July 23, 2025 • 24 mins
Sports Doc Talk with Will Sanchez & Dr. Grant Garcia discusses Grigor Dimitrov’s shocking mid-match retirement from Wimbledon 2025 due to a right pectoral tendon tear.
Orthopedic surgeon Dr. Garcia explains the rarity of pec tendon tears in tennis players, the types of tissues affected, the differences between repairable and non-repairable tears, and the importance of surgical timing.
He also discusses recovery expectations, compares them to NFL players, Dimitrov’s future in pro tennis at age 34, surgical innovations like grafts, cadaver tendons, and internal bracing, and the impact of the injury on power and serve velocity post-recovery.
From diagnosis to elite-level recovery techniques, this masterclass covers how elite athletes battle back from rare injuries. It’s a must-watch/listen for orthopedic surgeons, sports clinicians, rehab professionals, and tennis fans.
Available on Spotify, Apple Podcasts, and YouTube.
Visit sportsdoctalk.com for transcripts, past shows, and guest requests.
Sponsored by The Recovery Shop – your go-to for post-surgical rehab and DME solutions.
00:00 - Intro & shoutout to The Recovery Shop
01:35 - Dimitrov’s injury live at Wimbledon: the moment it happened
03:00 - What is a pec tendon tear? Anatomy explained
05:15 - How this rare injury occurs in tennis
06:45 - Surgical challenges: tendon vs myotendinous tear
08:00 - Time-sensitive repairs and internal bracing
10:50 - Surgical options: repair vs reconstruction
12:00 - JJ Watt’s return in 10 weeks: how?
14:00 - Recovery timelines for elite vs average patients
16:00 - Will Dimitrov lose serve power?
17:45 - Power loss data & rehab outlook
19:00 - Scar size and surgical incisions in 2025
20:15 - Biologics in pec repairs: future potential?
21:30 - CrossFit and high-force pec injuries
22:45 - Dimitrov’s legacy and his fifth consecutive injury
23:40 - Final thoughts + upcoming surgical technique video
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:15):
Welcome to Sports Talk Talk. I'm Will Sanchez, along with our
orthopedic surgeon and sports medicine specialist, Doctor
Grant Garcia. You you see how that just kind
of flows out of my mouth at thispoint.
Dude, you're getting better eachtime.
You are our specialist and top doctor.
But enough with the accolades because you don't need any more
(00:35):
hyped up. We've got a great show.
We have a topic that it's reallyconcerning, really interesting,
so I'm really looking forward todiscussing it.
But before we do all of that, we're talking about injuries.
That means that we need to talk about the Recovery Shop.
Let's give a shout out to Mike Band tell everybody why you love
the Recovery Shop. Well, big thanks to our
(00:56):
sponsors. They've been our sponsors for a
long time now, man. It's been at least a year or
more. No, we've been.
Yeah, I appreciate it. So any else?
So the idea is if you're a surgeon, you're taking care of
the injuries we're going to talkabout today, right?
These patients get a lot of swelling afterwards.
They ask for what else can I do?Right?
It's not just the standard medicines you can give them.
There's other options for them, supplements, nice machines, more
(01:19):
advanced recovery systems. And so we have those there at
the recovery shop. And as a surgeon, you can have
your own specified section, which is really pretty cool
because you know, patients can use it for non surgical
injuries, surgical injuries, whatever they want.
And all kind of comes in one package.
And the nice thing it's vetted by the surgeons.
You can vet. We own products with them on
things that are, you know, DME approved, etcetera.
(01:40):
So it's pretty awesome. So reach out to Mike B.
I've been super happy with it. I have patients all the time
calling me, even non patients asking, hey, can I get something
your patient got? I'm like yeah no problem, happy
to help so. The reason we wanted to do the
show was because of this injury.And I was watching the match
live and we're talking about Grigor Dimitrov's Wimbledon exit
(02:02):
as he was up two games or two sets to none on the number one
player on of the World Yonic Center, which eventually won
Wimbledon. And he was cruising along and
I'm watching it and I'm like, man, he is, he's going to beat
this. I think he was.
I think they would tie 22 in thethird set and playing so well.
(02:25):
It was absolutely incredible. And then you see a serve and he
kind of grabs his PEC a little bit.
And then when he goes to serve again, which was an ace, he
collapses to the floor. First off, did you see the
injury live or did you just go back to the video, you know, as
(02:45):
we just decided to discuss exactly what had happened.
What's your your take on? So I didn't see it live,
probably working and who knows what I was doing.
But the but none the less that next day in the operating room,
my tech was coming up to me and my PA was like, hey man, did you
see what happened? It was crazy.
It's really unusual for tennis. And again, we hear about it in
(03:07):
some of the football players, right?
But to see it, you know, happen on real time and a tennis player
is very unusual. Yeah, there's.
There if you're watching on YouTube, he is reaching for that
right PEC. And when I first saw it, I
thought it was just some kind oflike, yeah, maybe a muscle
(03:28):
injury, a pull. You know, they're they're
they're swinging so hard, right?You look at 135 miles an hour,
118, you know, return serves at,you know, 87 mph every swing,
forehand, backhand, just, you know, it's, it's at the highest
level, right? We're talking about the best
(03:48):
athletes in the world. Why don't we talk a little bit
about what this injury is and how it will affect Grigor going
forward? Yeah.
So why don't you put the slide? You want to put that slide, that
one perfect. Yeah, pull that slide up.
So he had a PEC tenantear and I know we put down word partials
(04:08):
because you know, they're not always fully torn off, but you
have a lot of issues with the lower part of the PEC you can
see right there. So there the PEC has 2 heads,
there's a cavicular head and a sternal head.
And sometimes you can get a partial tear.
And a lot of times the challengehere is it seems it's hard to
see exactly what type of tear they had.
But a lot of times it's from, you know, getting caught on a
tree. I've had caught on a tree.
(04:29):
You've had wrestlers, you have bodybuilders, you have football
players, a lot less common in throwing sports and tennis.
