Intercostal Muscle Strain: Causes and Treatment

Intercostal muscle strain is a common injury that affects many people, especially athletes, musicians, and those who perform repetitive motions. The intercostal muscles are located between the ribs, and they play a crucial role in breathing.

When these muscles become strained, it can cause immense discomfort and pain, making it difficult to perform even simple tasks. Intercostal muscle strain can occur due to various reasons, such as sudden twisting or bending, overuse, or even coughing or sneezing.

If left untreated, it can lead to more severe complications, such as respiratory problems. That’s why it’s essential to be aware of the symptoms and seek prompt medical attention. In this article, we’ll discuss the causes, symptoms, and treatment options for intercostal muscle strain, so you can be better equipped to deal with this common injury.

What are Intercostal muscle strains?

The intercostal muscles are composed of many groups: internal intercostal muscles, external intercostals, subcostal muscles, and transverse thoracic muscles. These muscles are located between the ribs.

Intercostal muscle strains occur when the muscles between the ribs are stretched or torn. These muscles help with breathing and are important for everyday activities such as laughing and coughing.

Symptoms of an intercostal muscle strain can include sharp pain when taking a deep breath, pain in the chest or back when laughing or coughing, and difficulty fully expanding the chest when taking a deep breath.

When the strain is mild or moderate, intercostal muscles commonly recover for 4 to 6 weeks with proper physiotherapy. However, severe intercostal muscle strain will require a longer period before it recovers fully.

Intercostal muscle strains have three gradings:

  • Grade I Strain – A mild strain damages some muscle fibers. This usually heals within 2 to 3 weeks.
  • Grade II Strain – A moderate muscle strain extensively damages the muscle fibers. The muscle in grade II strain is not fully ruptured and can heal within 3 to 6 weeks.
  • Grade III Strain – This severe injury occurs when the muscle is wholly damaged or ruptured. It usually requires a surgical repair. Grade III strain can heal up to 3 months.
Intercostal Muscle Strain
Intercostal Muscle Strain

Symptoms of Intercostal Muscle Strain

The typical symptom of intercostal muscle strain is a pain in the side of the chest area, usually in the lower ribs. The sudden stabbing pain is described as sharp, accompanied by a pulling sensation. There are cases that the pain is experienced gradually.

In mild cases, the affected person can continue with the day-to-day tasks as the pain is still bearable. However, the symptoms may get worse.

In severe cases, the affected person and athletes must stop performing their activities for enough time until the muscle has completely recovered.

The symptoms of intercostal muscle strain may include:


  • Sharp and stabbing pain
  • Tenderness when touching the ribs area
  • Constant and severe pain
  • Sudden tearing pain
  • Intensifies when moving, twisting, sneezing, or coughing

Swelling and Tenderness

  • Injured parts are swollen
  • The swollen area is filled with blood (Hematoma)
  • Swollen ribs
  • Tenderness over the ribs
  • Bruising
  • Painful to get up or down from a chair
  • Pain when turning over in bed

Muscle Tightness

  • The muscles in the chest wall feel tight
  • Difficulty moving the chest area as well as the arms
  • Severe tightness in the injured area

An individual may also experience shortness of breath as the muscles feel too tight to let air in. Breathing becomes shallow and painful.

Causes of Intercostal Muscle Strain

These are the most common causes of intercostal muscle strain.

1. Twisting the Upper Body

Sudden twisting of the upper body can strain the muscles. Overdoing it can also lead to intercostal muscle strain as it exerts too much pressure on the ribs.

Some activities involving twisting the upper body are dance moves, yoga postures, wrestling, and other sports. Turning around to check if someone or something is behind you can strain the intercostal muscles.

2. Improper Warm up Before Training or Exercising

Not all individuals warm up properly, which may lead to more harm than good. Not warming up properly can increase the chance of torn muscles, which can be very painful. It may also take months, up to a year, before it completely recovers.

It is essential to protect your muscles. While many believe securing the body parts can prevent a torn muscle, the only way to avoid it is by performing proper warm-ups.

