TRAINING INJURY: Please lend advice on Chest Insertion Tendon Injury

[Outstanding]

NOTE: I know this 'looks' long, and it is... but the first half of the post is a very quick read and I included "Cliff's Notes" below, if you don't have time to make it through all of the complete summary at the bottom - I really just need some assistance please)

[HR][/HR]
Hey everyone! This is not the ideal way to be back on the forums, but under these circumstances I had to make time to pop in because I know the WEALTH of knowledge these great members here have and are willing to share. That being said, please share some of your 'best practices' and experience regarding an injury (chest/deltoid tie-in) I just suffered last night while training.

(*I WILL also author a complete breakdown of the events leading up to the injury at the bottom of this post for more insight if there are any medical doctors, physical therapists etc, in the forum - also, if you KNOW OF ANY therapists or doctors personally or in the form, please direct them to this thread or paste this in an email to them)

Please share your thoughts on (don't forget, the entire description of the injury is below for 'diagnosis'):

1. Effective supplements/topicals for increasing blood flow to connective tissue to increase the rate of recovery
2. Effective drugs to be used in increasing the rate of recovery (ex: GHRP-6 or real hGH? IGF-1-LR3, etc?) 2b. and do such drugs have to be site-injected for localized healing, or since they are water based and don't create a depot anyway, can they be normally injected and their effects enjoyed systemically?
3. Rehabilitative exercises with bands, tubes, body-weight?
4. Usual time-frame for A. Recovery enough to resume light training, and B. Weeks/Months until FULL recovery and normal training can resume?
5. Protocol for icing, or heating? Frequency, duration etc, of either/or method

MAIN POINTS BELOW (Cliff's Notes): Occurred during Smith Machine flat-bench at 350 pounds, felt a slight tingle and 'tinge of burning' during the upward/concentric portion of the press, the mild discomfort occurred through reps 4-5, and then ON REP 6 I FELT A DISTINCT "pop, pop, pop" in the same exact location, as if the insertion tendon from my front/anterior deltoid into my middle-pectoral was a dry brittle branch being bent too far, however, there was no audible sound my training partner could hear, only something I felt about TWICE as dramatic as the sensation during rep-3. It was as if a warm piece of Silly Putty was being pulled end-for-end too quickly, and thinned out in the middle from being over-taxed.

- NO discoloration or swelling (which I am hoping is indicative of ZERO full or even partial tears, right?)
- Pain only creeps in when I flex/squeeze my chest, or try to bring my left arm (side of injury) across my body to wash my right arm/right armpit for example in the shower
- Site of injury is tender to the touch, but ZERO pain exists at rest with arm at my side relaxed

FULL SUMMATION OF INJURY BELOW:

SUNDAY MARCH 4TH 2012:
While in the gym doing flat bench press using the Smith Machine (rod-guided lateral pressing movement) I worked my way effortlessly up to around 335 pounds after having done 3 or 4 preceding warmup sets. The weight didn't seem 'heavy' as I am in the midst of an anabolic-assisted cycle, yet during the concentric (pushing) portion of the repetition I felt a slight tension-strain and very subtle burning sensation between my pec and anterior/front deltoid in the near the center of my pectoral. This sensation continued but didn't worsen during reps 4-5, but then once again on the pressing/concentric motion of rep 6, the initial strain and burning reached an instant climax and I felt a sort of "three-staged" pop, pop, pop that I would describe as pulling a piece of silly-putty end-for-end where it doesn't snap in two pieces, yet it lengthens and becomes elongated and thin/weak.

As I have never experienced any true debilitating injury before to compare it to, I wised up at this point in time and decided to call it a day and racked the weight and immediately became very concerned as I have read about and seen pictures of a pectoral tendon/insertion detachment before and know it is a severe and hard-to-rehabilitate injury. The pain at first was negligible, almost as if nothing happened, UNLESS I tried to flex my left pectoral specifically and then I could feel something was wrong/weakened. The discomfort continually grew for the next hour, but never reached a point of 'agony' by any means, only enough pain to keep me aware that something wrong had indeed occurred. As I type this, a couple hours after the incident at home on my laptop, if I keep my left arm stationary and type by only moving my wrists, no pain occurs, HOWEVER if I try to move my left arm across my body from left-to-right or shift it left-to-right on the key board, the pain is evident and constant.

