胸大肌修复术
Patients › Rehabilitation
Rehabilitation protocol after pectoralis major repair, with the protected safe zone and staged return to chest loading.
本方案由基兰·希尔帕拉(Kieran Hirpara)医生在罗克汉普顿 Mater 私人医院为您提供胸大肌修复术后的康复指导。以下每个阶段均以通俗易懂的语言解释当前情况及最关键事项,随后提供您的物理治疗师所需的结构化细节;请将此页面或其 PDF 文件带给您的首次物理治疗就诊,以确保康复过程协调一致。您的物理治疗师可能会根据您的康复进展调整该方案。
如果您在术后对伤口有任何担忧,请联系诊所。拍摄伤口照片并发送电子邮件供审查通常很有帮助。切口位于靠近腋窝褶皱处,此处容易积聚汗水和湿气;请保持其清洁干燥,并及时报告任何红肿、分泌物或发热情况。
预期情况
胸大肌是驱动推和抱动作的强大胸部肌肉:卧推、俯卧撑以及将手臂横过身体。撕裂通常发生在年轻力壮的男性身上,进行大重量卧推的下降阶段时,此时肌肉同时被拉伸和负荷。修复手术将撕裂的肌腱重新附着,整个康复计划围绕一个简单理念构建:在肌腱愈合期间,使其避免拉伸和避免负荷。
胸大肌将手臂拉向身体内侧并内收,同时使其内旋。对修复处拉伸和张力最大的两个动作是将手臂向侧面展开(外展)和向外旋转(外旋),尤其是两者同时进行,这正是导致撕裂的初始位置。因此,早期手臂保持在身体前方,轻柔内旋,并严格限制上述两个动作,每次仅逐步增加几度。
由于过度负荷会导致修复后的肌腱将肌肉从骨骼上撕脱,因此刻意将大重量胸部训练(卧推、飞鸟、双杠臂屈伸、俯卧撑和接触性运动)推迟至术后四到六个月。这比感觉上所需的时间要长,但这是保护修复效果的最重要因素。
您的时间线还取决于肌腱的修复方式。 骨-腱修复(肌腱通过锚钉或纽扣重新附着于上臂骨)比腱-腱修复愈合更慢,且从悬吊带中取出的时间稍晚。Hirpara 医生会告知您属于哪种情况。在整个计划中,当您的肩膀准备好时再进入下一阶段,而不仅仅是根据日历时间:以下每个阶段都列出了“准备好”的标准。
手术过程
胸大肌修复术将撕裂的胸肌肌腱重新附着。肌腱最常从其在肱骨(上臂骨)上的附着点撕脱,此时通过锚钉或纽扣使用强效缝线将其重新固定;有时撕裂发生在肌腱本身内部,需将其缝合修复。康复的任务是在愈合期间保护该修复部位,随后逐步恢复完全的活动度、力量以及可靠的推举能力。
佩戴您的悬吊带
您将佩戴简易悬吊带:Hirpara 医生使用简易悬吊带,而非厚重的外展枕或枪支手 Brace。悬吊带将您的手臂保持在保护性位置:位于身体前方并轻柔内旋,使修复的胸肌处于放松状态。
- 佩戴悬吊带 4 至 6 周(骨-肌腱修复的佩戴时间比肌腱-肌腱修复更长;Hirpara 医生会告知您具体属于哪种情况)。您无需在睡眠时佩戴。
- 仅在淋浴以及在接受指导后进行锻炼时取下悬吊带;只要悬吊带被取下,请将手臂保持在身体前方并贴近身体侧面,不要向外侧伸展,也不要外旋。
- 在家休息时,如果注意得当,可以取下悬吊带:手臂用枕头支撑,并保持位于身体前方。
- 如果肩部肿胀或疼痛,请使用冰敷,尤其是在锻炼后。
在佩戴悬吊带期间,请注意您的姿势。保持耳朵、肩膀和髋部在一条直线上,避免肩膀下垂;良好的姿势可以保护您的背部,并有助于防止肩部僵硬。
关键注意事项——禁止事项
- 严禁将手臂外旋超过物理治疗师设定的每周限制。外旋从正前方(中立位,0°)开始,每周仅允许增加约 5°,因为外旋会牵拉修复部位。
- 严禁将手臂向侧面抬起超过每周允许的少量幅度,且绝不可将手臂外展与外旋结合:该姿势会导致肌肉撕裂。
- 严禁让肘部向后移动至胸部连线之后(这会牵拉修复部位);在健身房锻炼时,此后很长一段时间内都应避免此动作。
- 严禁在最初几周进行钟摆(手臂悬垂)或借助拐杖杠杆的运动;与肩部手术常规不同,让手臂悬垂或使用拐杖杠杆会牵拉修复的胸肌。(借助拐杖的辅助训练将在后期进行,约从第 4 周开始。)