So this is actually one of the first professional athletes I've
seen with the PEC tear that was a tennis player.
So it's quite unusual, but that massive force caulking back and
basically what that tendon does is it gives you that nice
contour we all know about, you know, pecks and the PEC flex,
(04:51):
but it usually pops off of wherethe humerus is.
So there's a little tendon. The misnomer, though, is that
it's a PEC tendon tear, because usually the tendon is so thin
and the tendon's so short that you pretty much never have
tendon left on it. It's very unusual.
It's usually something we call aMyo tendonous junction tear,
where it tears where the muscle and the tendon connect together.
(05:12):
What's interesting though is youguys see on the picture there on
the top right, that's the muscle.
But underneath that is somethingcalled a fascia.
So you've probably seen like when you're cutting meat, you
have got that thin white stuff in between that's kind of hard
and tough. When you're cutting the steak,
that's exactly what that is. So that fascia, if that gets
ripped off, it's a lot harder tofix.
But that's the ones we want to have get the get the fascia on
(05:32):
there, plus the tendon and that PEC.
But it's such a big muscle, it balls up and you can really see
a lot of deformity. So he was clutching the area
that he tore it on. The problem is sometimes it
depends on what type of tear youhave.
Now, his was something, you know, we had surgery, likely
successful. Obviously the tear that was
repairable. Sometimes though, you can tear
it in the middle of the muscle and those are not fixable, but
(05:53):
it's a different look. So it's a little bit tricky
because these are kind of hard to see on MRI.
Like no matter how much people say they look at these Mr. is,
they know exactly what they're looking at.
These Mr. is are a little challenging to read compared to
my, you know, rotator cuff tears, shoulder dislocations,
Acls, you name it. They can be more challenging and
obviously this is a time dependent thing which we can get
into in a second. Yeah, yeah.
(06:17):
So I want to go back to what yousaid.
You said if it's in the middle, it's unrepairable.
Why? Can you explain that?
Because, you know, that was the key that you mentioned there.
Yeah. So it can attach to the humerus,
which is around the biceps area,and that's where there's tendon
attached. It attached it to the chest wall
on the inside, right. That's when people have their
(06:37):
pecs that you can see it flexes all the way to the middle of
their sternum. And so the tears off there, the
good news about those, they usually heal a lot faster and
they usually get the contour back.
The problem is if they tear the other one, that's where the
power comes from with this muscle because the muscles so
big like this and then it weavesdown into some tiny little bit
of a tendon and the muscle attachment.
So that's usually the weaker point.
(06:58):
And that's the, the the way it happens is usually the last four
to five inches of the bench press.
That's almost always where it happens or an abrupt check or
from what he had is that tennis serve.
But these lineman that I've gotten, you know, we talked
about JJ Watt shortly, but they get caught and then it pulls
back and it pops a tendon. The challenging part here is
that, you know, if you don't do a lot of these, I've been in
(07:21):
surgeries before when even in training with some good guys
that they were, it was challenging effects sometimes
because it gets really distortedin there.
It's not the same as like a biceps tendon where it pulls
off. You can see the muscle.
The, the muscle is like a three-dimensional.
It's like a, it's like a circle and it, it folds on itself.
So you have to understand the anatomy a little more when you
(07:42):
fix these. Plus it's such a powerful muscle
and the time is dependent, right?
Like we can fix bicep tendon tears of three months, but you
get past six weeks, 5 weeks, youhave to reconstruct this, which
is a big problem, right? Like it's not, they just don't
do as well. If you have to reconstruct it,
they, they have good results, but it's just not the same as if
(08:02):
we have a fresh PEC tendon repair back to the bone, right?
Anything's always better when it's your own natural anatomy.
Yeah. If you're watching, I, I put
some of the examples between thesurgical repair and the non
operative for, for partial tearsa low demand.
If you could just explain both options when it becomes a non
(08:25):
operative and how you make that decision compared to the
surgical repair, which may seem obvious, but still I would like
for your input on that. Yeah.
So the word personal tear is kind of a misdemer, right?
Like a partial tear Here he partially, he didn't tear off
both heads, so usually still have the sternal head.
So he pulls off the sternal headand then he keeps the clavicular
head. And then The thing is that
(08:46):
basically that's a partial tear,but all the contour and muscle
strength is gone. Does that make sense?
So that still needs to be fixed.Now someone really low demand,
like, you know, maybe 80s, maybe70s, they don't really need to
do a lot. Yeah, it's a big surgery because
you're pulling that all muscle back.
You've got to make a big incision in the shoulder and
pull back you wouldn't do it for.
But even up to 60s, I've had weight lifters, bodybuilders in
(09:08):
their 60s that I've done it on and they've done quite well.
It kind of depends on the patient.
It's exactly the same thing. It's a custom approach.
But let's say you have that, it pulls off, then you want to fix
it. Usually we try to do in the
first six weeks. But I'll be honest with you, I
have a guy who's actually, thankfully doing well.
He was like 70 weeks out. I thought it was going to be
super straightforward. I went into the PEC tendon.
I tried to pull it back and the tendon was about 4 centimeters
(09:29):
too short. So look at this.
That's a lot, right? You got to fill that with
something or you leave them, right?
But this is a guy that he's 40 years old and he has he can't
get his, he can't pull his arm in like this total contour loss.
So I remade it with a cut Aber tendon and that that's a pretty.
Effective aber and scutures and things like that are just trying
to at that point you're connecting.
(09:50):
Yeah, well, we'll see that. The audience will see shortly.
In about six weeks, we're going to post the technique and how I
did it. But the idea is that you
basically take this Achilles tendon.
Achilles is from the lower part of your ankle.
You fan it out and then you weave it into the muscle, which
is pretty sick, and then you allsew it in.
There's some, there's a little bit of techniques, but on this
one you're going to love it because I added an internal
(10:11):
brace, which has not been out published yet.
