About this guide
This guide shows when you can restart each gym exercise after pectoralis major (pec) tendon surgery. Find your column:
- Acute repair: tendon reattached to bone (anchors or bone tunnels), usually within 6 weeks of injury.
- Chronic reconstruction: tendon rebuilt with a graft (for example Achilles or dermal allograft). These timelines run about 2 to 4 weeks behind acute repair because the graft must incorporate and the muscle is often under more tension.
Important: The dates provided are general guidelines. Dr. Jazayeri may modify these timelines based on your unique case, your repair, and whether an allograft was used. Each step requires the milestones at the end of this guide, not just the calendar date.
Your Surgical Athlete plan
A strong repair is only part of your recovery. Dr. Jazayeri’s plan also protects your muscle, strength, and conditioning, starting before surgery.
Before surgery
- Metabolic Report Card: a preoperative lab panel checking hormonal (testosterone, estradiol, thyroid), metabolic (blood sugar, inflammation, red blood cells), and nutritional (protein status, vitamin D, iron) markers. Anything out of range is optimized before surgery.
- Targeted amino acids: start one week before surgery and continue through early recovery to help limit muscle loss.
- Peptide therapeutics (BPC-157 and TB-500): an HHS interim enforcement-discretion policy addresses certain patient-specific 503A compounding of BPC-157 acetate and TB-500 acetate when its conditions are met. This is not FDA approval; compounded drugs are not reviewed by FDA for safety, effectiveness, or quality before marketing. Dr. Jazayeri will discuss whether an option is appropriate for your individual care and, if prescribed, its timing, dosing, duration, and pharmacy sourcing.
- Muscle-centric diet: protein needs go up after surgery. You’ll get a nutrition plan to protect lean mass without adding body fat. Explore the Muscle-Centric Nutrition Calculator and review your targets with your care team.
In the operating room
- Orthobiologics (PRP and BMAC): growth factors and healing cells from your own blood or bone marrow, placed where tendon meets bone.
- Allograft / acellular dermal matrix (ADM) augmentation: reinforces the repair. In a 2020 biomechanical study (Acellular dermal matrix augmentation significantly increases ultimate load to failure of pectoralis major tendon repair), augmented repairs were approximately 57% stronger than standard repairs (1,450 N vs. 921 N) and as strong as an intact tendon. This was a lab study measuring strength at the time of surgery, not long-term healing.
Rules for every phase (until cleared)
- No loaded “arm out and rotated back” positions on the operated side: wide grip, behind-the-neck, or deep stretch movements.
- No pressing, flyes, or dips until the final phases.
- No straps or hooks to shift load onto the operated side.
- Train the non-operated arm only with seated, supported, one-arm exercises that don’t require bracing with the operated arm.
- Wear your sling for all lower-body work until it is discontinued. Use machines, not free bars: racking a bar loads the chest.
Viewing tables on a phone? Swipe horizontally to view all columns.
Recovery phases at a glance
| Phase | Acute repair | Chronic reconstruction |
|---|---|---|
| Sling / protection | Weeks 0 to 4 (up to 6) | Weeks 0 to 6, continuous |
| Passive range of motion | From approximately week 4 | From approximately week 6 |
| Active range of motion | Weeks 6 to 8 | Weeks 8 to 12 |
| Light resistance (bands, cable) | From approximately week 8 | From approximately week 12 |
| Progressive loaded training | Months 3 to 4 | Months 4 to 5 |
| Pressing reintroduced | Months 4 to 5 | Months 6 to 7 |
| Unrestricted / competition | Around month 6 | Months 9 to 12 |
At a glance: what you can train, and when
Your legs and cardio can train from week 1. Chest is the last body part back, and a graft reconstruction adds several months.
Summary chart: read the detailed exercise restrictions and milestones below before progressing. Colors are also identified in words.
| Body part | Weeks 0 to 6 | Weeks 6 to 12 | Months 3 to 4 | Months 4 to 6 | Month 6+ |
|---|---|---|---|---|---|
| Cardio | Walk, bike training, progressing | Rowing machine training, progressing | Swimming training, progressing | Full training training, progressing | Full training training, progressing |
| Legs and glutes | Machines training, progressing | Hack squat training, progressing | Squat, deadlift training, progressing | Full training training, progressing | Full training training, progressing |
| Arms | Grip work light or limited | Light curls light or limited | Overhead ext. training, progressing | Close-grip bench training, progressing | Dips at 6 mo training, progressing |
| Back | Squeezes light or limited | Cable rows light or limited | Barbell rows training, progressing | Wide pulldowns training, progressing | Pull-ups training, progressing |
| Shoulders | Not yet not yet | Band rotation light or limited | Lateral raises light or limited | Overhead press training, progressing | Full training training, progressing |
| Chest: acute repair | Not yet not yet | Wall push-ups light or limited | Isometrics light or limited | Machine, DB press light or limited | Barbell bench training, progressing |
| Chest: graft reconstruction | Not yet not yet | Not yet not yet | Wall push-ups light or limited | Light pec deck light or limited | Machine, DB press light or limited |
Graft reconstruction: barbell bench at months 9 to 12; dips at months 9 to 12, or avoided for good.
