 
Massachusetts General Brigham Sports Medicine  

Rehabilitation Protocol for Pectoralis Major Repair 
 
This protocol is intended to guide clinicians and patients through the post-operative course for a pectoralis major repair. 
This protocol is time based (dependent on tissue healing) as well as criterion based. Specific intervention should be 
based on the needs of the individual and should consider exam findings and clinical decision making. If you have 
questions, contact the referring physician.  
 
Considerations for the Post-operative Pectoralis Major Repair Rehabilitation Program 
One major factor that influences the post-operative pectoralis major repair rehabilitation outcome is type of repair. It is 
recommended that clinicians collaborate closely with the referring physician to establish if the repair is bone-tendon, 
tendon-tendon or muscle-tendon which will dictate soft tissue time constraints.  
 
Post-operative considerations 
If the patient develops a fever, unresolving numbness/tingling, excessive drainage from the incision, uncontrolled pain 
or any other symptoms you have concerns about you should contact the referring physician. Special care should be 
taken to monitor an incision in the axillary area due to increased risk of bacterial and moisture buildup. 
 
PHASE I: IMMEDIATE POST-OP (0-3 WEEKS AFTER SURGERY) 
Rehabilitation 
Goals 
• Protect surgical repair  
• Reduce swelling, minimize pain  
• Promote scar mobility 
• Maintain UE ROM in elbow, hand and wrist  
• Gradually increase shoulder PROM  
• Minimize muscle inhibition  
• Patient education 
Sling  
• Neutral or internal rotation 
• Use at night while sleeping 
Intervention 
Swelling Management 
• Ice/compression 
 
Range of Motion/Mobility (Week 2) 
• PROM 
• ER: Neutral in 0 degrees ADD progressing 5 degrees each week 
• Flex: 45 degrees progressing 5-10 degrees each week 
• ABD: 30 degrees progressing 5 degrees each week 
• AROM 
• Elbow, wrist and hand 
 
Soft Tissue Mobilization 
• Scar massage (once scar is closed and dry) 
 
Strengthening (Week 3) 
• Periscapular: inferior glide (<35 degrees ABD), low row 
• Ball squeeze 
Criteria to 
Progress 
• PROM ER @ 0 degrees ADD 5 degrees 
• PROM Flex 50 degrees 
 
 
• PROM ABD 35 degrees 
• Palpable muscle contraction felt in scapular and shoulder musculature 
• No complications with Phase I 
 
PHASE II: INTERMEDIATE POST-OP (4-6 WEEKS AFTER SURGERY) 
Rehabilitation 
Goals 
• Protect surgical repair  
• Reduce swelling, minimize pain  
• Gradually increase shoulder PROM 
• Initiate shoulder AAROM 
• Minimize muscle inhibition  
• Improve scapular muscle activation 
• Patient education 
Sling 
• Neutral or internal rotation 
• Bone-tendon repairs can begin weaning out of the sling at 4 weeks 
• Tendon-tendon or muscle-tendon repairs should begin to wean at 5-6 weeks 
Additional 
Intervention 
*Continue with 
Phase I 
interventions 
Swelling Management 
• Ice/compression 
 
Range of Motion/Mobility 
• PROM 
• ER: increase 5 degrees each week 
• Flex: continue to increase 5-10 degrees each week 
• ABD: continue to increase 5 degrees each week 
• AAROM 
• Active assistive shoulder flexion, shoulder flexion with cane, cane external rotation 
stretch, washcloth press 
 
Strengthening 
• Shoulder: Submaximal isometrics: ABD, ext, ER (no IR) 
• Periscapular: scap retraction, prone scapular retraction, standing scapular setting, 
supported scapular setting 
 
Criteria to 
Progress 
• PROM ER @ 0 degrees ADD 20 degrees 
• PROM Flex 65-85 degrees 
• PROM ABD 50 degrees 
• Minimal substitution patterns with AAROM 
• No complications with Phase II 
 