So that is a pretty cool con. I knew it, I knew it.
So the cool part about this is it's amazing.
He came back in eight weeks and he looked like JJ woah, not the
same size, but the same outcome.I mean, literally killing it.
So I wonder if that had some level to do with it.
But the idea is that basically now we're using these, as long
(10:33):
as we can fix the brace from oneside to the other side, we're
adding these fiber tapes, internal braces to patients.
So I'm finding any ways I can doit.
So you know, they got the graft,they have the graft tendon
interface and now they also intothe bone have this internal
brace. You brought up JJ Watt and I
remember when he tore his pack and, you know, over here it says
(10:55):
that, you know, supposed to be out four to six months, but he
was back in 10 weeks. And for the football fans, they
remember he wore that big, bulkyblack, you know, restraint on
his arm that went all the way down.
And he pretty much, I think he played with it for the rest of
his career. I think at that point, he kind
(11:15):
of kept that on. So let let's talk.
It's twofold the question. One, what did they do for him to
get back so fast? And then two and two, why?
Why should he, you know, especially playing football,
keep that protected for the restof his career?
Is it something that that point it would have been vulnerable
(11:36):
due to age, sport or maybe the procedure itself in order for
him to get back fast? So let me make the caveat that
you have now hosed me for any ofmy PEC tendon repair patients
because I used to think that notas many people were listening to
this, but I've had multiple patients ask me.
They're, like you said on your podcast, that this is the way it
is. So just so everybody hears,
(11:58):
there's a disclaimer here. This is JJ Watt, a professional
athlete with millions of dollarson the line in the playoffs,
right? This is a different level.
If he had torn it like his otherWhitney Marcellus, who was also
on the team, if he had torn it at the end of the season, they
would have taken him out for theentire recovery period, right?
(12:19):
So that's that's the first. Yeah.
I'm sure they did some crazy stuff during his surgery.
I'm sure they repaired it. And I used to work with some of
the guys that did a lot of the football players and whatever
they did, they might have added something addition.
So if they got an acute repair, which is what they did, I mean
for, for, for Gregor, they got to them so quickly, like, you
(12:40):
know, my average time to see these is 3 to 4 weeks, just
because you got to wait to see the doctor and get an MRI and
everything else. But if you're on the field and
they tear, they can fix it rightaway.
You can get a really good fixation right away.
But I bet you with him, they added something else too, right?
Did they add a patch? Did they add some extra stuff in
there that, you know, not alwaysthe best case scenario, but in
this case helps him back it up. But at the same point, you know,
(13:03):
if he's not, I mean, grappling is good, but if he's got this
solid restraint, he's really notusing his arm.
He just needs to use it as like a peg.
Right. So when I let him play, I can't
say that I feel comfortable enough to let my A player play
at 10 weeks after a massive injury like this, but again, I
am. Defensive Player of the year
(13:24):
also as they're making a run allthis money like we we've talked
about. We don't know what the contract
was though either. So the answer is that that's
really impressive. We know they continue to prove
it, right. We've always said like some of
these players get back faster, but the part of it that's
important people to understand is that the average time for
this is like a six month recovery, right?
(13:46):
The average time is 6 month recovery.
That is what you should expect if you're getting this surgery.
He is an outstanding one. Now, I know there's been other
players that have been in like the 10:50 week recovery, but you
need to understand again that this is there's different
constraints on the line here. So this is what's pointing part.
You got this sort of immobilization phase four weeks,
then you start working on gentlemotion because remember this
(14:08):
muscle so massive and so strong in many of the players and
patients that we take care of. You know, no offense, but the
little old ladies are not popping their pecks, right?
The guy I just saw today that hedefects his PEC tear.
He's 280 lbs and he moves stones, right?
Like this is not, this is not something that these people are
not weaklings that are hearing something.
(14:30):
So there's a few massive musclesand massive strength you need
here, right? They're bodybuilders, they're
high level weight lifters. They're football players.
They're very high intensity laborers, right?
This is or there are massive injuries where they hit a tree
or something. So you're progressively letting
this muscle sort of scar down and then you start the motion,
usually four to six weeks. Then they start moving their arm
(14:52):
and strengthening. And really six months is that
sort of return to sport. Four to six months.
It depends on the athlete, depends on the on how they're
doing and what they have to get back to.
It also depends on the getting emotion back.
Sport, right? I mean, I would think for for
Grigor that has to swing his arm, right.
His, his tennis season is completely done.
He won't be back in time for U.S.
(15:13):
Open. The next time that he plays
maybe is on Australia, or if not, maybe waiting to Wimbledon.
But let's talk about what I think might happen to him.
Because if he doesn't get a perfect repair, that whip that
he does that in, we call that like that's the internal
rotation where you're like bellypressing and you're pushing in.
That's his pack. His pack allows him to whip it
(15:34):
around that fast. Does that make sense?
It's just rotator cuff. But really the PEC is what's
pulling on it. And it as it as it fires, it's
yeah, it's like basically launching that arm forward.
So the concern we have here, right.
Is he going to be the same in terms of his his serve speed?
He's probably going to have a lot of. 34 years old, Doctor, I
(15:55):
just want to add that as you're speaking.
No. And I think that's important.
And I think, you know, modern medicine, we've talked about
this. I'm sure maybe the maybe they
added an internal brace to them,maybe they added some graft,
maybe they did all these fancy things and the recoveries are
quite good. I mean, usually we can get them
relatively symmetric. We can get really good results
with these and my patients tend to do quite well with this.
So it's not like it's something that's like, you know,
(16:16):
incredibly poor results and people don't do well, but it's
you, the data shows you will lose power, right?
You lose some bench press power no matter what talk show you
look at. This is not something we're like
the we've looked at this return report.
It's actually on one of these papers for Pectares and the the
bench press Max decreased on theinjured side, no matter how much
(16:37):
we try to do. So again, we know this are
papers, they're not perfect. It's an average.