A couple points that may be of importance to note is that my mobility is only truly limited when laterally raising my stretched-out arm in front of my body, or even when I use by chest for anything as small as situating myself upon sitting down, or pushing myself up from a seated position. Lastly, I am nearly 100% certain a complete rupture/tear didn't occur, because my pectoral didn't detach and shrink down toward my sternum into an isolated lump as I have seen online with other athletes.

Absolutely any insight, possible diagnosis, and treatment/ongoing care suggestions (ice/heat/time off/rehab exercises, etc) would be hugely appreciated. Without sounding melodramatic, weight training is literally my life blood, it enriches my life like nothing else imaginable, so I will follow absolutely any instructions.

I forgot to mention: About three-four years ago I suffered a very severe distal biceps tendon strain doing hammer curls in the gym, which caused me to receive multiple MRIs and extremity MRIs, along with ultrasound therapy and a couple months off from the gym - my condition never truly healed, it only became manageable enough to return to training once again. I was told by more than one doctor at the time of the biceps tendon injury that the origination of the problem could very well be in my shoulder where the tendon ultimately began (and I have been able to feel this prediction countless times doing curls even years later, my deltoid tendon becomes very taxed and seem to take the brunt of the workout while training). Well, last night, my inner-elbow or what was referred to as the distal biceps tendon, was very sore and felt 'brittle,' after training. I simply assumed I was dehydrated and didn't think anything else of it. Today at the gym, the chest injury I experience could have very well sprang from a weakened tendon/connective tissue in my arm/shoulders, which gave way under the load of the bench press. I feel as though these injuries all coincide, even though they have a few years separating them.

 

[ZiR RED]

I'm subbing here to come back and read closely when I get some time....

 

[ZiR RED]

Man, this is a tough one. The fact that there IS pain when moving means that it was only a partial tear, and not a full tear, as there would be no pain.

It's hard to distinguish whether it is the pec tendon or biceps tendon (which is more commonly injured).

My first piece of advice is get to a sports doc to get it checked out.

Next, do NOT stretch it or try to use it/work through the pain. Stretching only prolongs the recovery process.

A mix of ice heat ice (in that order will help remove chemicals/debris, bring in new blood, and reduce inflammation). You can also (if the inflammation gets bad) use a topical ibuprofen cream.

If you can get a professional diagnosis, than I can give you rehab exercises to do when we know what it is.

Br

 

[Outstanding]

Man, this is a tough one. The fact that there IS pain when moving means that it was only a partial tear, and not a full tear, as there would be no pain.

It's hard to distinguish whether it is the pec tendon or biceps tendon (which is more commonly injured).

My first piece of advice is get to a sports doc to get it checked out.

Next, do NOT stretch it or try to use it/work through the pain. Stretching only prolongs the recovery process.

A mix of ice heat ice (in that order will help remove chemicals/debris, bring in new blood, and reduce inflammation). You can also (if the inflammation gets bad) use a topical ibuprofen cream.

If you can get a professional diagnosis, than I can give you rehab exercises to do when we know what it is.

Br

So you're ruling out any type of severe strain, and you believe I actually did tear it, on some level? I believe the biceps tendon was the START of the injury a few years ago when I hurt it, leaving the shoulder vulnerable under heavy workload, however, the pain I felt was definitely isolated to the insertion tendon area between the shoulders and pectoral. Does the 'feel' of where the injury occurred rule out biceps tendon injury? Thanks!

 

[ZiR RED]

Semantics...a strain is tendon damage - some degree of tearing. I do not think it was a complete tear...but I do think there was some damage.

The pecs attach to the bicpital groove on the humerus. This also happens to be very close to where the biceps tendon runs, and often the pain is confused. Notice the pec attaches laterally on the humerus over the two biceps tendons.

The way you describe the pain, such as the out reached arm, lends me to think its biceps in nature...here is how the pain would be for the biceps (the red dots):

vs. a pec injury:

Still, I am not a sports doc, and diagnoses over the internet are quite unreliable...So I still highly suggest you get it checked out by a pro.

