Intercostal Muscle Strain: Causes, Symptoms, and Effective Treatment

An intercostal muscle strain can cause sharp, aching, or tight pain in the chest or ribs, often making simple tasks like breathing, coughing, or turning uncomfortable. While not typically serious, this injury can disrupt daily activities and, if left untreated, may lead to prolonged discomfort.

In this blog, we'll explore what intercostal muscle strains are, their common causes and symptoms, and how to effectively manage and prevent them.

What Is an Intercostal Muscle Strain?

The intercostal muscles are the muscles located between the ribs, helping expand and contract the ribcage during breathing. There are three layers of intercostal muscles:

• External intercostals – Aid in inhalation.
• Internal intercostals – Assist in forced exhalation.
• Innermost intercostals – Support the other layers and contribute to rib stability.

An intercostal muscle strain occurs when these muscles are overstretched or torn due to sudden movements or repetitive stress.

What Causes Intercostal Muscle Strain?

Intercostal muscle strains often result from activities that involve twisting, overstretching, or heavy breathing. Common causes include:

1. Physical Activities and Sports Injuries

• Sudden twisting motions (e.g., swinging a bat or racket)
• Lifting heavy objects improperly
• Intense or repetitive upper body workouts (e.g., rowing, weightlifting)

2. Trauma to the Chest Wall

• Direct impact to the ribs during contact sports (e.g., football, rugby)
• Accidents or falls that bruise or strain the chest muscles

3. Overexertion or Repetitive Movements

• Overuse of the intercostal muscles through repetitive motions like rowing or swimming
• Prolonged or intense coughing due to illness

4. Poor Posture and Muscle Imbalance

• Slouched posture or weak core muscles can increase the strain on intercostal muscles during daily activities.

Symptoms of Intercostal Muscle Strain

The symptoms of an intercostal muscle strain can vary based on the severity of the injury but typically include:

• Sharp or stabbing pain along the ribs, especially during sudden movements
• Aching or tightness in the chest wall
• Pain when breathing deeply, coughing, sneezing, or laughing
• Tenderness or swelling along the ribcage
• Muscle spasms in the intercostal area
• Reduced range of motion in the upper body due to pain

Severity of Intercostal Strains:

Intercostal strains are often classified into three grades:

• Grade I (Mild): Minimal muscle fibre damage, slight pain and tightness but no significant functional loss.
• Grade II (Moderate): Partial tearing of muscle fibres, moderate pain, swelling, and limited range of motion.
• Grade III (Severe): Complete muscle tear, intense pain, significant swelling, and difficulty with upper body movements.

Diagnosing an Intercostal Muscle Strain

A healthcare provider can diagnose an intercostal strain through:

• Medical History: Understanding how the injury occurred and the nature of the symptoms.
• Physical Examination: Palpating the ribcage to identify tenderness, swelling, or muscle spasms.
• Movement Tests: Evaluating pain during deep breaths, coughing, or upper body twisting.
• Imaging (if needed):
  • X-rays to rule out rib fractures.
  • MRI or ultrasound to assess soft tissue damage in severe cases.

Effective Treatment Options for Intercostal Muscle Strain

Most intercostal strains heal with conservative treatment over several weeks, depending on severity.

1. Initial Pain Management (First 48–72 Hours)

• Rest: Avoid activities that worsen pain, especially movements that involve twisting or lifting.
• Ice Therapy: Apply ice packs to the affected area for 15–20 minutes every few hours to reduce inflammation and pain.
• Compression: Use an elastic bandage (if recommended) to reduce swelling, but avoid overly tight wrapping that restricts breathing.
• Pain Relief:
  • NSAIDs (e.g., ibuprofen) can help reduce pain and inflammation.
  • Muscle relaxants may be prescribed in cases of significant muscle spasms.