So there's always someone that'sabove and there's always someone
that's below. So it's important to have that
in understanding of this. Now again, there are young
Pactares, the 20 fives, 30s, high level athletes like this.
(16:58):
They're a different animal than the 50 to 60 year old pactaire.
So it's just there is still a difference and their recoveries
are faster. But also some of these Pactaires
get really, really, really stiff, right?
Because you're not moving them and you're trying to get it up.
And my biggest thing turn is canhe get his motion back?
Because that's his sort of throwing, serving shoulder.
I mean, we talked about some baseball players, you stepping
(17:20):
up the shoulder in a baseball player, they're done.
Yeah, yeah, no, that and that's what I was going to ask.
So you know, when that injury looked, I mean, he finally sat
down right after he felt it the second time.
So I'm not sure what the damage was.
Obviously he tore it on the first time when he felt it and
then finished it off on the second one and then sat down,
(17:42):
grabbed himself. I mean, I'm assuming that in
that muscle area by the chest area, by the arm area, that's
extremely painful as well, right?
From a cough to a move to layingon your side, everything that
that's going along with it, let alone because, you know, on the
(18:03):
graph they were talking about, it was like 0 to 4 weeks.
We're just managing and we're managing pain well and.
He and he might start earlier, right?
Because I mean, there's no way JJ Watt was zero to four weeks
if he's that fast at 10 weeks. But I mean, the good news here
is there was Reese there, it's 2022.
There was a study by young GargiET all and 90% return to sport.
(18:25):
Now, again, they're not looking at professional tennis players
because it's not that common. But here's the caveat. 74%
return to pre engine performance.
So it's not 100%. And we know of players, Terrell
Suggs, one of them, he just was never the same afterwards.
Like not everybody comes back atfull motion.
But again, tennis serving made me a little bit less power
(18:49):
needed if he's got other musclesand he's that good.
But we also talked about this before that some of these
professional athletes, if they lose 5%, they're still elite,
right? Like if LeBron James has three
body parts out of four total limbs, he'd probably still be
equivalent to maybe some of the average players in the league,
right? So this just it's a different.
Animal 2 questions. I've seen this scar from the
(19:12):
injury in the past, it look quite big with in 2025.
Has that shrunken down or is it still something because of the
operation you're still dealing with that scar?
It just depends on the surgeon approach etcetera.
And obviously as we get better like I do, I do a fair number of
these. So my incision, this is my phone
(19:35):
right here. It's about half the size of my
iPhone. I'm sorry, I tried to see the
picture, but probably like my average size is like 5 to 6
centimeters. So it's not terribly big.
They're definitely, and we definitely move it over to make
it a little more cosmetic. It kind of depends on your
approach. You can't go much smaller than
that, especially on a big guy, right?
(19:55):
Like he's, the good news here isthis is going to be an easier
approach than doing JJ Watt, right?
Like imagine it's probably half the distance you got to go to
get it down there to the bone, right, 'cause he's not a very
big guy, he's skinnier. So this is going to be a pretty
straightforward situation and it's acute.
So, you know, you get in there, it's going to basically show
itself. You can be able to fix it.
I mean, it probably would take the surgeon under an hour to do
(20:17):
that, which is good. Obviously the the surgery is not
the big part, it's the recovery.But you know, this is a good
outcome. I mean, this is of some of the
the times we talked about this is a good outcome.
It's just uncommon, especially in most players.
I mean, we know JJY is a big deal.
We know Dante Hightower, we knowyou know Terrell Suggs, but it's
overall not a common thing. Like if you look up all the
(20:37):
number of athletes, there's a handful, it's under 12.
Silly question. Would this be a procedure that
you would possibly use kind of like that lavender effect to
treat it depending on that surgery or is that something
we're we're talking about applesand oranges at this point?
(20:59):
So the idea behind biologics is can you do like amniotic wraps
or anything else to get adhesions right?
Like because really anything we do, we want it to heal faster.
So like if I could get the tendon to heal to the muscle in
two weeks instead of 6, then I would start moving them and then
they'd go, they would as soon as, because the challenge here
(21:20):
is once you fix it, sometimes the patients take forever.
Like some of these patients are so tight because I don't want to
do a graft on them because a graft in my opinion, it's good,
but it's not as good as the tenant itself.
I put them so tight. They're like this when they
start. And then if they stretch out
over time, right? Some people like put them loose
enough because they're not able to do they're able.
They're they're fine. You don't need to stress about
(21:41):
it too much. But the ones that are super
tight, they take a while to get back.
But if I knew that they would behealed right faster with
biologics, like using some sort of putty, some sort of bone
marrow aspirator, amniotic thing, we could.
The problem you have too though,is you don't want to increase
the risk of infection. You start throwing on patches
and everything else. You don't want to cause it's
(22:01):
different in the knee because the knee is getting flow with
fluid. It's much lower risk.
But and also it's the challenge here is like the outcomes aren't
bad, right? Like there's not enough of them.
They're kind of rare. Like even high volume surges,
they do like 5510A year. Like I remember myself study
some guy like 26. I was like, that's incredible,
(22:23):
right? It's not that common unless you
cover the CrossFit Games or theyhad almost over 20 of them in
one event. Wow, wow well, you know, they're
they're they're moving so much weight and it's so fast.
You know that it's it's almost kind of like you tell people
when you're working at the gym, like slow down, take your time.
You're trying not to get injuredCrossFit Games you're you're
(22:43):
you're just moving heavyweight and you're trying to get through
it as fast I. Was just telling you that
surgeon was very busy. Yeah, very busy that day.
It's like we got another one. Geez.
Yeah. Listen, you know, we we hope for
the best, obviously, as being a tennis player with that type of
injury and his age is a little bit concerning.
I know he's a fan favorite. I know a lot of the tennis
(23:03):
players like him. Sinner was really disappointed.
This is the fifth major in a rowthat he has sustained an injury
that that made him pull out of the tournament, you know, for
various reasons. I think it was one, a couple of
them were leg injuries and groinand things like that.
