Intercostal Muscle Strain

What Is Intercostal Muscle Strain?

Intercostal muscle strain (also called intercostal neuralgia) is a condition that inflames the intercostal muscles found in the chest cavity. The intercostal muscles run between the ribs joining them together and stabilizing the chest. 1

Intercostal Muscle Strain Picture 1

The major function of intercostal muscles is to facilitate the inspiration and expiration motions of breathing by allowing the up and down movement of the chest muscles. Intercostal muscles can be categorized into internal, external, subcostal and transverse. Broadly there are eleven pairs of intercostal muscles on each side of the chest.

Intercostal muscles are thinner than other muscles and therefore more prone to injury and strain. There are three grades of typical muscle strain that are also used to categorize strain in the intercostal muscles:

  • Grade one strain is mild and features only a few damaged muscle fibers and if treated before exacerbation can heal in a maximum of three weeks.
  • Grade two strain is moderate and involves more extensive damage to muscle fibers and usually heals in three to six weeks.
  • Grade three strain is severe due to the complete rapture of a muscle that usually has to be surgically repaired and usually takes around three months to heal.


Intercostal muscles can be stretched beyond their limits by some of the activities listed below:

  • Trauma or a forceful blow to the chest wall can strain the ribs and hence the intercostal muscles. Such an injury can be sustained through automobile accidents, sports injury, physical assault etc.
  • Sudden or extreme twisting of the upper body for example when wrestling, dancing, doing yoga or turning suddenly one can overstretch the intercostal muscles and put pressure on the ribcage.
  • Forceful arm swinging as in baseball or tennis stretches the ribs in the direction of the swinging arm hence straining or even tearing the intercostal muscle depending on the force applied.
  • Lack of proper warm up before exercising or starting sports training.
  • Inefficient body mechanics and training techniques.
  • People who have suffered lower back injury are more prone to intercostal muscle strain if they didn’t heal properly.
  • Poor posture and joint stiffness in the upper or lower back can also gradually lead to weakening of the muscles.


Symptoms of intercostal muscle strain differ in intensity depending on the degree of injury one has sustained. They include:

  • An intense sharp shooting pain is felt in the rib muscles; the pain increases during coughing, sneezing or sudden movement. If the strain is not severe the pain may go away by itself in a few days.
  • Tenderness and pain just over the ribs when pushed or touched. Painful bruising may or may not be visible.
  • Difficulty turning over or getting up or down from a chair. One may also be unable to wear clothing that is tight around the chest area.
  • Swelling occurs in the affected area. Sometimes the swelling may be filled with blood (hematoma).
  • Muscles feel tight especially in the area around the injury. Muscle tightness can restrict movement of the arms and chest due to the pain that further strain causes.
  • Difficulty breathing due to swelling and tightness of intercostal muscles that causes pain when breathing. Intercostal muscle strain causes shallow breaths as one attempts to breath without pain.
  • Muscle spasms or weakness in the chest cavity usually exhibited by inability to take deep breaths.


When one goes to the hospital suffering symptoms akin to those of intercostal muscular strain, the doctor carries out the following tests to rule out any other injuries:

  • A physical examination
  • Imaging tests such as X-ray and MRI.
  • Ultrasound.

Treatment of Intercostal Muscle Strain3,4

When treating intercostal muscle strains, doctors aim at relieving pain, speeding up healing and prevent the recurrence of a similar injury. Therapy combined with medicine is the most effective way to treat intercostal muscle strain.

  • Anti-inflammatory and non steroidal medication can be prescribed to ease the pain e.g. Advil or ibuprofen.
  • Muscle relaxants like Robaxine can be prescribed to ease the swelling and tightness in the intercostal muscles hence alleviating other symptoms like pain.
  • Joint mobilization and manipulation are forms of therapy that restore the normal functions of the intercostal muscles and relax the muscles thereby reducing the strain.
  • Acupuncture is known to reduce muscle stiffness and can be applied effectively to intercostal muscle strain. Acupuncture also reduces pain.
  • For severe cases doctors perform an intercostal nerve block (INB) guidance of X-rays to inject anesthesia and corticosteroid in the affected area hence relieving pain and inflammation.

Home Remedies

  • Wrap your chest in ace wraps making sure to compress the ribs just enough so that breathing is not interfered with.
  • Hot and cold packs can alternatively be applied to the chest to ease the inflammation. For the first day begin with an ice pack before beginning to alternate with heating pads severally in a day. Ice packs reduce swelling and inflammation while heat pads promote healing by increasing blood flow to the affected area.
  • Regulate your breathing to minimize pain and further damage to the intercostal muscles by breathing slowly and holding the breath then breathing out slowly.
  • Mild exercise e.g. foam roller stretches and rotation in lying exercise the intercostal muscles without straining them and can ease the symptoms suffered,
  • Soak in Epsom salts that are known to relieve muscle pain. Add one and a half cups of Epsom salts to your hot water bath and soak in it until the water cools.
  • Rest – it is vital not to overwork intercostal muscles that are already strained. Minimizing mobility and refraining from the activity suspected to have caused the intercostal muscle strain is a way to accelerate healing.


Intercostal muscular strain can be prevented by adhering to the following simple guidelines:

  • Maintain a good posture and exercise regularly to keep your muscles healthy.
  • Avoid sudden twisting of your upper torso e.g. when looking behind and instead turn the whole body or adapt gradual movements that won’t overexert your intercostal muscles.
  • Athletes should take caution to warm up properly before beginning exercise and to use the proper techniques in the respective sport.
  • Allow any previous injuries sustained particularly to the upper or lower back enough time to heal properly.

Reference List

  1. Intercostal Muscle Strain. Retrieved from Body Motion –
  2. Intercostal Muscle Strain: Causes, Symptoms and Recovery. Retrieved from New Health Advisor –
  3. Intercostal Muscle Strain. Retrieved from MDDK Online Medical Doctor –
  4. Intercostal Muscle Sprain: Causes, Symptoms, Diagnosis, Treatment, Conservative Medications. Retrieved from ePainAssist –

One comment

  1. I have had intercostal neuralgia off and on for 20 years, and in the last 6 years it has got slowly worse, and I also have degenerative discs in my lower spine. I’m taking Tramadol for the back pain, and Gabapentin for the pain in my ribs, but the Gabapentin isn’t really doing any good, and the side effects are not nice. The neuralgia pain is making my life miserable, and it’s ruling my life.

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