Br

 

[Outstanding]

Wow, one of the best reply posts I have ever read. Thank you.

I wanted to say according to the pictures you posted above though, that the bottom (pec injury) is actually where I feel the current pain radiating from without a doubt.

**The bottom "X" on the the second (very bottom) the inside of the left arm's front-delt is RIGHT WHERE I feel the discomfort when I move my arm with any amount of quickness, or I try to move my left arm across my body toward my right armpit.

Since there is no lumping (complete tear), swelling, or purple bruising, and I can still carry out very light tasks (like pulling on my jeans, or blowing my nose) how long would you say the rehabilitation period would be?

Please see my awesome Microsoft Paint work in the attached image

 

[ZiR RED]

Ok, so than it is most likely the pec. Good to get that narrowed down.

As for the recovery period....its going to depend on (I know you'd rather an absolute answer..sorry) the degree of the injury and how fast you recover. Best thing to do is keep it immobilized and treat the symptoms. Don't do anything that causes any discomfort for the first week or two, and then slowly start adding back in movements (non-weight training) that don't cause pain.

Br

 

[Outstanding]

Ok, so than it is most likely the pec. Good to get that narrowed down.

As for the recovery period....its going to depend on (I know you'd rather an absolute answer..sorry) the degree of the injury and how fast you recover. Best thing to do is keep it immobilized and treat the symptoms. Don't do anything that causes any discomfort for the first week or two, and then slowly start adding back in movements (non-weight training) that don't cause pain.

Br

Would you suggest a sling? I need to type for my job, but that doesn't cause any pain, other than that maybe I should use a sling to keep it immobilized?

Now that the injury does seem to be discovered, what about treatment? I have access to hGH, IGF-1-LR3, GHRP-6 etc etc etc... thanks!

 

[ZiR RED]

I don't think a sling would be nessessary. I haven't done much research into the use of peptides for CT healing. Might want to take that to the AAS forum

Br

 

[Outstanding]

Any further insight anyone?

I'm going to begin a 6 month HGH therapy program @ 2iu per day for expediting the reparation process...

 

[ejschmidt]

Here's the skinny Outstanding; last April I suffered a full pectoral tendon tear. The doctor told me I would never see full recovery and I might recover to 70 percent. I opted for the reconstructive surgery, which reattached the pectoral tendon and the ligament in my armpit. I was in a sling for 8 weeks and suffered serious atrophy in my affected arm. I got back and went to three weeks of physical therapy. I began slowly working out again, only doing very light weight with dumbbell bench press. That August I started an H-Drol cycle (something weak to aid recovery) and lo and behold, here we are in March and I'm above and beyond where I was before the injury.

To be noted: I was on an anabolic cycle at the time and, too, did not feel that I was at risk of injury when benching. There was a slight rubbing and burning sensation, and then all of the sudden, a ripping/ popping sound (NOT sensation) like bubble wrap. My hand went numb and I experienced serious bruising under my armpit. All indicative of a pectoral tear, so I took the surgery. Apparently anabolics make your muscles and tendons very brittle.

Best of luck. Keep me posted.

 

[Outstanding]

Here's the skinny Outstanding; last April I suffered a full pectoral tendon tear. The doctor told me I would never see full recovery and I might recover to 70 percent. I opted for the reconstructive surgery, which reattached the pectoral tendon and the ligament in my armpit. I was in a sling for 8 weeks and suffered serious atrophy in my affected arm. I got back and went to three weeks of physical therapy. I began slowly working out again, only doing very light weight with dumbbell bench press. That August I started an H-Drol cycle (something weak to aid recovery) and lo and behold, here we are in March and I'm above and beyond where I was before the injury.

To be noted: I was on an anabolic cycle at the time and, too, did not feel that I was at risk of injury when benching. There was a slight rubbing and burning sensation, and then all of the sudden, a ripping/ popping sound (NOT sensation) like bubble wrap. My hand went numb and I experienced serious bruising under my armpit. All indicative of a pectoral tear, so I took the surgery. Apparently anabolics make your muscles and tendons very brittle.

Best of luck. Keep me posted.

Great post.... gives me a lot of hope knowing you had such success, and I only have a partial tear. I never had bruising or discoloration, so I remain somewhat optimistic.

