I was on an overhanging wall when my feet slipped off. With an audible pop heard by people 20 yards away my pectoralis muscle partly tore off my humerus. The orthopedic suggested no surgery because there is enough tendon still attached, and said I should do rehab exercises to get back to climbing. Is there a chance I could tear off what’s left of a partly detached tendon?
— Kurt A. Hoellrich, via e-mail
Yours is an uncommon injury. Typically, one of the rotator-cuff tendons will tear, or the shoulder will dislocate, before the load is sufficient to tear the tendon insertion of pectoralis major. When a small piece of connective tissue tears, like a pulley, it will sound like something between a small twig snapping to clothing stitches ripping. When a large piece like an ACL ligament or Achilles tendon gives way, it is akin to a small weapon discharging. Any noise, however, arising from an area under load is a sure sign of internal calamity.
I tend to agree with the specialist’s approach. Worst-case scenario is you may require surgery to reattach the tendon if the insertion point ultimately fails. Best-case scenario is that the tear heals, and you carry on with business as usual. Given that you are now six months post injury, you should progressively increase your climbing intensity back up to your previous level, say, over the next few months.
Pull-ups, push-ups and dumbbell exercises should be fine for strengthening and rehabbing, but whatever gets you training is good. If you are doing a few different pectoral exercises in the gym, you are covered in terms of strength in various ranges. Bear in mind that the tendon virtually ruptured when it was otherwise sound, so you will have to thoroughly rehab the area to avoid further injury.
The fear of tearing the tendon off the bone is reasonable to a point— it will keep you paying attention to potentially damaging movement. If, however, you have comprehensively rehabilitated the tendon and progressively increased the climbing load, then it is what it is, and you should just get on with climbing. If the tendon breaks or reinjures easily, then you are likely off to surgery.