3. Swinging the Arms with Force

Swinging the arms with extreme force can stretch the ribs towards the arms. This condition is worse than suddenly twisting the upper body. Excessive pressure can tear the muscles, which will take months up to a year to recover.

4. Direct Blow to the Chest Wall

A blow to the chest wall can also strain the intercostal muscles. This can occur while playing sports, in car accidents, fights, or injuries received while working. A strong direct impact on the chest area can also bruise the chest wall, ribs, and muscles (chest contusion).

5. Overstretching

Stretching the muscles excessively can strain or rupture the intercostal muscles. Even when pulling gently, you can strain the muscles in your rubs. When the intercostal nerves get trapped between the forces and ribs, it can lead to painful spasms, strain, and nerve pain.

Excessive training or repetitive movement can also strain the muscles.

6. Not Enough Time to Heal the Muscles

When the muscle fibers are damaged, it usually takes two to six weeks to heal. While the pain is still bearable, giving your muscles enough time for a full recovery is essential. Using the muscles for daily activities, exercises, or sports can worsen the symptoms and lead to a complete muscle rupture.

7. Poor posture

Poor posture can strain the intercostal muscles and may cause them to become weak over time. It can also lead to chest, neck, and back pain. Not correcting the posture increases your risk of Sciatica or Piriformis Syndrome, Shoulder Impingement, and knee pain.

Other causes of intercostal muscle strain are:

  • The presence of joint and muscle stiffness
  • Weakness and fatigue
  • Lower back injury

10 Natural Remedies for Intercostal Muscle Strain

Here are how to treat mild to moderate intercostal muscle strain.

1. Rest

After an injury, rest your muscles and do not perform intense physical activities. Give your muscles enough time to recover completely. Do not twist your torso to protect your muscles from further injury.

2. Hot and Cold

The cold temperature of ice can reduce pain and swelling. Apply an ice pack as soon as possible for ten to twenty minutes. Do not apply direct ice to the skin.

Once the swelling disappears, you can use a heat compress on the area. Repeat this treatment three or more times daily to alleviate the inflammation quickly.

3. Brace or Splint the Area

Wrap or compress the area to decrease the swelling. Do not wrap it tightly, and ensure you loosen the bandage if it is too tight. Do this treatment during the first couple of days.

4. Therapeutic Exercise

Gentle stretching can strengthen the muscles, such as side bends with a bit of rotation. Get moving when the pain subsides. Not moving your body and muscles can increase the risk of further complications, such as muscle wasting, deep vein thrombosis, and chest infections.

Therapeutic exercises can restore mobility, strengthen the muscles, and improve the range of motion. It can also decrease the pressure on the neck, discs, and spinal joints.

5. Deep Breathing

Breathing can be painful due to chest and rib pain. This may result in pneumonia and can delay the healing process of the muscles due to a lack of oxygen. You will need to take deep breathing exercises to prevent this from happening.

  • Slowly inhale and open the lungs as much as possible.
  • Hold your breath for a few seconds.
  • Exhale slowly.

Repeat these exercises once every hour to prevent pneumonia.

6. Pain Killers or Anti-inflammatory Drugs

Pain relievers can reduce inflammation and pain. One of the best is Paracetamol, which has minor side effects. Nonsteroidal Anti-inflammatory Drugs (NSAIDs) such as ibuprofen, aspirin, and naproxen are available over the counter.

Other NSAIDs for severe cases should be used only when prescribed by a doctor. Anti-inflammatories may delay healing during the first 2 to 3 days.

7. Physical Therapist

Help from a physical therapist can speed up the healing process of the muscles. They can also assist you in your exercises, providing soft tissue massage, joint mobilization, and gentle stretching to improve the spine’s range of motion, mobility, and alignment.

8. Neuromuscular Re-Education

This technique is used by therapists to restore an individual’s normal movements. With neuromuscular re-education, you can improve your posture and learn the proper sitting, sleeping, and body mechanics to protect the injured parts of the body.