When to restart each exercise
Times are counted from your surgery date.
Lower body
| Exercise | Acute repair | Chronic reconstruction | Notes |
|---|---|---|---|
| Stationary bike, walking | Week 1 | Week 1 | Upright bike, sling on |
| Leg extension, seated/lying leg curl | Week 2 | Weeks 2 to 3 | Machine, sling on, no gripping with operated arm |
| Seated machine calf raise | Week 2 | Weeks 2 to 3 | |
| Hip abductor/adductor, glute kickback machine | Week 3 | Week 4 | |
| Leg press | Weeks 3 to 4 | Weeks 4 to 6 | Moderate loads; no straining or breath-holding; don’t push on handles with operated arm |
| Belt squat | Week 6 | Week 8 | Good substitute for back squat |
| Bulgarian split squat (no weights in hands) | Week 6 | Week 8 | Dumbbells at your sides only once light resistance starts |
| Hack squat / pendulum squat | Weeks 6 to 8 | Weeks 8 to 10 | Shoulder pads load the chest wall; start light |
| Barbell back squat | Months 3 to 4 | Months 4 to 5 | Bar position rotates the shoulder; low-bar is hardest on the repair |
| Romanian / conventional deadlift | Months 3 to 4 | Months 4 to 5 | Start light; double overhand grip: avoid mixed grip |
Back
| Exercise | Acute repair | Chronic reconstruction | Notes |
|---|---|---|---|
| Shoulder blade squeezes (no load) | Weeks 2 to 4 | Weeks 4 to 6 | Arm at side |
| Light band row | Week 8 | Week 12 | First resisted pulling |
| Seated cable row, neutral grip | Weeks 8 to 10 | Weeks 12 to 14 | Arm low and in front; start at 30 to 40% of usual load |
| Chest-supported machine row | Week 10 | Week 14 | |
| Single-arm dumbbell row | Weeks 10 to 12 | Weeks 14 to 16 | Avoid deep stretch at the bottom |
| Straight-arm pulldown | Week 12 | Week 16 | Keep range short |
| Lat pulldown, close/neutral grip, to the front | Weeks 11 to 14 | Weeks 15 to 18 | Needs full, pain-free overhead motion; 3 to 4 weeks after seated row |
| Barbell bent-over row, T-bar row | Months 3 to 4 | Months 4 to 5 | |
| Assisted pull-up | Month 4 | Months 5 to 6 | |
| Lat pulldown, wide grip | Months 4 to 5 | Months 5 to 6 | |
| Bodyweight pull-up / chin-up | Months 5 to 6 | Months 6 to 8 | Never kip |
| Behind-the-neck pulldown | Avoid / month 6+ | Avoid / month 9+ | Highest-risk position for the repair |
Shoulders
| Exercise | Acute repair | Chronic reconstruction | Notes |
|---|---|---|---|
| Light isometrics | Weeks 6 to 8 | Weeks 10 to 12 | Shoulder in neutral |
| Cable/band external & internal rotation | Week 8 | Week 12 | Comfortable range only |
| Rear-delt machine / band face pull | Week 10 | Week 14 | |
| Light dumbbell lateral raise | Weeks 10 to 12 | Weeks 14 to 16 | Raise to 90° only |
| Front raise | Week 12 | Week 16 | Loads the upper pec |
| Machine shoulder press | Month 4 | Months 5 to 6 | Neutral grip, partial range first |
| Dumbbell / barbell overhead press | Months 4 to 5 | Months 6 to 7 |
Arms
| Exercise | Acute repair | Chronic reconstruction | Notes |
|---|---|---|---|
| Wrist and grip work | Weeks 1 to 2 | Weeks 1 to 2 | Squeeze a ball in the sling |
| Light biceps curl, arm at side | Weeks 6 to 8 | Weeks 8 to 10 | Elbow tucked, no shoulder movement |
| Preacher / machine curl | Week 8 | Week 12 | |
| Cable triceps pushdown | Weeks 8 to 10 | Week 12 | Elbows tucked |
| Overhead triceps extension | Weeks 12 to 14 | Weeks 16 to 18 | Needs overhead motion |
| Skull crusher / close-grip bench | Months 4 to 5 | Months 6 to 7 | Treat as pressing |
| Dips | Month 6+ | Months 9 to 12, or avoid permanently | High-risk for pec rupture |
Chest (last body part)
| Exercise | Acute repair | Chronic reconstruction | Notes |
|---|---|---|---|
| Wall push-up / isometric squeeze | Weeks 10 to 12 | Weeks 14 to 16 | |
| Light cable crossover / pec deck, short range | Month 4 | Months 5 to 6 | No deep stretch; stop arms in line with body |
| Machine chest press, neutral grip | Months 4 to 5 | Months 6 to 7 | Start at 20 to 30% of pre-injury load |
| Floor push-up | Month 5 | Month 7 | |
| Dumbbell bench press (flat/incline) | Months 5 to 6 | Months 7 to 9 | Preferred over barbell; many switch permanently |