- 严禁在获得许可前进行推、压或负重胸部训练(包括卧推、飞鸟、双杠臂屈伸、蝴蝶机夹胸、俯卧撑或接触性运动),时间不得早于 4 至 6 个月。
- 严禁强行或拉伸任何动作,且在医疗团队开始指导前(约从第 9 周起),不得直接锻炼修复的胸肌(如抗阻内旋或推压动作)。
第一阶段 — 保护期(第0–3周)
最初几周的重点完全在于保护修复的肌腱,使其与骨骼愈合。您需全天24小时佩戴简易吊带,手臂置于身前并轻微内旋。您的手、腕、手指和肘部保持正常活动。从大约第2周开始,您的物理治疗师可能会在严格限制范围内为您进行轻柔的肩关节被动活动,但严禁任何主动发力、严禁强行活动,且禁止进行钟摆或棍棒练习。
- 吊带: 简易吊带,手臂置于身前并轻微内旋,全天24小时佩戴。
- 允许的活动: 仅允许被动(辅助)活动,从大约第2周开始,并严格限制在以下范围内:外旋仅至中立位(0°),前屈仅至约45°,外展仅至约30°。您的肘部、腕部和手部可自由活动。
- 练习: 手、腕和肘部活动;轻柔的手部握力练习;肩胛骨周围肌肉(位置较低,远低于肩高)的肩胛骨设定练习和低拉练习。完全避免胸肌负荷。
进入下一阶段的条件: 疼痛得到控制;伤口愈合且无异常迹象;被动活动在上述限制范围内感觉舒适;且无修复部位过度受力的迹象。
第二阶段——恢复活动度并逐步脱离吊带(第4–6周)
修复处正在愈合,吊带正在逐步脱离,骨-肌腱修复者较早(约第4周),肌腱-肌腱修复者稍晚(第5–6周)。您的保护性活动度每周仅增加几度,现在可以开始轻柔的辅助(使用拐杖辅助)训练。肩部周围肌肉可开始进行轻度肌肉等长收缩训练,但不包括胸肌本身,也不包括内旋,因为这两者都会对修复处产生负荷。
- 吊带: 正在逐步脱离(骨-肌腱修复者约第4周,肌腱-肌腱修复者第5–6周)。
- 允许的活动: 被动和辅助活动,每周增加约5°:外旋从中立位逐渐增加,前屈至约65–85°,外展至约50°。仍不可进行主动活动,且不可超过每周设定的活动度限制。
- 练习: 仰卧位辅助前屈;使用拐杖辅助外旋(仅限每周设定的活动度限制);外旋、外展和后伸的按压保持(等长)训练,不包括内旋;肩胛骨定位训练。
进入下一阶段的条件: 已脱离吊带;保护性活动度按计划进展;外旋至极限时肩前部无疼痛;等长训练感觉舒适。
第三阶段——主动活动(第6–8周)
大约从第6周开始,悬吊带被移除,您开始自主活动手臂,从重力影响最小的轻松体位开始:仰卧位,或向天花板方向伸展。您的受限活动范围每周逐步增加几度,直至完全恢复。肩周肌肉得到强化,并开始进行肩后方的轻柔拉伸,但修复的胸大肌仍保持保护,避免受力。
- 悬吊带: 停用。
- 允许的活动: 继续被动活动直至完全活动范围(每个方向每周增加约5°),并开始自主主动活动。允许手臂承受轻度负重。
- 锻炼: 仰卧出拳(敬礼式);侧卧外旋(无负重);弹力带划船及肩胛骨训练;二头肌轻度训练;针对肩后方的交叉臂拉伸和睡眠者拉伸。
进入下一阶段的标准: 所有方向的活动范围完全或接近完全;能够以良好控制力自主活动手臂(无耸肩或代偿性牵拉);且肩前方无疼痛。
第四阶段——胸肌开始负重(第9–14周)
这是一个转折点:从大约第9周开始,修复后的胸肌本身开始轻柔地工作。它从缩短(放松)的位置开始,随着对负荷的耐受性增加,逐渐向拉长位置进展。内旋动作——胸肌自身的功能此前一直刻意避免——也在此阶段引入,并缓慢增加。运动应达到全范围,重点转向受控的轻度负重。较重的推举动作仍需等待。
- 运动: 各个方向的全范围或接近全范围的被动和主动活动(对于骨-肌腱修复,在第12–14周达到全范围)。
- 练习: 轻柔的内旋和胸肌收缩训练,先从缩短位置开始;使用棍棒进行内旋;弹力带外旋;使用弹力带的PNF对角线模式(由物理治疗师设定的受控对角线运动)。
进入下一阶段的条件: 您拥有全范围且无痛的活动度;并且能够进行轻柔的胸肌训练而事后无任何疼痛。
第五阶段——强化训练(第14–20周)