PHASE III: LATE POST-OP (6-8 WEEKS AFTER SURGERY) 
Rehabilitation 
Goals 
• Gradually increase shoulder PROM/AAROM 
• Initiate shoulder AROM 
• Promote scar mobility 
• Gradually increase muscle strength 
• Patient education 
Weight Bearing 
• Can begin bearing weight through surgical side 
Additional 
Intervention 
*Continue with 
Phase I-II 
Interventions  
Range of Motion/Mobility 
• PROM 
• ER: increase 5 degrees each week to full 
• Flex: continue to increase 5-10 degrees each week to full 
• ABD: continue to increase 5 degrees each week to full 
• AAROM 
• Seated shoulder elevation with cane, seated incline table slides, ball roll on wall, wall 
climbs 
• AROM 
 
 
• Supine flexion, salutes, supine punch 
 
Strengthening 
• Shoulder: Submaximal flex isometrics, side-lying external rotation 
• Periscapular: Row on physioball, shoulder extension on physioball, resistance band 
shoulder extension, resistance band seated rows, rowing, lawn mowers, robbery, serratus 
punches 
• Elbow: Biceps curl, resistance band bicep curls and triceps 
 
Soft Tissue Mobilization 
• Scar mobilization 
 
Motor Control  
• External rotation in scaption and Flex 90 degrees (rhythmic stabilization)  
 
Stretching  
• Sidelying horizontal ADD, sleeper stretch  
Criteria to 
Progress 
• PROM ER @ 0 degrees ADD 30 degrees 
• PROM Flex 75-105 degrees 
• PROM ABD 60 degrees 
• Minimal substitution patterns with AROM 
• No complications with Phase III 
 
PHASE IV: TRANSITIONAL (9-14 WEEKS AFTER SURGERY) 
Rehabilitation 
Goals 
• Restore full shoulder PROM/AROM (week 12-14 for bone-tendon) 
• Gradually increase muscle strength 
• Initiate shoulder IR/pec major isometrics 
• Patient education 
 
Additional 
Intervention 
*Continue with 
Phase I-III 
interventions 
Range of motion/mobility 
• PROM: Full  
• AROM: Full 
 
 
 
Strengthening 
• Shoulder: Submaximal IR isometrics, submaximal pectoralis isometrics (starting in a 
shortened position; progressing towards a more lengthened position), standing 
external rotation w/ resistance band, external rotation, sidelying ABD→standing ABD 
• Periscapular: Push-up plus on knees, prone shoulder extension Is, tripod, pointer 
 
Motor Control 
• PNF – D1 diagonal lifts (concentric to begin, then eccentric; manual resistance 
progressing to resistance bands) 
• PNF – D2 diagonal lifts (concentric to begin, then eccentric; manual resistance 
progressing to resistance bands) 
• Quadruped alternating isometrics  
• Ball stabilization on wall 
 
Stretching 
• Triceps and lats 
Criteria to 
Progress 
• Full pain-free PROM/AROM 
• Minimal to no substitution patterns with shoulder AROM 
• Performs all exercises demonstrating symmetric scapular mechanics 
 
 
 
 
PHASE V: ADVANCED STRENGTHENING (14-20 WEEKS AFTER SURGERY) 
Rehabilitation 
Goals 
• Restore full shoulder PROM/AROM (week 14-16 for tendon-tendon or muscle-tendon) 
• Gradually increase muscle strength through the full ROM 
• Do not overstress healing tissue 
• Patient education 
Additional 
Intervention 
*Continue with 
Phase II-IV 
interventions 
Range of motion/mobility 
• PROM: Full  
• AROM: Full 
 
Strengthening 
• Shoulder: Standing internal rotation w/ resistance band, internal rotation, pectoralis 
isotonics, counter push-ups→push-ups, lat pull downs  
• Periscapular: Resistance band forward punch, forward punch, T and Y, “T” exercise, “W” 
exercise, resistance band Ws, dynamic hug, resistance band dynamic hug 
 
Motor Control 
• Field goals, wall slides w/ resistance band 
 
Stretching 
• Hands behind head, IR behind back with towel, doorway series (gentle stretch only) 
Criteria to 
Progress 
• Full pain-free PROM/AROM 
• Minimal to no substitution patterns with shoulder AROM 
• Performs all exercises demonstrating symmetric scapular mechanics 
 
