Question about scar tissue

[Tommy Gunn]

As you guys know, I had a partial pec tear that occured on March 21. I have been going to physical therapy 3 times a week for the last 4 weeks. My PT uses ultra sound, massaging, hot/cold pack, stretching, etc. My doctor said that this should take 6 months before this is fully healed.

My question is, once the scar tissue is formed, is there a good chance that I will tear that pec again? I heard that scar tissue is very tough and that the chances of tearing that pec again in that spot is slim (once it is fully healed).

I heard that broken bones are more likely to break again once they're healed, but I heard muscle tears are the opposite: once they're healed they're tougher to rip again. Is this true?

Does this mean that once this is fully healed, I can go back to lifting, boxing, and grappling without having to constantly worry about that pec ripping again easily? I want to one day be able to throw a right hand again on the heavy bag without having to worry about repeating this injury.

[barbndr]

The maximum strength of scar tissue is approximately 70% of the conntective tissue it has replaced (this applies to skin, tendon, ligament etc.... There is also research to suggest that when you have scar tissue, the surrounding musculature will get stronger when put under stress (resistance training) to protect the muscle and joint.

If I remember correctly, you had a partial tear which involves a small percentage of muscle fibers. Your risk of repeating the tear may be slightly higher than an uninjured individual but IMO, it would not be worth losing sleep over. If it were a large tear...the risk goes up. The biggest obstacle you'll have to overcome is trying not to think about it when training as this may cause a slight change in form which can lead to problems.

As far as broken bones go, a fully healed broken bone maintains the original bones strength if it heals properly and at the same density is was previously. This is not always the case if the bone is not set properly or for some reason doesn't heal correctly, causing less bone density in the area (making it more prone to a break). There is also the theory that the body may overcorrect and allow more calcium---bone reformation creating a denser area which can be stronger than the original.

[Tommy Gunn]

Thanks for the reply barbndr. I gather from the info in your post 3 things.

1) You say scar tissue is about 70% as strong as real muscle. So you're saying I should only regain 70% of the strength I had in that pec?

2) You say the muscles that surround my pec tear will get stronger (with weight training) because they have to pick up the slack to protect the weakened previously torn muscle. So does this mean my pec MIGHT actually become stronger as a result of this injury? I'm confused

3) You said I will have a slightly higher chance of reinjuring this pec than an uninjured person. So you're saying that (as long as I warm up properly, stretch out good, etc) I won't have to worry about this re-tearing again in the future. Is this correct?

Are these assumptions right

Also, I have more questions:

1) Is there a chance (me being a former amateur boxer) that I will one day be able to punch as hard and as fast again with my right hand (the injury was in my right pec)?

2) Will I one day be able to bench press as much as I did?

3) My injury happened March 21. I stopped all lifting and have been going to PT 3 times a week (hot/cold packs, massaging, ultra sound, stretching, etc.). There is still pain in my right pec when I push in my desk, slam a door, etc.
Will this pain ever go away or am I stuck with it forever? Will I ever be able to throw a punch again pain free? How long until this starts to feel better? This happened more than a month ago (March 21). Should this still be hurting?

4) My PT said I could start going back to lifting in 2 weeks (7 weeks after my injury) but he said GO VERY LIGHT WITH HIGH REPS. He said every week gradually increase the weight and every 3 weeks lower the reps (increasing weight each set, do reps of 16,14,12 for 3 weeks, 14,12,10 for 3 weeks, 12,10,8 for 3 weeks, than 10,8,6 and by Sept. I should be ready to go back to boxing). Does this sound like a good plan? Does lifting actually help heal the injury?

4) How many months until this is fully healed?

Thanks in advance barbndr!

[barbndr]

1) You say scar tissue is about 70% as strong as real muscle. So you're saying I should only regain 70% of the strength I had in that pec?

No, I'm saying that the scar tissue itself is only 70% as strong as the original tissue. However, considering that if you take the overall volume of the tear compared to the muscle mass, I would guess 1-3% of the total mass of the pec was affected which would create a negligible loss in strength. If you could just take a cross section of that individual scar tissue, it would only be 70% as strong.

2) You say the muscles that surround my pec tear will get stronger (with weight training) because they have to pick up the slack to protect the weakened previously torn muscle. So does this mean my pec MIGHT actually become stronger as a result of this injury? I'm confused
Again, were dealing with a very small portion of the muscle. So, in this scenario, let's say on a microscopic level the muscle fibers around the scar hypertrophy to provide additional support. They get stronger but it probably won't show a gain in strength as far as poundage goes.