从大约第14周开始,进行规范的胸部强化训练(使用轻重量和阻力,或“等张训练”),并逐渐、对称地加强另一侧。俯卧撑训练从靠墙开始,仅当力量允许时才逐步过渡到地面。现在有两个健身房规则需要长期遵守,因为违反这些规则会以撕裂修复肌腱的方式对其施加负荷:在推举、飞鸟或夹胸动作的底部,切勿让肘部向后移动超过身体所在的垂直线;并且避免使用大重量低次数的训练:应选择较轻负荷和较高次数,并缓慢热身。
- 活动范围: 完全。
- 训练动作: 靠墙俯卧撑逐步过渡到地面俯卧撑;弹力带内旋训练;过头臂屈伸;轻负荷渐进式胸部及推举训练;轻柔的门框胸部拉伸。
进入下一阶段的准备标准: 与另一侧相比,力量均衡增长;且在抗阻胸部训练中无疼痛。
第六阶段 — 早期重返运动(5–6个月)
此时手臂力量已恢复且活动范围完全正常,训练将针对您的运动项目进行,包括更快的、更具爆发力(增强式)的练习,如胸前传球和投掷姿势。这是为重返运动做准备,但尚未获得无限制大负荷训练的许可。
- 动作: 完全。
- 练习: 在90/90(运动)体位下进行外旋和内旋;按照物理治疗师的指导进行增强式胸前传球和投掷练习。
进入下一阶段的时机: 当您通过针对您运动项目的力量和任务特异性测试;并且Hirpara医生与您的物理治疗师均批准您继续时。
第七阶段——完全恢复(6个月及以上)
大约在6个月后,经医生许可,您可恢复所有高强度工作和运动。卧推从之前最大重量的约一半开始,逐步增加负荷;接触性运动在6个月后方可恢复。恢复标准基于您的力量达到健侧的至少85–90%,并获得Hirpara医生的许可,而非仅依据日历时间。
- 活动度: 完全恢复。
- 训练: 完全恢复大重量推举和负重训练,从轻负荷逐步增加,并进行全面的专项运动训练。
恢复条件: 您的力量达到健侧的至少85–90%;活动度完全恢复且无痛,耐力良好,大负荷训练后无反应性疼痛;且Hirpara医生和您的物理治疗师均已批准。
重返运动与工作
重返胸部负荷及运动遵循基于标准的原则:需具备足够的关节活动度、力量与耐力,且无疼痛,经Hirpara医生及您的物理治疗师共同签字确认,而非仅依据日历时间决定。
- 工作: 久坐工作视耐受情况而定;体力劳动或重体力劳动至少需3个月。
- 驾驶: 大约6至8周。
- 胸部轻度强化训练: 约从第14周开始。
- 卧推、重体力举重、俯卧撑及对抗性运动: 不早于4至6个月,且仅在力量恢复后进行;卧推从约既往最大值的50%开始,并逐步缓慢增加负荷。
对于投掷类及对抗性运动,在恢复 unrestricted(无限制)参与前,需完成分级渐进训练计划。
您的早期锻炼
这些是早期(保护)阶段的轻柔锻炼,从病房开始并延续至家中进行,操作时您的患侧手臂需保持在身体前方,肩部肌肉放松。请根据物理治疗师的指导开始锻炼,若引起尖锐的肩部疼痛,请立即停止任何动作。请记住早期注意事项:目前尚不进行钟摆或棍棒锻炼,且绝不可同时将手臂外展并外旋。
术后康复方案
本方案与诊所的一般康复建议配合使用:请参阅术后疼痛管理和伤口护理。
Evidence & references
Pectoralis Major Tendon Repair -- Post-operative Rehabilitation
Topic scope: Rehabilitation after surgical repair of a pectoralis major (PM) tendon rupture/tear (typically a humeral-insertion avulsion in a 20-40 yr-old male, classically during the eccentric phase of a bench press). Covers protected positioning, the early restrictions on abduction (ABD) and external rotation (ER), ROM progression, when active ROM and strengthening start, and return to heavy lifting / bench press / sport.