So, you know, maybe the toll of the body with this sport is not
(23:26):
ideal, but he's a he's a great player.
He was phenomenal. And I thought he was going to
beat the number one player when I was watching him and he he he
had him right there until he suffered that injury.
So, you know, we wish him the best and hopefully you'll get a
chance to play and going into next year so.
We'll see, hopefully speed, speedy recovery.
All right. Any last thoughts?
(23:47):
I know you kind of teased it a little bit that you're going to
have a video coming out in about6 weeks, six weeks things so
we'll. Check it out.
We'll refer back to this episodeand hope you guys learned a
little bit more about this. It's a it's a really interesting
injury and listen, we, we alwayshave this sports.talk.com.
We get guest requests all the time.
We're getting them like jeez, like two a month now or more.
(24:10):
We get questions from the audience.
So let us know if you have any questions about this, we're
happy to answer them and always refer to our websites.
There's tons of information on this, more than you need to know
so. All right, say goodbye, Doctor
Garcia.
Welcome to Sports Talk Talk. I'm Will Sanchez, along with our
orthopedic surgeon and sports medicine specialist, Doctor
Grant Garcia. You you see how that just kind
of flows out of my mouth at thispoint.
Dude, you're getting better eachtime.
You are our specialist and top doctor.
But enough with the accolades because you don't need any more
(00:35):
hyped up. We've got a great show.
We have a topic that it's reallyconcerning, really interesting,
so I'm really looking forward todiscussing it.
But before we do all of that, we're talking about injuries.
That means that we need to talk about the Recovery Shop.
Let's give a shout out to Mike Band tell everybody why you love
the Recovery Shop. Well, big thanks to our
(00:56):
sponsors. They've been our sponsors for a
long time now, man. It's been at least a year or
more. No, we've been.
Yeah, I appreciate it. So any else?
So the idea is if you're a surgeon, you're taking care of
the injuries we're going to talkabout today, right?
These patients get a lot of swelling afterwards.
They ask for what else can I do?Right?
It's not just the standard medicines you can give them.
There's other options for them, supplements, nice machines, more
(01:19):
advanced recovery systems. And so we have those there at
the recovery shop. And as a surgeon, you can have
your own specified section, which is really pretty cool
because you know, patients can use it for non surgical
injuries, surgical injuries, whatever they want.
And all kind of comes in one package.
And the nice thing it's vetted by the surgeons.
You can vet. We own products with them on
things that are, you know, DME approved, etcetera.
(01:40):
So it's pretty awesome. So reach out to Mike B.
I've been super happy with it. I have patients all the time
calling me, even non patients asking, hey, can I get something
your patient got? I'm like yeah no problem, happy
to help so. The reason we wanted to do the
show was because of this injury.And I was watching the match
live and we're talking about Grigor Dimitrov's Wimbledon exit
(02:02):
as he was up two games or two sets to none on the number one
player on of the World Yonic Center, which eventually won
Wimbledon. And he was cruising along and
I'm watching it and I'm like, man, he is, he's going to beat
this. I think he was.
I think they would tie 22 in thethird set and playing so well.
(02:25):
It was absolutely incredible. And then you see a serve and he
kind of grabs his PEC a little bit.
And then when he goes to serve again, which was an ace, he
collapses to the floor. First off, did you see the
injury live or did you just go back to the video, you know, as
(02:45):
we just decided to discuss exactly what had happened.
What's your your take on? So I didn't see it live,
probably working and who knows what I was doing.
But the but none the less that next day in the operating room,
my tech was coming up to me and my PA was like, hey man, did you
see what happened? It was crazy.
It's really unusual for tennis. And again, we hear about it in
(03:07):
some of the football players, right?
But to see it, you know, happen on real time and a tennis player
is very unusual. Yeah, there's.
There if you're watching on YouTube, he is reaching for that
right PEC. And when I first saw it, I
thought it was just some kind oflike, yeah, maybe a muscle
(03:28):
injury, a pull. You know, they're they're
they're swinging so hard, right?You look at 135 miles an hour,
118, you know, return serves at,you know, 87 mph every swing,
forehand, backhand, just, you know, it's, it's at the highest
level, right? We're talking about the best
(03:48):
athletes in the world. Why don't we talk a little bit
about what this injury is and how it will affect Grigor going
forward? Yeah.
So why don't you put the slide? You want to put that slide, that
one perfect. Yeah, pull that slide up.
So he had a PEC tenantear and I know we put down word partials
(04:08):
because you know, they're not always fully torn off, but you
have a lot of issues with the lower part of the PEC you can
see right there. So there the PEC has 2 heads,
there's a cavicular head and a sternal head.
And sometimes you can get a partial tear.
And a lot of times the challengehere is it seems it's hard to
see exactly what type of tear they had.
But a lot of times it's from, you know, getting caught on a
tree. I've had caught on a tree.
(04:29):
You've had wrestlers, you have bodybuilders, you have football
players, a lot less common in throwing sports and tennis.
So this is actually one of the first professional athletes I've
seen with the PEC tear that was a tennis player.
So it's quite unusual, but that massive force caulking back and
basically what that tendon does is it gives you that nice
contour we all know about, you know, pecks and the PEC flex,
(04:51):
but it usually pops off of wherethe humerus is.
So there's a little tendon. The misnomer, though, is that
it's a PEC tendon tear, because usually the tendon is so thin
and the tendon's so short that you pretty much never have
tendon left on it. It's very unusual.
It's usually something we call aMyo tendonous junction tear,
where it tears where the muscle and the tendon connect together.
(05:12):
What's interesting though is youguys see on the picture there on
the top right, that's the muscle.
But underneath that is somethingcalled a fascia.
So you've probably seen like when you're cutting meat, you
have got that thin white stuff in between that's kind of hard
and tough. When you're cutting the steak,
that's exactly what that is. So that fascia, if that gets
ripped off, it's a lot harder tofix.
