Rehabilitation Protocol Utilized Following Pectoralis Major Repair

Phase	Goals	Therapeutic Exercises	Precautions
Phase 1 Protection (generally first 2‐6 weeks)	Patient education Protection of surgical repair	Gentle PROM below shoulder level ER to neutral Pendulum exercises In sling first 1‐2 weeks Progress to full pendulum after week 2 Elbow, wrist, hand exercises with shoulder in neutral position	Avoid active shoulder ABD, FLEX, and ER minimum of 2 weeks No lifting >1 pound Wear sling at all times Repairs that require significant mobilization or greater tension should be immobilized for full 6 weeks
Phase 2a Motion (generally weeks 4‐8)	Scar mobility Restore AROM Painfree ADLs	AAROM Supine assisted flexion wand exercise Scapular retraction & protraction Progression to full AROM Gentle “two‐finger” isometrics in all planes Aerobic conditioning (stationary bike ‐wearing sling) Lower extremity resistance training allowed	Wean from sling (may wear sling during lower body and aerobic exercises) Avoid overhead activity AAROM & AROM should be in painfree range Avoid PROM horizontal abduction & shoulder flexion above 90°
Phase 2b Motion Progression (generally weeks 6‐10)	Progress AROM Painfree ADLs	Continue Phase 2 exercises as needed Progress ROM Wand exercises Progress to pulley Upper body bike	Avoid overhead activity Strengthening should be in painfree range NO push‐ups, heavy lifting, or sports participation Avoid PROM horizontal abduction & shoulder flexion above 90°
Phase 3a Strength (week 9 up to 3 months)	Maintain full AROM Painfree strengthening progression	Continue Phase 2 exercises as needed Neuromuscular & strength exercise progression Body blade™ in front of body (below chest level) Two‐hand chest ball toss Weight shifting onto UE (against wall) Cuff strengthening (IR/ER arm at side, FLEX & scaption at 60° to 90° Supine shoulder stabilization at 90° Scapular strengthening (ceiling “pushes” and light rows) Begin jogging and return‐to‐running program	In general, beginning strength exercises are performed with light resistance in ranges below shoulder level No heavy lifting (varies by patient / athlete) Avoid approaching 90° ABD and ER positions No contact sports / activities No military schools (i.e., airborne or air assault school for military &cadets)
Phase 3b Strength Progression (4 months to 8 months)	Progress painfree strengthening Push-ups at own pace painfree Return to most military and cadet activities	Continue Phase 3 exercises as needed Neuromuscular & strength exercise progression Body blade™ at 90° for FLEX, scaption Two-hand overhead ball toss Quadruped weight shifting Push-up progression (inclined push-ups to knee to standard) Cuff strengthening progression (add scaption to 120°) Supine shoulder stabilization at 90°-120° Scapular strengthening progression (standing forward “pushes” and rows)	In general, progression of strength exercises are performed with moderate resistance in ranges below 90°-120° Avoid painful overhead activities Avoid resistance in 90° ABD and ER positions No contact sports / activities No military schools (i.e., airborne or air assault school for military & cadets) No chest press type exercises
Phase 3c Strength Progression (6 months to 12 months)	Pass APFT push-up test at 6-8 months Return to sports activities	Neuromuscular & strength exercise progression Body blade™ approaching or at endrange Two-hand overhead diagonal ball toss progressing to regular throwing toss Weight shifting & progression to unstable platforms push-up progression adding “push-up plus” Progression of diagonal (chop and lift type) exercises Supine shoulder stabilization at available ranges Scapular strengthening progression (push-up plus)	In general, progression of strength exercises are performed with moderate to heavy resistance in full range and should be painfree Avoid painful overhead activities Avoid heavy resistance in 90° ABD and ER positions No contact sports / activities until 9-12 months No military schools (i.e., airborne or air assault school for military & cadets) until 9-12 months Avoid heavy bench press type exercises indefi nitely

Abbreviations: Abduction (ABD), Flexion (FLEX), External Rotation (ER), Internal Rotation (IR), Passive Range of Motion (PROM), Active Range of Motion (AROM), Active Assisted Range of Motion (AAROM)