What is an intercostal strain?

Your intercostal muscles lie between your ribs, attaching them to one another. They help stabilize your upper body and help you breathe. There are three layers of intercostal muscles: the external intercostals, the internal intercostals, and the innermost intercostals.

A strain is when a muscle stretches, pulls, or is partially torn. A strain of any of the layers of the intercostal muscles can cause pain and difficulty breathing.

Muscle strains are a common cause of chest pain. From 21 to 49 percent of all musculoskeletal chest pain comes from the intercostal muscles.

You can strain or pull your intercostal muscles in many different ways. These muscles are usually hurt during some twisting motion. Pain can start either from a sudden injury, or it can begin gradually from repetitive motions.

Activities that may cause you to strain these rib muscles include:

  • reaching, like when painting a ceiling
  • lifting while twisting
  • chopping wood
  • coughing or sneezing
  • participating in sports like rowing, golf, tennis, or baseball
  • falling
  • being hit in the ribcage, like in a car accident or during contact sports

Tips for identification

Symptoms of intercostal muscle strain include:

  • Pain: You may feel a sharp pain at the time of injury, or it may come on more gradually. The pain will get worse when you twist, stretch, breathe in deeply, cough, or sneeze.
  • Tenderness: The area of the strain between your ribs will be sore to the touch.
  • Difficulty breathing: Because it’s so painful to breathe, you may find yourself taking small, shallow sips of air. This can leave you short of breath.
  • Swelling: A partially torn or strained muscle will become inflamed. You may see some swelling between and around the affected ribs.
  • Muscle tightness: The injured muscles may feel tight when you breathe, reach, or twist.

These symptoms can be similar to those of more serious problems, so schedule an appointment with your doctor. They can assess your symptoms and determine the underlying cause.

How to cope until your doctor’s appointment

If you think you’ve injured the muscles between your ribs, make an appointment with your doctor. They can identify which muscle has been strained, and make sure you haven’t injured some other structure in your chest.

Your doctor will give you a complete treatment plan, but in the meantime, avoid twisting and reaching activities that make the pain worse. You can also try these methods for relief:

Over-the-counter pain killers

While you wait to see your doctor, you can take over-the-counter anti-inflammatories like ibuprofen (Advil) or naproxen (Aleve), or simple pain relievers like acetaminophen (Tylenol). Follow the package directions for how much and how often to take these medicines.

You should also be sure that you’re not overmedicating by taking several products that contain pain relievers, including medicines for colds or menstrual cramps. Consult with your doctor before taking over-the-counter medication together with your normal medication.

Hot and cold therapy

Cold therapy can help ease your pain and reduce inflammation of the muscle. Apply a cold pack to the injured area for 20 minutes at a time, several times a day for the first two days. You can use an ice bag, a gel cold pack, a plastic bag filled with ice and wrapped in a towel, or even a bag of frozen veggies.

After the first 48 hours, you may want to start using heat on the injured ribs. Heat can help loosen and relax the muscles so you can do your physical therapy. You can apply heat for 20 minutes at a time with a heating pad or a warm damp towel.

Epsom salt soaks

As part of your heat therapy, you may want to take a warm bath with magnesium sulfate (Epsom salts) added. You can find Epsom salts at your local drug store or online at Amazon.com. Simply add about 2 cups to your bath, and soak for 15 or more minutes.

The dissolved minerals absorb through your skin and may slightly increase your blood levels of magnesium. Magnesium is an important mineral for muscle function. Although the small amount of magnesium absorbed from your bath is unlikely to actually do anything to help your strained muscles, the hot bath can help you relax.

Breathing exercises

Breathing with an intercostal muscle strain is painful. But taking only shallow breaths —instead of full, deep breaths — can lead to infection and pneumonia. Deep breathing exercises can also be a form of meditation to reduce stress.

Try to do a few minutes of breathing exercises every hour. For example:

  1. Hold a pillow against your injured muscles.
  2. Breathe in slowly and as deeply as you can.
  3. Hold the breath for a few seconds.
  4. Breathe out slowly.
  5. Repeat 10 times.

Once you see your doctor, they may send you home with a spirometer, a plastic tool that gives you a visual clue to how deeply you should breathe.

How it’s diagnosed

Your doctor will diagnose your intercostal muscle strain by asking you some questions and doing a physical exam. They’ll want to know if you remember falling or twisting when the pain began. They’ll ask about any sports you play. They’ll touch the tender area and test your range of motion and pain level during motion.

Your doctor may order a chest X-ray to make sure your lungs weren’t bruised or punctured when you were injured.

Grading

Muscle strains are graded according to their severity.

  • Grade 1: Mild strain with less than 5 percent of muscle fibers damaged, causing minimal loss of motion. These injuries take two to three weeks to improve.
  • Grade 2: More extensive damage of muscle fibers, but the muscle isn’t completely ruptured. You’ll have significant loss of motion and may need two to three months to heal.
  • Grade 3: Complete rupture of the muscle. These injuries may require surgery.

What about physical therapy?

Along with rest, ice, heat, and breathing therapy, physical therapy may ease your discomfort and speed your healing. Your doctor may refer you to a physical therapist after making a diagnosis.

A physical therapist can give you tips for sleeping — like trying a recliner so your chest is elevated — and for loosening up in the morning. Following a physical therapy program can help you get back to your usual activities sooner.

What’s the outlook?

Intercostal muscle strains can take a long time to heal, which may be frustrating. If your strain is especially stubborn, your doctor may inject the area with lidocaine and corticosteroids to reduce pain and swelling.

Intercostal muscle strains are sometimes accompanied by a rib stress fracture. But even if you do have a stress fracture, your treatment probably won’t change. Follow your therapy regimen, do your breathing exercises, and you’ll be feeling like yourself again and back on the playing field soon.

To prevent future muscle strains, be sure to warm up well before sports or exercise, and don’t overdo activities that your body isn’t used to doing.

Healthline and our partners may receive a portion of revenues if you make a purchase using a link above.