But that's the ones we want to have get the get the fascia on
(05:32):
there, plus the tendon and that PEC.
But it's such a big muscle, it balls up and you can really see
a lot of deformity. So he was clutching the area
that he tore it on. The problem is sometimes it
depends on what type of tear youhave.
Now, his was something, you know, we had surgery, likely
successful. Obviously the tear that was
repairable. Sometimes though, you can tear
it in the middle of the muscle and those are not fixable, but
(05:53):
it's a different look. So it's a little bit tricky
because these are kind of hard to see on MRI.
Like no matter how much people say they look at these Mr. is,
they know exactly what they're looking at.
These Mr. is are a little challenging to read compared to
my, you know, rotator cuff tears, shoulder dislocations,
Acls, you name it. They can be more challenging and
obviously this is a time dependent thing which we can get
into in a second. Yeah, yeah.
(06:17):
So I want to go back to what yousaid.
You said if it's in the middle, it's unrepairable.
Why? Can you explain that?
Because, you know, that was the key that you mentioned there.
Yeah. So it can attach to the humerus,
which is around the biceps area,and that's where there's tendon
attached. It attached it to the chest wall
on the inside, right. That's when people have their
(06:37):
pecs that you can see it flexes all the way to the middle of
their sternum. And so the tears off there, the
good news about those, they usually heal a lot faster and
they usually get the contour back.
The problem is if they tear the other one, that's where the
power comes from with this muscle because the muscles so
big like this and then it weavesdown into some tiny little bit
of a tendon and the muscle attachment.
So that's usually the weaker point.
(06:58):
And that's the, the the way it happens is usually the last four
to five inches of the bench press.
That's almost always where it happens or an abrupt check or
from what he had is that tennis serve.
But these lineman that I've gotten, you know, we talked
about JJ Watt shortly, but they get caught and then it pulls
back and it pops a tendon. The challenging part here is
that, you know, if you don't do a lot of these, I've been in
(07:21):
surgeries before when even in training with some good guys
that they were, it was challenging effects sometimes
because it gets really distortedin there.
It's not the same as like a biceps tendon where it pulls
off. You can see the muscle.
The, the muscle is like a three-dimensional.
It's like a, it's like a circle and it, it folds on itself.
So you have to understand the anatomy a little more when you
(07:42):
fix these. Plus it's such a powerful muscle
and the time is dependent, right?
Like we can fix bicep tendon tears of three months, but you
get past six weeks, 5 weeks, youhave to reconstruct this, which
is a big problem, right? Like it's not, they just don't
do as well. If you have to reconstruct it,
they, they have good results, but it's just not the same as if
(08:02):
we have a fresh PEC tendon repair back to the bone, right?
Anything's always better when it's your own natural anatomy.
Yeah. If you're watching, I, I put
some of the examples between thesurgical repair and the non
operative for, for partial tearsa low demand.
If you could just explain both options when it becomes a non
(08:25):
operative and how you make that decision compared to the
surgical repair, which may seem obvious, but still I would like
for your input on that. Yeah.
So the word personal tear is kind of a misdemer, right?
Like a partial tear Here he partially, he didn't tear off
both heads, so usually still have the sternal head.
So he pulls off the sternal headand then he keeps the clavicular
head. And then The thing is that
(08:46):
basically that's a partial tear,but all the contour and muscle
strength is gone. Does that make sense?
So that still needs to be fixed.Now someone really low demand,
like, you know, maybe 80s, maybe70s, they don't really need to
do a lot. Yeah, it's a big surgery because
you're pulling that all muscle back.
You've got to make a big incision in the shoulder and
pull back you wouldn't do it for.
But even up to 60s, I've had weight lifters, bodybuilders in
(09:08):
their 60s that I've done it on and they've done quite well.
It kind of depends on the patient.
It's exactly the same thing. It's a custom approach.
But let's say you have that, it pulls off, then you want to fix
it. Usually we try to do in the
first six weeks. But I'll be honest with you, I
have a guy who's actually, thankfully doing well.
He was like 70 weeks out. I thought it was going to be
super straightforward. I went into the PEC tendon.
I tried to pull it back and the tendon was about 4 centimeters
(09:29):
too short. So look at this.
That's a lot, right? You got to fill that with
something or you leave them, right?
But this is a guy that he's 40 years old and he has he can't
get his, he can't pull his arm in like this total contour loss.
So I remade it with a cut Aber tendon and that that's a pretty.
Effective aber and scutures and things like that are just trying
to at that point you're connecting.
(09:50):
Yeah, well, we'll see that. The audience will see shortly.
In about six weeks, we're going to post the technique and how I
did it. But the idea is that you
basically take this Achilles tendon.
Achilles is from the lower part of your ankle.
You fan it out and then you weave it into the muscle, which
is pretty sick, and then you allsew it in.
There's some, there's a little bit of techniques, but on this
one you're going to love it because I added an internal
(10:11):
brace, which has not been out published yet.
So that is a pretty cool con. I knew it, I knew it.
So the cool part about this is it's amazing.
He came back in eight weeks and he looked like JJ woah, not the
same size, but the same outcome.I mean, literally killing it.
So I wonder if that had some level to do with it.
But the idea is that basically now we're using these, as long
(10:33):
as we can fix the brace from oneside to the other side, we're
adding these fiber tapes, internal braces to patients.
So I'm finding any ways I can doit.
So you know, they got the graft,they have the graft tendon
interface and now they also intothe bone have this internal
brace. You brought up JJ Watt and I
remember when he tore his pack and, you know, over here it says
(10:55):
that, you know, supposed to be out four to six months, but he
was back in 10 weeks. And for the football fans, they
remember he wore that big, bulkyblack, you know, restraint on
his arm that went all the way down.
And he pretty much, I think he played with it for the rest of
his career. I think at that point, he kind
(11:15):
of kept that on. So let let's talk.
It's twofold the question. One, what did they do for him to
get back so fast? And then two and two, why?