 
 
PHASE VI: EARLY RETURN TO SPORT (5-6 MONTHS AFTER SURGERY) 
Rehabilitation 
Goals 
• Maintain pain-free ROM  
• Continue strengthening and motor control exercises  
• Enhance functional use of upper extremity  
Additional 
Intervention 
*Continue with 
Phase II-V 
interventions 
Strengthening 
• Shoulder: External rotation at 90 degrees, internal rotation at 90 degrees, resistance band 
standing external rotation at 90 degrees, resistance band standing internal rotation at 90 
degrees  
 
Motor control/Plyometrics 
• 90/90 ball dribbles, over-head soccer throws, medicine ball chest pass, prone ball drops, 
standing ball drops, 90/90 over the shoulder eccentric catch and throw, body blade  
Massachusetts General Brigham Sports Medicine 
5 
Criteria to 
Progress 
•
No pain or tenderness
•
5/5 shoulder strength
•
Satisfactory shoulder stability
•
Use Quick DASH and/or PENN shoulder scale
•
Upper Extremity Functional Assessment
•
Full pain-free PROM and AROM
•
Joint position sense < 5-degree margin of error
•
Strength 85% of uninvolved arm with isokinetic testing or handheld dynamometer
•
ER/IR ratio > 64%
•
Scapular dyskinesis test symmetrical
•
Functional performance and shoulder endurance tests > 85% of uninvolved arm
•
Males > 21 taps; females > 23 taps on CKCUEST
•
Additional UE Functional Tests
•
One-arm hop test
•
Push-up test
•
BABER
PHASE VII: UNRESTRICTED RETURN TO SPORT (6+ MONTHS AFTER SURGERY) 
Rehabilitation 
Goals 
•
Maintain full pain-free ROM
•
Gradual return to strenuous work activities
•
Gradual return to recreational activities
•
Gradual return to sports activities
Additional 
Intervention 
*Continue with
Phase II-VI
interventions
Strengthening 
•
50% 1 RM bench press, progress slowly (coordinate with physician)
•
See specific return-to-sport program (coordinate with physician)
Criteria to 
Progress 
•
For the recreational or competitive athlete, return-to-sport decision making should be
individualized and based upon factors including level of demand on the upper extremity, contact
vs non-contact sport, frequency of participation, etc. We encourage close discussion with the
referring surgeon prior to advancing to a return-to-sport rehabilitation program.
Contact 
•
Please email MGHSportsPhysicalTherapy@partners.org with questions specific to this protocol
Revised 7/2023 
References: 
1. 
Falsone SA, Gross MT, Guskiewisc KM, Schneider RA. One-arm hop test: reliability and effects of arm dominance. JOSPT. 2002; 32:98-103. 
2. 
Kibler, W.B., Sciascia, A. D., Uhl, T. L., et al. Electromyographic analysis of specific exercises for scapular control in early phases of shoulder rehabilitation. The American Journal of
Sports Medicine. 2008. 36(9): p. 1789-1798. 
3. 
Manske RC, Prohaska D. Pectoralis major tendon repair post surgical rehabilitation. North American Journal of Sports PT. 2007; 2(1): 22-33. 
4. 
Olds M, Coulter C, Marant D, Uhl T. Reliability of a shoulder arm return to sport test battery. Physical Therapy in Sport. 2019; 39:16-22. 
5. 
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. 
6. 
Thompson K, Kwon Y, Flatow E, Jazrawi L, et al. Everything pectoralis major: from repair to transfer. The Physican and Sportsmedicine. 2020; 48(1): 33-4 
7. 
Uhl TL, Muir TA, et al. Electromyographical assessment of passive, active assistive, and active shoulder rehabilitation exercises. PMR. 2010; 2: 132- 141. 
8. 
Wilk KE, Bagwell MS, Davies GJ, Arrigo CA. Return to sport participation criteria following shoulder injury: a clinical commentary. IJSPT. 2020;15(4): 624-642. 
. 