I am thinking of something like 2-4iu hgh per day, and may stack it with GHRP-2. I need to get back into join/connective tissue supplements research, and load up on those as well.

I am just near wit's end when I think about not being able to lift for weeks all because I let my ego tell me "Go heavier" for the first time in a long time.

 

[B5150]

pparently anabolics make your muscles and tendons very brittle.

Best of luck. Keep me posted.

Anabolics steroids increase muscle contractile strength and weaken tendons.

 

[ZiR RED]

See below post.

Br

 

[B5150]

There are many risk factors for tendon rupture, but the most common predisposing factor for individuals involved in physical development, and particularly competitive bodybuilding and strength competition, is the use of anabolic steroids. These drugs lead to increased muscle strength, as well as weakening of the tendons1-4.

 

[ZiR RED]

Good citation, I just went through those refs and a few others. It appears that A. I was wrong (thus I retract my statement), and B., AAS affect tendon remodeling making tendons stiffer...but does not appear to affect tensile strength in humans:

Am J Sports Med. 1995 Mar-Apr;23(2):227-32.
The effects of anabolic steroids on rat tendon. An ultrastructural, biomechanical, and biochemical analysis.

Inhofe PD, Grana WA, Egle D, Min KW, Tomasek J.
Source

Department of Orthopaedic Surgery, University of Oklahoma College of Medicine, Oklahoma City, USA.

Abstract

Forty-eight male rats were randomly separated into four groups: a control group, a group treated with anabolic steroids, a group treated with daily exercise, and a group treated with both steroids and exercise. At 6 weeks, biomechanical, ultrastructural, and biochemical testing was performed on the Achilles tendons of half of the rats in each group. The remaining rats continued in the experimental protocol, but steroid administration was discontinued. Similar testing was then performed on the remaining rats at 12 weeks. Testing showed anabolic steroids produced a stiffer tendon that absorbs less energy and fails with less elongation; tendon strength was unaffected. Effects were entirely reversible on discontinuation of the steroids. Light microscopic analysis revealed no changes in the appearance of the fibrils. No change in fibril diameter or shape was noted on electron microscopic analysis. Biochemical testing revealed no change in qualitative immunofluorescence staining with Type III collagen or fibronectin. Abuse of anabolic steroids is a widespread problem among competitive athletes; consequently, complications after their use are seen with increasing frequency. Knowledge of the effects of these drugs on tendon and the musculotendinous unit may prove helpful in counseling athletes who use anabolic steroids.


PMID:7778710 [PubMed - indexed for MEDLINE]

It also seems that AAS + inactivity may increase collagen synthesis and tendon thickness....whereas AAS plus loading increases inflammation and inhibits tendon adaptation by inhibiting the gene expression of many enzymes involved in tendon remodeling.

One could then speculate that the rate of muscle growth/strength increases significantly; however, the tendons do not adapt while on AAS. This would further increase the risk of tendon injury.

Am J Sports Med. 2006 Aug;34(8):1274-80. Epub 2006 Apr 24.
Androgenic-anabolic steroids associated with mechanical loading inhibit matrix metallopeptidase activity and affect the remodeling of the achilles tendon in rats.

Marqueti RC, Parizotto NA, Chriguer RS, Perez SE, Selistre-de-Araujo HS.
Source

Departamento de Ciências Fisiológicas, Universidade Federal de São Carlos, Rodovia Washington Luis, Km 235, São Carlos, SP, 13565-905, Brazil.

Abstract

BACKGROUND:

The indiscriminate use of anabolic-androgenic steroids has been shown to induce pathologic changes in the Achilles tendon in several situations.
PURPOSE:

To study tendon remodeling in rats treated with anabolic-androgenic steroids combined with an exercise program.
STUDY DESIGN:

Controlled laboratory study.
METHODS:

Wistar rats were grouped as follows: sedentary (group I), injected with anabolic-androgenic steroids only (group II), trained only (group III), and trained and injected with anabolic-androgenic steroids (group IV). The trained groups performed jumps in water: 4 series of 10 jumps each, with an overload of 50% to 70% of the animal's body weight and a 30-second rest interval between series, for 6 weeks. Anabolic-androgenic steroids (5 mg/kg) were injected subcutaneously. Activity of matrix metallopeptidases, a marker for tendon remodeling, was analyzed in tissue extracts by zymography on gelatin-sodium dodecyl sulfate-polyacrylamide gel electrophoresis.
RESULTS:

Morphological analyses of tendons showed that in group II, the most external layer that covers the tendon was thicker with aggregation of the collagen fibers, suggesting an increase in collagen synthesis. In group IV, an inflammatory infiltrate and fibrosis in tendons as well as a pronounced increase of the serum corticosterone level were observed. This training protocol upregulated matrix metallopeptidase activity, whereas anabolic-androgenic steroid treatment strongly inhibited this activity. The appearance of lytic bands with molecular masses of approximately 62 and 58 kDa suggests the activation of matrix metallopeptidase-2.

CONCLUSION:

Anabolic-androgenic steroid treatment can impair tissue remodeling in the tendons of animals undergoing physical exercise by down-regulating matrix metallopeptidase activity, thus increasing the potential for tendon injury.
CLINICAL RELEVANCE:

Since the AAS abuse is so widespread, a better comprehension of the pathological effects induced by these drugs may be helpful for the development of new forms of therapy of AAS-induced lesions.

Eur J Appl Physiol. 2011 Aug 14. [Epub ahead of print]
[h=1]Gene expression in distinct regions of rat tendons in response to jump training combined with anabolic androgenic steroid administration.[/h]Marqueti RD, Heinemeier KM, Durigan JL, de Andrade Perez SE, Schjerling P, Kjaer M, Carvalho HF, Selistre-de-Araujo HS.
[h=3]Source[/h]Department of Physiological Sciences, Federal University of São Carlos, São Carlos, SP, Brazil, [email protected].

[h=3]Abstract[/h]The aim of this study was to evaluate the expression of key genes responsible for tendon remodeling of the proximal and distal regions of calcaneal tendon (CT), intermediate and distal region of superficial flexor tendon (SFT) and proximal, intermediate and distal region of deep flexor tendon (DFT) submitted to 7 weeks of jumping water load exercise in combination with AAS administration. Wistar male rats were grouped as follows: sedentary (S), trained (jumping water load exercise) (T), sedentary animals treated with AAS (5 mg/kg, twice a week) and animals treated with AAS and trained (AAST). mRNA levels of COL1A1, COL3A1, TIMP-1, TIMP-2, MMP-2, IGF-IEa, GAPDH, CTGF and TGF-β-1 were evaluated by quantitative PCR. Our main results indicated that mRNA levels alter in different regions in each tendon of sedentary animals. The training did not alter the expression of COL1A1, COL3A, IGF-IEa and MMP-2 genes, while AAS administration or its combination with training reduced their expression. This study indicated that exercise did not alter the expression of collagen and related growth factors in different regions of rat tendon. Moreover, the pattern of gene expression was distinct in the different tendon regions of sedentary animals. Although, the RNA yield levels of CT, SFT and DFT were not distinct in each region, these regions possess not only the structural and biochemical difference, but also divergence in the expression of key genes involved in tendon adaptation.


PMID:21842416 [PubMed - as supplied by publisher]

Br

 

[Outstanding]

There are many risk factors for tendon rupture, but the most common predisposing factor for individuals involved in physical development, and particularly competitive bodybuilding and strength competition, is the use of anabolic steroids. These drugs lead to increased muscle strength, as well as weakening of the tendons1-4.

Thanks David, I'm going to do some reading. Hopefully reducing my cycle dosage parameters and beginning a long term HGH therapy along with time off from the gym will encourage expedited healing.

 

[Outstanding]

Some pain started to come back last night, I've decided on doing the following:

-GH @ 6iu/day (2iu: upon waking, pre-workout meal, post-workout meal)
-GHRP @ 100mcg before falling asleep along with ECGC + Huperzine-A + 20g Glutamine 15 minutes prior to injection
-IGF-1-LR3 for the first month only at 100mcg daily, either post-workout or with largest meal of the day

Q: Is 100mcg GHRP-2 still considered the largest saturation dose at one time that can be assimilated and utilized properly?