2. Restoring Mobility and Strength (After 72 Hours)

• Heat Therapy: Applying heat can help relax tight muscles and improve blood flow once initial swelling subsides.
• Gentle Stretching Exercises:
  • Side bends to gently stretch the intercostal muscles.
  • Torso rotations to improve flexibility without overstressing the injury.
• Deep Breathing Exercises:
  • Practice controlled deep breaths to prevent lung complications (e.g., pneumonia) and maintain ribcage mobility.
• Physical Therapy:
  • A physiotherapist can guide you through a structured rehab program to restore strength, flexibility, and prevent re-injury.

3. Gradual Return to Activity

• Progressive Strengthening:
  • Focus on core and upper body strengthening to support the ribcage.
  • Exercises like planks and wall push-ups can help rebuild strength.
• Avoid Re-injury:
  • Gradually return to sports or strenuous activities, ensuring proper technique and posture.

Home Exercises for Intercostal Muscle Strain

Here are some simple exercises to aid recovery:

1. Side Stretch:

   • Stand with feet shoulder-width apart.
   • Raise one arm overhead and lean to the opposite side, stretching the ribcage.
   • Hold for 20–30 seconds and repeat on the other side.

2. Thoracic Rotation:

   • Sit or stand upright.
   • Cross your arms over your chest and slowly rotate your torso to one side.
   • Hold for a few seconds, then rotate to the opposite side.

3. Deep Breathing Exercise:

   • Sit comfortably with your hands on your lower ribs.
   • Inhale deeply through your nose, expanding your ribcage.
   • Exhale slowly through your mouth.
   • Repeat for 5–10 breaths, focusing on slow, controlled movements.

How Long Does It Take to Recover From an Intercostal Muscle Strain?

Recovery time depends on the severity of the strain:

• Grade I (Mild): 1–2 weeks
• Grade II (Moderate): 3–6 weeks
• Grade III (Severe): 6–10 weeks or more

Adhering to treatment and rehabilitation guidelines can help speed up the healing process.

Preventing Intercostal Muscle Strain

To reduce the risk of future intercostal injuries:

✅ Warm Up Before Exercise: Include dynamic stretches and gentle torso rotations.
✅ Strengthen Core Muscles: A strong core provides better support to the ribcage.
✅ Practice Proper Lifting Techniques: Engage the core and avoid twisting when lifting heavy objects.
✅ Avoid Overexertion: Gradually increase the intensity and duration of physical activities.
✅ Maintain Good Posture: Especially during desk work or activities involving repetitive upper body movements.

FAQs: Intercostal Muscle Strain

1. How can I tell if I have an intercostal muscle strain or a rib fracture?

• An intercostal strain typically causes muscle pain that worsens with movement or deep breathing.
• A rib fracture often presents with sharp, localized pain and may be accompanied by a cracking sound at the time of injury.
• A medical evaluation (including X-rays) can confirm the diagnosis.

2. Is it safe to exercise with an intercostal muscle strain?

• Initially, it’s important to rest the injured area.
• After the acute phase, gentle stretching and breathing exercises can help recovery.
• Strenuous activities should only resume once pain subsides and strength returns.

3. How long should I rest after an intercostal strain?

• Mild strains may only require a few days of rest, while more severe strains may need several weeks.
• Gradual reintroduction of activities is key to avoid re-injury.

4. Can an intercostal strain cause breathing difficulties?

• Pain from the strain may make deep breathing uncomfortable, but it should not cause significant breathing difficulties.
• If you experience shortness of breath, consult a doctor to rule out more serious issues (e.g., rib fracture or lung injury).

5. When should I see a doctor for an intercostal strain?

• If pain is severe, worsens over time, or is accompanied by swelling, bruising, or breathing issues, seek medical advice.
• Persistent pain beyond 6 weeks also warrants a medical evaluation.

Final Thoughts: Managing and Recovering From Intercostal Muscle Strain

An intercostal muscle strain can be painful and frustrating, but with the right care and rehabilitation, most people make a full recovery. Early rest, gentle stretching, and a gradual return to activity are key to restoring strength and flexibility.

If you’re struggling with chest or rib pain that isn’t improving, consult a physiotherapist or sports medicine specialist for a personalised treatment plan. With proper guidance, you’ll be back to your regular activities in no time!