Why should he, you know, especially playing football,
keep that protected for the restof his career?
Is it something that that point it would have been vulnerable
(11:36):
due to age, sport or maybe the procedure itself in order for
him to get back fast? So let me make the caveat that
you have now hosed me for any ofmy PEC tendon repair patients
because I used to think that notas many people were listening to
this, but I've had multiple patients ask me.
They're, like you said on your podcast, that this is the way it
is. So just so everybody hears,
(11:58):
there's a disclaimer here. This is JJ Watt, a professional
athlete with millions of dollarson the line in the playoffs,
right? This is a different level.
If he had torn it like his otherWhitney Marcellus, who was also
on the team, if he had torn it at the end of the season, they
would have taken him out for theentire recovery period, right?
(12:19):
So that's that's the first. Yeah.
I'm sure they did some crazy stuff during his surgery.
I'm sure they repaired it. And I used to work with some of
the guys that did a lot of the football players and whatever
they did, they might have added something addition.
So if they got an acute repair, which is what they did, I mean
for, for, for Gregor, they got to them so quickly, like, you
(12:40):
know, my average time to see these is 3 to 4 weeks, just
because you got to wait to see the doctor and get an MRI and
everything else. But if you're on the field and
they tear, they can fix it rightaway.
You can get a really good fixation right away.
But I bet you with him, they added something else too, right?
Did they add a patch? Did they add some extra stuff in
there that, you know, not alwaysthe best case scenario, but in
this case helps him back it up. But at the same point, you know,
(13:03):
if he's not, I mean, grappling is good, but if he's got this
solid restraint, he's really notusing his arm.
He just needs to use it as like a peg.
Right. So when I let him play, I can't
say that I feel comfortable enough to let my A player play
at 10 weeks after a massive injury like this, but again, I
am. Defensive Player of the year
(13:24):
also as they're making a run allthis money like we we've talked
about. We don't know what the contract
was though either. So the answer is that that's
really impressive. We know they continue to prove
it, right. We've always said like some of
these players get back faster, but the part of it that's
important people to understand is that the average time for
this is like a six month recovery, right?
(13:46):
The average time is 6 month recovery.
That is what you should expect if you're getting this surgery.
He is an outstanding one. Now, I know there's been other
players that have been in like the 10:50 week recovery, but you
need to understand again that this is there's different
constraints on the line here. So this is what's pointing part.
You got this sort of immobilization phase four weeks,
then you start working on gentlemotion because remember this
(14:08):
muscle so massive and so strong in many of the players and
patients that we take care of. You know, no offense, but the
little old ladies are not popping their pecks, right?
The guy I just saw today that hedefects his PEC tear.
He's 280 lbs and he moves stones, right?
Like this is not, this is not something that these people are
not weaklings that are hearing something.
(14:30):
So there's a few massive musclesand massive strength you need
here, right? They're bodybuilders, they're
high level weight lifters. They're football players.
They're very high intensity laborers, right?
This is or there are massive injuries where they hit a tree
or something. So you're progressively letting
this muscle sort of scar down and then you start the motion,
usually four to six weeks. Then they start moving their arm
(14:52):
and strengthening. And really six months is that
sort of return to sport. Four to six months.
It depends on the athlete, depends on the on how they're
doing and what they have to get back to.
It also depends on the getting emotion back.
Sport, right? I mean, I would think for for
Grigor that has to swing his arm, right.
His, his tennis season is completely done.
He won't be back in time for U.S.
(15:13):
Open. The next time that he plays
maybe is on Australia, or if not, maybe waiting to Wimbledon.
But let's talk about what I think might happen to him.
Because if he doesn't get a perfect repair, that whip that
he does that in, we call that like that's the internal
rotation where you're like bellypressing and you're pushing in.
That's his pack. His pack allows him to whip it
(15:34):
around that fast. Does that make sense?
It's just rotator cuff. But really the PEC is what's
pulling on it. And it as it as it fires, it's
yeah, it's like basically launching that arm forward.
So the concern we have here, right.
Is he going to be the same in terms of his his serve speed?
He's probably going to have a lot of. 34 years old, Doctor, I
(15:55):
just want to add that as you're speaking.
No. And I think that's important.
And I think, you know, modern medicine, we've talked about
this. I'm sure maybe the maybe they
added an internal brace to them,maybe they added some graft,
maybe they did all these fancy things and the recoveries are
quite good. I mean, usually we can get them
relatively symmetric. We can get really good results
with these and my patients tend to do quite well with this.
So it's not like it's something that's like, you know,
(16:16):
incredibly poor results and people don't do well, but it's
you, the data shows you will lose power, right?
You lose some bench press power no matter what talk show you
look at. This is not something we're like
the we've looked at this return report.
It's actually on one of these papers for Pectares and the the
bench press Max decreased on theinjured side, no matter how much
(16:37):
we try to do. So again, we know this are
papers, they're not perfect. It's an average.
So there's always someone that'sabove and there's always someone
that's below. So it's important to have that
in understanding of this. Now again, there are young
Pactares, the 20 fives, 30s, high level athletes like this.
(16:58):
They're a different animal than the 50 to 60 year old pactaire.
So it's just there is still a difference and their recoveries
are faster. But also some of these Pactaires
get really, really, really stiff, right?
Because you're not moving them and you're trying to get it up.
And my biggest thing turn is canhe get his motion back?
Because that's his sort of throwing, serving shoulder.
I mean, we talked about some baseball players, you stepping
(17:20):
up the shoulder in a baseball player, they're done.
Yeah, yeah, no, that and that's what I was going to ask.
So you know, when that injury looked, I mean, he finally sat
down right after he felt it the second time.
So I'm not sure what the damage was.
Obviously he tore it on the first time when he felt it and
then finished it off on the second one and then sat down,
(17:42):
grabbed himself. I mean, I'm assuming that in
that muscle area by the chest area, by the arm area, that's
extremely painful as well, right?