Defining principle (contrast with frozen-shoulder release): PM repair rehab is a classic protect-the-repair protocol -- the OPPOSITE of frozen-shoulder release. The repaired tendon runs anteriorly to its humeral insertion; abduction and external rotation stretch/tension the repair, so both are strictly limited early and the arm is held in adduction + internal rotation in a sling/immobiliser. Progression is deliberately slow, and heavy resisted pec loading (bench press, flyes, dips, contact sport) is delayed to ~4-6 months to avoid re-rupture.
A key modifier throughout: repair type dictates the timeline. Bone-tendon repairs (suture anchors/cortical buttons into humerus) heal slower than tendon-tendon or muscle-tendon repairs and wean from the sling later (MGH protocol).
CONSENSUS PHASED TIMELINE
Synthesised from the Mass General Brigham (MGH) Sports Medicine protocol (rev. 7/2023, the most granular degree-by-degree protocol) and the University Orthopedics protocol, cross-checked against the published literature (Cordasco/HSS 2017; Manske & Prohaska 2007; Schepsis 2000; Haley/Zacchilli 2014). Both published protocols agree on the core structure; the ROM numbers below are the MGH degree targets.
| Phase | Window | Sling / position | ROM allowed + RESTRICTIONS | Active ROM | Strengthening | RTS / lifting |
|---|---|---|---|---|---|---|
| I -- Immediate | 0-3 wk (UnivOrtho: 0-2 wk) | Sling/immobiliser, arm in NEUTRAL or INTERNAL ROTATION, worn day & night | PROM only, started ~week 2. ER limited: start at 0 deg in adduction, progress ~5 deg/week. Flexion start 45 deg, +5-10 deg/wk. ABD start 30 deg, +5 deg/wk. Elbow/wrist/hand AROM free. No active shoulder motion; no ER beyond limit; no abduction/extension stretch | None at shoulder (distal joints only) | Wk 3: periscapular only (inferior glide <35 deg ABD, low row), ball squeeze. No pec loading | None |
| II -- Intermediate | 4-6 wk | Begin weaning sling: bone-tendon at 4 wk; tendon-tendon / muscle-tendon at 5-6 wk (UnivOrtho: immobiliser to 6 wk for all) | PROM continues (ER +5 deg/wk; flex +5-10 deg/wk to ~65-85 deg; ABD +5 deg/wk to ~50 deg). Begin AAROM (cane flexion, cane ER stretch, washcloth press). Still no aggressive ER/ABD past targets | AAROM introduced | Submaximal isometrics: ABD, extension, ER -- explicitly NO IR isometrics (IR/adduction tension the pec); periscapular setting | None |
| III -- Late | 6-8 wk | Sling discontinued | PROM continue to full (ER, flex, ABD each +5 deg/wk to full). Initiate AROM (supine flexion, salutes, supine punch). Can begin weight-bearing through arm | Active ROM starts ~6 wk | Sidelying ER, periscapular rows/extension, biceps/triceps; rhythmic stabilisation; sleeper/cross-body stretch | None |
| IV -- Transitional | 9-14 wk | None | Restore full PROM/AROM (full by wk 12-14 for bone-tendon) | Full | Initiate shoulder IR isometrics + pec major isometrics (~week 9) -- shortened position first, then lengthened; ER w/ band, ABD; PNF D1/D2 | None |
| V -- Advanced strengthening | 14-20 wk (~3.5-5 mo) | None | Full | Full | Pectoralis isotonics begin; IR w/ band, counter push-ups -> push-ups, lat pulldowns; doorway pec stretch gentle | Begin sport-specific prep |
| VI -- Early return to sport | 5-6 months | None | Full | Full | ER/IR at 90 deg, plyometrics (med-ball chest pass, ball drops, 90/90 throws) | Begin return-to-sport program when criteria met |
| VII -- Unrestricted RTS | 6+ months | None | Full | Full | Bench press resumed at 50% 1-RM, progress slowly with physician; full return to strenuous work, recreation, contact sport NOT before 6 months | Heavy lifting / bench press / contact sport: 6+ months, criterion-based |
Key numeric consensus points
- Sling: ~4-6 weeks (4 wk bone-tendon may wean earlier; 6 wk common; UnivOrtho keeps immobiliser a full 6 wk), arm in adduction/internal rotation.