3) You said I will have a slightly higher chance of reinjuring this pec than an uninjured person. So you're saying that (as long as I warm up properly, stretch out good, etc) I won't have to worry about this re-tearing again in the future. Is this correct?

Yes, exactly. Once the muscle is allowed to heal, as long as you adequately prep the area with stretching and warm ups, you should not have to worry any more than previously.

The important thing to remember is that people come back from major tears and have full returns to normal and then some. Your tear was minimal so there is an excellent chance of recovery and continued increase in strength as you progress your training.

1) Is there a chance (me being a former amateur boxer) that I will one day be able to punch as hard and as fast again with my right hand (the injury was in my right pec)?
2) Will I one day be able to bench press as much as I did?

I see no reason with the damage you described that after proper healing you could have full return to normal. These injuries can take a while to heal so make sure to do the proper rehab.

3) My injury happened March 21. I stopped all lifting and have been going to PT 3 times a week (hot/cold packs, massaging, ultra sound, stretching, etc.). There is still pain in my right pec when I push in my desk, slam a door, etc.
Will this pain ever go away or am I stuck with it forever? Will I ever be able to throw a punch again pain free? How long until this starts to feel better? This happened more than a month ago (March 21). Should this still be hurting?

Physiologically, full healing and subsequent scar tissue build up can take as long as 6 months to one year (dependant on your personal recovery rate, rehab, amount of damage etc...). The pain can take quite a while as well. There is no way to accurately answer your question regarding pain. My best guess would be pain should subside after 2-3 months but it is very variable. You are doing the right thing with PT (I'm one as well).

4) My PT said I could start going back to lifting in 2 weeks (7 weeks after my injury) but he said GO VERY LIGHT WITH HIGH REPS. He said every week gradually increase the weight and every 3 weeks lower the reps (increasing weight each set, do reps of 16,14,12 for 3 weeks, 14,12,10 for 3 weeks, 12,10,8 for 3 weeks, than 10,8,6 and by Sept. I should be ready to go back to boxing). Does this sound like a good plan? Does lifting actually help heal the injury?

I would stress pain free lifting. And yes, lifting can help heal. It will help the scar tissue formation in the appropriate planes of stess in the muscle and help the muscle surrounding the scar tissue begin to regain its strength. Most people forget that time off is only part of the healing process. True rehab is knowing when to begin engaging the musculature again and how to properly re-train the area in a safe way. It sounds like your PT has good sports related knowledge.

4) How many months until this is fully healed?

There really is no way to tell. Bad tears can take a year or more but as I said before, you never can tell. Don't try to rush it too much because reinjury in the early stages of rehab is a concern.

[Doc.Sust]

i keep telling you t gunn NOBODY knows how long it will take for you to fully heal. you asked this quetion ten times,. do the rehab, see how it goes . and that is all you could do

[Tommy Gunn]

Thanks fellas. This is the worst period I've ever been through in my life.

For those who didn't see it, here is a copy of my MRI report:

"There is moderate diffuse thickening of the entire right pectoralis major muscle compared to the left. There are moderatly to moderatly severe poorly-defined longitudinally-oriented linear regions of increased internal T2 signal intensity throughout the right pectoralis major muscle, lateral greater than medial, posterior greater than interior. There is evidence of poorly-defined deep soft tissue inflammation/edema interposed between the right pectoralis major and minor muscles. There is mild/moderate diffuse anterior subcutaneous inflammation/edema, most prominent overlying the inferior lateral margin of the right pectoralis major muscle. The right pectoralis minor muscle is normal in configuration and patterns of signal intensity. The limited evaluation of the left pectoralis major and minor muscles is unremarkable.

Impression:

1. There is evidence of a moderate to moderatly severe diffuse strain/intrasubstance tear throughout the right pectoralis major muscle, lateral greater than medial, posterior greater than anterior. There is mild/moderate superficial and deep soft tissue inflammation/edema overlying the right pectoralis major muscle as detailed above.

2. The right pectoralis mior muscle is intact, demonstrating normal configuration and patterns of signal intensity."

I hate life. There goes my summer.

[Doc.Sust]

dont let the words fool you it isnt a good report but it isnt a bad report. a comeback can be made,listen to your PT, stick with your plan, and stop driving yourself crazy thinking about it, patience. give it time to heal. listen to yourpt and you will get better , much better than you are now, i know bench press specialists who blew out there entire pec and within a year and a hlaf, were back to pressing over 500lbs, it is possible