9. Epsom Salt Bath

Epsom salt is effective in alleviating muscular strains. It is composed of magnesium sulfate, which is a natural muscle relaxant. It can also alleviate both pain and swelling.

  1. Add 2 cups of Epsom salt to your warm bathwater.
  2. Soak your body in the water for at least thirty minutes.
  3. Repeat this treatment once a day until the strained muscle is recovered completely.

10. Tart Cherry Juice

Tart cherries are packed with antioxidants that can alleviate the pain and swelling of the strained muscle. It also contains high amounts of anti-inflammatory content that can deal with aches. Drink tart cherry juice once daily to improve your strength and alleviate pain and soreness.

5 Best Exercises for Intercostal Muscle Strain

1. Isometric Chest Wall Squeezes

This exercise is designed to strengthen your intercostal muscles while decreasing strain. To perform this exercise, begin by lying on your back on a flat surface with your knees bent and your feet flat on the ground.

Place your hands on your sides near your ribcage, and press your hands into your ribs. Squeeze your chest wall muscles for five to 10 seconds, then slowly relax for another five to 10 seconds. Repeat this 10 to 15 times for one set.

2. Diaphragmatic Breathing

Diaphragmatic breathing is an important exercise for intercostal muscle strain. To perform this exercise, lie on your back with your knees bent and feet flat on the ground.

Place one hand on your abdomen and the other on your chest. Inhale slowly and deeply through your nose, allowing your abdomen to expand. As you exhale, contract your abdominal muscles and draw your navel toward your spine. Repeat this 10 to 15 times for one set.

3. Chest Expansion

This exercise is designed to stretch the intercostal muscles and increase the range of motion in the chest. To perform this exercise, stand up straight with your feet shoulder-width apart.

Clasp your hands behind your back and slowly stretch your arms out to the sides. Hold this position for five to 10 seconds, then slowly relax your arms back to the starting position. Repeat this 10 to 15 times for one set.

4. Back Extensions

Back extensions are an effective exercise for strengthening the intercostal muscles and improving posture. To perform this exercise, begin by lying on your stomach on a flat surface with your arms extended to your sides.

Gently lift your upper body off the ground, and hold this position for five to 10 seconds. Slowly lower your body back down, and repeat this 10 to 15 times for one set.

5. Wall Push-Ups

This exercise is designed to strengthen the intercostal muscles while increasing your range of motion. To perform this exercise, stand facing a wall with your feet shoulder-width apart.

Place your hands flat against the wall, and slowly lower your body towards the wall until your chest is about six inches away. Hold this position for five to 10 seconds, then slowly push back up to the starting position. Repeat this 10 to 15 times for one set.

How to Prevent Intercostal Muscle Strain?

1. Warm-Up: Before engaging in any type of physical activity, it is important to perform a warm-up routine. This will help to loosen the muscles and increase flexibility. Focus on dynamic stretches that target the intercostal muscles, such as torso twists, side bends, and arm swings.

2. Proper Form: When engaging in physical activities that require repetitive motions, it is important to maintain proper form. This will help to prevent over-stretching of the intercostal muscles.

3. Strength Training: Regular strength training exercises can help to improve the strength and stability of the intercostal muscles. Focus on exercises such as chest presses, pull-ups, and planks.

4. Core Training: Core training exercises can help to improve the overall stability and strength of the torso. Focus on exercises such as crunches, bridges, and twists.

5. Adequate Rest: It is important to allow the body to rest to prevent intercostal muscle strain. Make sure to take breaks in between physical activities and get adequate sleep.

6. Posture: Maintaining proper posture can help to reduce the risk of intercostal muscle strain. Try to keep your shoulders back, chest up, and abdominals engaged when standing and sitting.

7. Nutrition: Eating a balanced and healthy diet can help to provide the body with the nutrients it needs to stay healthy and prevent intercostal muscle strain. Focus on eating plenty of fruits, vegetables, and lean proteins.

8. Physical Therapy: Undergoing physical therapy can help to improve the strength and flexibility of the intercostal muscles. This can help to reduce the risk of strain.

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