- ER early limit: 0 deg at the side, advance ~5 deg/week -- because ER tensions the anterior repair.
- ABD/flexion early limit: ABD ~30 deg and flexion ~45 deg initially, advancing ~5-10 deg/week.
- Active ROM: ~6 weeks.
- Isometrics: scapular wk 3; submaximal shoulder (ABD/ext/ER, no IR) wk 4-6; pec/IR isometrics ~wk 9 (Phase IV).
- Pec isotonics / push-ups: ~14 weeks (Phase V).
- Bench press / heavy lifting / contact sport: deferred to ~4-6 months (MGH: 50% 1-RM bench at 6+ mo; UnivOrtho: light bench from ~4 mo with very light resistance, no contact until 6 mo).
The rationale for restricting ER and ABD is biomechanical: the PM is a strong adductor, internal rotator and flexor; abduction + external rotation is the position of maximal stretch on the anterior insertion (this is the injuring mechanism -- eccentric load in abduction/ER, e.g. bench press), so it maximally tensions the repair (Maier 2021; Schepsis 2000; Provencher 2010). Biomechanical work shows transosseous sutures, suture anchors and cortical buttons confer similar repair strength, and early activity should stay below identified failure loads until soft-tissue- to-bone healing is reliable (Sherman 2012; Edgar 2017) -- the biomechanical basis for the slow progression.
OUTCOMES / RETURN TO SPORT EVIDENCE
- Surgical > non-operative for restoring strength/function: objective strength testing shows repair recovers significantly more peak torque and work than conservative care (Hanna 2001 -- comparative cohort); literature "strongly supports early operative treatment" of complete tears in active patients/athletes (Kircher 2010 review; Schepsis 2000). Acute repair > chronic/delayed repair (Schepsis 2000).
- Return to sport in repaired athletes is generally good, with most returning by ~6 months to a year; Cordasco (HSS, 2017, n=40 acutely repaired athletes) reported high RTS and functional scores with low re-operation. Faster individual returns (5-7 mo) are reported in single cases but 6 months is the consensus floor for heavy/contact loading.
KEY CONTROVERSIES / VARIABLES
- Sling duration & wean point. 4 wk vs 6 wk; MGH ties it to repair type (bone-tendon later); UnivOrtho fixes 6 wk for all. No RCT defines the optimum. Weak/consensus.
- How fast to advance ER/ABD. ~5 deg/week is widely used but arbitrary; tissue quality, tear size and fixation method modify it -- larger tears / poor tissue / chronic repairs progress slower. Expert opinion.
- Repair construct. Cortical button vs suture anchor vs transosseous -- biomechanically similar (Sherman 2012; Edgar 2017), so construct should not, in principle, change the rehab timeline, but surgeons individualise. Strong biomechanical, weak clinical.
- RTS timing for bench press / contact sport. Range 4-6 months across protocols; no high-level evidence sets the safe threshold -- driven by re-rupture fear and biomechanical failure-load data, not RCTs. Weak/consensus.
- Acute vs chronic / augmentation. Chronic or retracted tears may need allograft or autograft (semitendinosus) augmentation and a more conservative timeline (Neumann 2018 dermal allograft: 6 wk full immobilisation then 4-phase PT from wk 6; Garofo 2025 semitendinosus technique). Weak (technique notes/small series).
- Overall evidence base. Almost entirely retrospective cohorts, technique notes and biomechanical studies -- no RCTs of one rehab protocol vs another for PM repair. The whole timeline is consensus/expert, anchored by biomechanical failure-load data. Flag: WEAK.
EVIDENCE STRENGTH FLAGS (summary)
- STRONG: biomechanical failure-load / repair-construct comparisons (Sherman 2012; Edgar 2017 -- cadaveric, controlled) -- these justify the load restrictions.
- MODERATE: surgical vs conservative superiority (Hanna 2001 comparative; Schepsis 2000; Cordasco 2017 n=40 outcome series; Campbell's / Pochini 2014 prospective 60-case series).
