pain whenever you bench press, then I would keep benching. Once you get to the preinjury area, you can slow the progression rate if it makes you feel safer. If you don't think the juice is worth the squeeze, you can choose not to bench heavy. There is also the option of just bringing your grip in closer permanently.
3) If you are taking fluoroquinolones, I would talk to your doctor about switching medications.

If you want to mitigate injury risk from life, keep strength training and an eye on the bigger picture on the totality of your life stressors. If your dog died, you haven't been sleeping, and you are experiencing high amounts of relationship turmoil (at home or work), it's probably not the best time to have the most challenging week of training in your life. In these circumstances, take a lower stress week and then pick up where you left off the following week. Participating in strength training, being strong, and possessing the capability to see your bigger picture and make these types of decisions are the best ways to mitigate injury risk.