From a cough to a move to layingon your side, everything that
that's going along with it, let alone because, you know, on the
(18:03):
graph they were talking about, it was like 0 to 4 weeks.
We're just managing and we're managing pain well and.
He and he might start earlier, right?
Because I mean, there's no way JJ Watt was zero to four weeks
if he's that fast at 10 weeks. But I mean, the good news here
is there was Reese there, it's 2022.
There was a study by young GargiET all and 90% return to sport.
(18:25):
Now, again, they're not looking at professional tennis players
because it's not that common. But here's the caveat. 74%
return to pre engine performance.
So it's not 100%. And we know of players, Terrell
Suggs, one of them, he just was never the same afterwards.
Like not everybody comes back atfull motion.
But again, tennis serving made me a little bit less power
(18:49):
needed if he's got other musclesand he's that good.
But we also talked about this before that some of these
professional athletes, if they lose 5%, they're still elite,
right? Like if LeBron James has three
body parts out of four total limbs, he'd probably still be
equivalent to maybe some of the average players in the league,
right? So this just it's a different.
Animal 2 questions. I've seen this scar from the
(19:12):
injury in the past, it look quite big with in 2025.
Has that shrunken down or is it still something because of the
operation you're still dealing with that scar?
It just depends on the surgeon approach etcetera.
And obviously as we get better like I do, I do a fair number of
these. So my incision, this is my phone
(19:35):
right here. It's about half the size of my
iPhone. I'm sorry, I tried to see the
picture, but probably like my average size is like 5 to 6
centimeters. So it's not terribly big.
They're definitely, and we definitely move it over to make
it a little more cosmetic. It kind of depends on your
approach. You can't go much smaller than
that, especially on a big guy, right?
(19:55):
Like he's, the good news here isthis is going to be an easier
approach than doing JJ Watt, right?
Like imagine it's probably half the distance you got to go to
get it down there to the bone, right, 'cause he's not a very
big guy, he's skinnier. So this is going to be a pretty
straightforward situation and it's acute.
So, you know, you get in there, it's going to basically show
itself. You can be able to fix it.
I mean, it probably would take the surgeon under an hour to do
(20:17):
that, which is good. Obviously the the surgery is not
the big part, it's the recovery.But you know, this is a good
outcome. I mean, this is of some of the
the times we talked about this is a good outcome.
It's just uncommon, especially in most players.
I mean, we know JJY is a big deal.
We know Dante Hightower, we knowyou know Terrell Suggs, but it's
overall not a common thing. Like if you look up all the
(20:37):
number of athletes, there's a handful, it's under 12.
Silly question. Would this be a procedure that
you would possibly use kind of like that lavender effect to
treat it depending on that surgery or is that something
we're we're talking about applesand oranges at this point?
(20:59):
So the idea behind biologics is can you do like amniotic wraps
or anything else to get adhesions right?
Like because really anything we do, we want it to heal faster.
So like if I could get the tendon to heal to the muscle in
two weeks instead of 6, then I would start moving them and then
they'd go, they would as soon as, because the challenge here
(21:20):
is once you fix it, sometimes the patients take forever.
Like some of these patients are so tight because I don't want to
do a graft on them because a graft in my opinion, it's good,
but it's not as good as the tenant itself.
I put them so tight. They're like this when they
start. And then if they stretch out
over time, right? Some people like put them loose
enough because they're not able to do they're able.
They're they're fine. You don't need to stress about
(21:41):
it too much. But the ones that are super
tight, they take a while to get back.
But if I knew that they would behealed right faster with
biologics, like using some sort of putty, some sort of bone
marrow aspirator, amniotic thing, we could.
The problem you have too though,is you don't want to increase
the risk of infection. You start throwing on patches
and everything else. You don't want to cause it's
(22:01):
different in the knee because the knee is getting flow with
fluid. It's much lower risk.
But and also it's the challenge here is like the outcomes aren't
bad, right? Like there's not enough of them.
They're kind of rare. Like even high volume surges,
they do like 5510A year. Like I remember myself study
some guy like 26. I was like, that's incredible,
(22:23):
right? It's not that common unless you
cover the CrossFit Games or theyhad almost over 20 of them in
one event. Wow, wow well, you know, they're
they're they're moving so much weight and it's so fast.
You know that it's it's almost kind of like you tell people
when you're working at the gym, like slow down, take your time.
You're trying not to get injuredCrossFit Games you're you're
(22:43):
you're just moving heavyweight and you're trying to get through
it as fast I. Was just telling you that
surgeon was very busy. Yeah, very busy that day.
It's like we got another one. Geez.
Yeah. Listen, you know, we we hope for
the best, obviously, as being a tennis player with that type of
injury and his age is a little bit concerning.
I know he's a fan favorite. I know a lot of the tennis
(23:03):
players like him. Sinner was really disappointed.
This is the fifth major in a rowthat he has sustained an injury
that that made him pull out of the tournament, you know, for
various reasons. I think it was one, a couple of
them were leg injuries and groinand things like that.
So, you know, maybe the toll of the body with this sport is not
(23:26):
ideal, but he's a he's a great player.
He was phenomenal. And I thought he was going to
beat the number one player when I was watching him and he he he
had him right there until he suffered that injury.
So, you know, we wish him the best and hopefully you'll get a
chance to play and going into next year so.
We'll see, hopefully speed, speedy recovery.
All right. Any last thoughts?
(23:47):
I know you kind of teased it a little bit that you're going to
have a video coming out in about6 weeks, six weeks things so
we'll. Check it out.
We'll refer back to this episodeand hope you guys learned a
little bit more about this. It's a it's a really interesting
injury and listen, we, we alwayshave this sports.talk.com.
We get guest requests all the time.
We're getting them like jeez, like two a month now or more.
(24:10):
We get questions from the audience.
So let us know if you have any questions about this, we're
happy to answer them and always refer to our websites.
There's tons of information on this, more than you need to know
so. All right, say goodbye, Doctor
Garcia.
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