- WEAK / CONSENSUS ONLY: every specific rehab parameter -- sling duration, ER/ABD degree-per- week limits, AROM/strengthening start weeks, 4-6 month RTS/bench-press timing. Derived from institutional PT protocols (MGH, University Orthopedics) and narrative reviews (Manske/Prohaska 2007; Haley/Zacchilli 2014; Maier 2021), not RCTs.
CITATIONS
RAG corpus (180,000+ Orthopaedic articles)
- Cordasco FA, Mahony GT, Tsouris N, et al. Pectoralis major tendon tears: functional outcomes and return to sport in a consecutive series of 40 athletes. J Shoulder Elbow Surg. 2017;26(3):458-463.
- Kang RW, Mahony GT, Cordasco FA. Pectoralis major repair with cortical button technique. Arthroscopy Techniques. 2014.
- Haley CA, Zacchilli MA. Pectoralis major injuries. Clin Sports Med. 2014.
- Schepsis AA, Grafe MW, Jones HP, et al. Rupture of the pectoralis major muscle. Am J Sports Med. 2000;28(1):9-15.
- Sherman SL, Lin EC, Verma NN, et al. Biomechanical analysis of the pectoralis major tendon and comparison of techniques for tendo-osseous repair. Am J Sports Med. 2012.
- Hanna CM, Glenny AB, Stanley SN, et al. Pectoralis major tears: comparison of surgical and conservative treatment. Br J Sports Med. 2001.
- Kircher J. Surgical and nonsurgical treatment of total rupture of the pectoralis major muscle in athletes: update and critical appraisal. Open Access J Sports Med. 2010.
- Maier J, Oak SR, Soloff L, et al. Management of common upper extremity injuries in throwing athletes: a critical review of current outcomes. JSES Rev Rep Tech. 2021;1(4).
- Neumann JA, Klein CM, van Eck CF, et al. Outcomes after dermal allograft reconstruction of chronic or subacute pectoralis major tendon ruptures. Orthop J Sports Med. 2018. (6 wk full immobilisation; PT from wk 6, 4 phases)
- Garofo AGP, Medina G, Schor B. Acute pectoralis major tendon tear reconstruction with semitendinosus augmentation: a technique note. JSES Rev Rep Tech. 2025;5(4).
- Azar FM, Canale ST, Beaty JH. Campbell's Operative Orthopaedics (cites Pochini 2014 prospective 60-case series; Edgar 2017 repair-configuration biomechanics; ElMaraghy classification). 2020.
- (Provencher MT, Handfield K, Boniquit NT, et al. Injuries to the pectoralis major muscle: diagnosis and management. Am J Sports Med. 2010;38(8):1693-1705 -- cited within MGH protocol.)
- (Manske RC, Prohaska D. Pectoralis major tendon repair post-surgical rehabilitation. N Am J Sports Phys Ther. 2007;2(1):22-33 -- cited within MGH protocol.)
Published rehab protocols (URLs)
- Mass General Brigham (MGH) Sports Medicine -- Rehabilitation Protocol for Pectoralis Major Repair (rev. 7/2023): https://www.massgeneral.org/assets/MGH/pdf/orthopaedics/sports-medicine/physical-therapy/rehabilitation-protocol-for-pectoralis-major-repair.pdf (source for the degree-by-degree ER 0 deg +5/wk, flex 45 deg, ABD 30 deg limits; sling neutral/IR; bone-tendon vs tendon-tendon wean; pec isometrics wk 9, pec isotonics wk 14; bench 50% 1-RM at 6+ mo).
- University Orthopedics, Inc. -- Pectoralis Major Repair Rehabilitation Protocol: https://universityorthopedics.com/assets/shoulder/PECTORALIS-MAJOR-REPAIR.pdf (immobiliser x6 wk; AROM ~6 wk; phased push-up progression; light bench from ~4 mo; no contact sport until 6 mo).
- Additional concordant institutional protocols: Melbourne Orthopaedic Group https://mgorthopaedics.com.au/wp-content/uploads/2021/04/PECTORALIS-MAJOR-REPAIR-PROTOCOL.pdf ; Summit Orthopedics https://www.summitortho.com/wp-content/uploads/2022/08/6575_SURGICAL-Pect-Major-Repair-Protocol_6.22_MB.pdf




