Friday, August 28, 2015

Why are Pectoralis Major Tears the Latest Epidemic in Sports?

A friend of mine sent me an email about the alarming number of pectoralis major muscle tears suffered by Minnesota Vikings players. In one year alone there were five reported cases. A cluster on one team is odd, so I did some research to try to determine whether other sports and teams were having similar occurrences. Australian rugby reported a similar pattern of seven pectoral tears in two years. There was also a sprinkling of pectoral tears plaguing other football and hockey teams and, of course, there are cases in the recent past. So what might be causing this latest rash of pectoral injuries?

Published literature often blames the bench press for this injury and the amount of weight being handled, when often the weight cited is not significant. This is a topic I am quite familiar with, as several colleagues and I published an article on case series of pectoralis major tears in 1993. We surmised that patients who were bodybuilders seemed to be more prone to the tear while performing the bench press than powerlifters. Powerlifters compete in the squat, bench press and deadlift, lifting maximum weights, so the logic that the bench press or the weight is the key factor in pectoralis major tears is not entirely accurate. (Pectoralis major tears: etiology and prevention. Reynolds EJ, Semel RH, Fox RT, Coughlin SP, Horrigan JM, Colanero AF. Chiropractic Sports medicine 1993 Vol 7 No 3:83-89)

Powerlifters typically have carefully planned training cycles in which the amount of weight lifted increases over a 12-to-14-week period. The number of sets and repetitions are preset and followed precisely. Once the maximum performances are achieved at a meet at the end of the 12-to-14-week period, the powerlifter usually takes 1-2 weeks off from training to recover from this maximal effort. Bodybuilders, on the other hand, tend to have less structured training plans and often a much higher volume of training (sets and repetitions) than powerlifters. There is typically less recovery and rest, and less effectively designed to reach the heaviest weights.

If an athlete needs to include the bench press in his/her training program, the plans must be carefully laid out. These training programs are even more complex because the strength and conditioning is just one component of the entire training package. The athlete may often have speed and agility components to training, in addition to the position-specific training for the sport. And, at some point, the off-season ends and practice begins, which leads to competition/games -- the entire focal reason the athlete was training.

Even with expert coaching, the Robert Burns expression applies, "The best laid plans of mice and men often go awry." An athlete can get a good plan, do everything right and yet still encounter problems. And these problems are only exacerbated if the athlete is given a good plan, but chooses to listen to someone else and either add to or change the training program. If the coach or personal trainer does not comprehend the entire training package of an athlete, the strength training can take on too much importance, time and energy, leading to less recovery time and possible injuries.

Minnesota Vikings Coach Zimmer offered several additional reasonable and viable causes for the tears, including dehydration, fatigue and over-strengthening. Dr. Peter Larkins in Australia commented that the players are simply faster today and the players are "throwing their arms out." He also noted that the weight training programs would be reviewed. Trauma is certainly another unpredictable factor. Athletes are bigger, stronger and faster today. A "clothesline tackle" can cause the pectoralis major or biceps brachii to rupture, which I have seen in my practice.

The bottom line is this injury is occurring too much, and all the factors must be reviewed, but one common theme should be addressed: athletes must have time and a plan to recover from their cumulative training loads. Powerlifters perform maximum bench presses with few pectoralis major injuries, but their training is their sport. They don't have to take the field, rink or court to perform other tasks which would tax their recovery.

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