| Barbell bench press | Month 6+ | Months 9 to 12 | Reduced-range board press first |
| Deep-stretch dumbbell flyes | Month 6+ | Months 9 to 12 | Highest-risk chest movement |
| Heavy singles / max testing | Month 9+ | Month 12+ | Optional |
Cardio and pool
| Activity | Acute repair | Chronic reconstruction |
|---|---|---|
| Incline treadmill walk, upright bike | Week 1 | Week 1 |
| Stair climber (light hand contact) | Weeks 3 to 4 | Weeks 4 to 6 |
| Pool walking / gentle motion in water (incision fully healed) | Weeks 4 to 6 | Weeks 6 to 8 |
| Elliptical with moving arms, rowing machine | Weeks 10 to 12 | Weeks 14 to 16 |
| Freestyle / breaststroke | Months 3 to 4 | Months 4 to 5 |
| Butterfly, competitive swimming | Months 5 to 6 | Months 7 to 9 |
Milestones before moving forward
- Before light resistance: wound healed, no tenderness at the repair, near-full passive motion, rotation and arm-out motion without pain.
- Before lat pulldown and overhead work: full, pain-free active overhead reach; seated row tolerated 3 to 4 weeks without symptoms.
- Before pressing: full active motion equal to the other side; adduction and internal rotation strength at least 70 to 80% of the other side; no pain at rest or with activity.
- Before unrestricted training or competition: strength at least 90% of the other side, normal contour when posing, and Dr. Jazayeri’s clearance.
How to load each new exercise
- Start at about 30% of your pre-injury working weight for 15 to 20 reps.
- Increase by no more than approximately 10% per week, only if there’s no pain at the repair afterward or the next day.
- No training to failure, forced reps, or negatives for the first 6 to 9 months.
Bodybuilding-specific risks
- The bottom (lowering) phase of the bench press is the classic injury mechanism; dips and wide flyes load the tendon the same way.
- Contest prep (calorie deficit, dehydration) is a higher-risk time to return to heavy loading.
- Anabolic steroid use can affect tendon quality and is common among lifters with pec tears.
Let’s talk openly about your training: no judgment
Dr. Jazayeri works with many bodybuilders and understands that anabolic steroids are often part of their training. Telling us what you use helps us protect your repair: it never affects the quality of your care.
Dr. Jazayeri welcomes these conversations and will work with you on:
- Tapering down: high-dose anabolics around surgery can raise your risk of infection, so we’ll plan how and when to taper before surgery
- Resuming safely: the safest approach to restarting, if and when you choose to
- Peptides and other agents: what may help or hurt tendon healing
- Nutrition and supplements: fueling recovery and protecting muscle while you rebuild
Which agents to continue, taper, or stop, and when, will be discussed as part of your individualized plan. Please don’t stop or change anything on your own before we talk.
Bring a list of everything you take, including compounds, doses, cycle timing, peptides, and supplements, to your visits. Questions you’d rather ask privately? Call or email us anytime.
Stop and call us right away if you notice
- A new pop or sudden weakness
- New bruising
- A change in the shape of your chest or armpit fold
- Pain at the repair site lasting more than 48 hours
Plan your recovery
Ready to plan your recovery? Call 1-844-JAZ-0911 or email [email protected]. Office: 310-746-5918 ext. 956.
Learn about pec major tendon repair, Dr. Jazayeri’s training and experience, or return to our athlete’s guide to return to training.
About the author
Reza Jazayeri, MD is a double board-certified orthopedic surgeon and sports medicine physician and Director of Longevity & Optimization at DOCS Health. He completed his residency at NYU–Hospital for Joint Diseases and his sports medicine fellowship at Kerlan-Jobe Orthopaedic Clinic.
Related reading
Bio-enhanced pectoralis major tendon reconstruction
Download your guide
Download the pec repair and reconstruction return-to-lifting guide (PDF)
Medically reviewed by Reza Jazayeri, M.D. on
