acute onset focal pectoralis pain

[danno89]

Good morning.
First post. Started with the books, learning from and enjoying the website (and now podcast) off and on as life allows for 10 years.
Have had steady training now for past 3 years (outside of a break from March 2020 until about Sept 2020) and have been injury free until 4 weeks ago.

37 y/o male, 6'0'' height, 220lb bodyweight. Employment during the week is mostly at a desk.
Squat 385x5, Deadlift 505x5, Press 195x1 (165x5), Bench 250x5.

On 11/4/21 during bench training, had warmed up just fine and on the first rep of the third work set (of 240x5) felt an acute pain in the right pectoralis.
Unwisely did a second rep that significantly aggravated the pain which felt worse during the eccentric phase of the lift. Racked the weight after that.

Pain is focal, about the size of a pecan and located about 2 inches lateral and 2 inches superiorly to the nipple. Immediately after the onset pain was about a 2/10 at rest, 4/10 on palpation of the area (there is a palpable mass of tissue there now, feels kind of like a knotted muscle) and escalated to about 7 or 8/10 during an attempt to do a pushup about 5 minutes after the injury occurred.
During the pushup the eccentric phase produced the worst pain and I could not lower myself to the ground controlled due to the pain.
There was no gross deformity in the area, no bruising or discoloration.

Pressed 175 for triples on 11/8/21 with no problem. Noticed the pain during squats when getting the bar into low bar position, pain in the pec at the bottom of the squat but not intolerable (felt the stretching sensation).

By 11/13/21 thought I had rested long enough, really no more pain on palpation.
Benched 200x3, 225x3 then 255x4 and on the fourth rep the pain returned with a vengeance (same location and characteristics).

No benching since then until 12/03/21. Workout 95x10 (fine), 115x8 (fine) and 135x6 and during the last rep the pain returned mildly so I stopped benching immediately.
Thought I had rested long enough by this time but pain is clearly still there and aggravated by benching.
I have been pressing this whole time with no problems and the benching only produced pain in this one focal area on the right pec (no shoulder pain).
Dips on a few workouts during the month of November were also fine, but didn't do them until mid November (about 2 weeks after the initial onset of the injury).

Appreciate feedback on what might be the nature of the injury and certainly advice on how to rehab it.
Injury has never been bad enough to interfere with work or life, not needed any pain meds, doesn't wake me from sleep.

Thank you,
Dan

[Mark Rippetoe]

This is most likely a pec tear. If you load it heavy, it will tear more, as you did the day you hurt it by ignoring the focal pain in the muscle belly. You should have waited 2 days, and started back with the empty bar, either high reps like the Starr protocol, or lower reps and light weight as Dr. Morris prefers. Either way, the weight should be light enough that the pain either subsides during the set or stays exactly the same -- if the pain increases, you've tweaked it and maybe reinjured it.

You've waited a month, and now a scar is in the process of forming that will be a problem. I suggest you do 45 x 10, 75 x 10, and 95 x 10 x 3, and see what happens.

[danno89]

Thanks Rip.

Did this today 45 x 10, 75 x 10, and 95 x 10 x 3.
Pain was present during the lift (started back up during the set with 75) but stayed exactly the same through the rest of the workout.

I'm wondering now how I should progress rehabbing it.
Stick with these light weights and higher reps for another month or two?
Do this same workout three or four times a week? Or every day?
How is a decision made about when to increase weight and/or lower the reps?
Should I avoid work on related movements (namely dips)? Pressing has never aggravated the pain.

Thank you.

[Mark Rippetoe]

The weight goes up every workout, as pain permits. After about 3 weeks change to 5s.

[danno89]

Will do, thanks.

Appreciate all the work you and the Starting Strength community are doing and have done for the industry.
I live down the road from the SS Austin gym. Been meaning to stop in and say hello.

Take care.