Intercostal Muscle Strain: Causes, Symptoms and Treatments

Intercostal Muscle Strain: Causes, Symptoms and Treatments

Intercostal muscles are found between each of your ribs and provide support to your upper body and assist in breathing. Sudden jerking movements or overstretching can strain the intercostal muscles resulting in mild to severe chest and back pain. Intercostal muscle strains can cause localized but debilitating pain in and around your chest area, or the pain can radiate to other areas of your body such as your shoulder blades and arms.

There are many ways that you can strain the muscles between your ribs. For example, over stretching or injuring your arms while playing sports, suffering an injury or trauma to your back or chest, or repetitive strain injuries can all cause intercostal muscle pain. There have even been cases when chronic coughing or sneezing have strained these rib muscles.

If you have strained your intercostal muscles, you may have extreme chest pain when going about your daily activities. The muscle pain in your chest or back could become worse when the ribs are touched or moved, or your rib cage could be tender to touch. Because intercostal muscles move with your lungs, breathing could even become painful because of the muscle strain.

In the article, you will learn about the important function your intercostal muscles have in supporting your rib cage. You will also find how and what causes intercostal muscle strain, how to prevent tearing, stretching or straining your chest muscles, and how to treat muscle pain.

What are Intercostal Muscles?

Intercostal muscles are a group of 11 muscles on each side of the rib cage that connect one rib to another. The muscles expand and shrink with breathing and support your rib cage. The intercostal muscles are made up from 3 layers called the external intercostal, internal intercostal, and the innermost intercostal muscles. Running through these muscles is a series of nerves called the intercostal nerves.

The journal Physiological Reviews states that all 3 layers of the intercostal muscles have a role to play in breathing. As you exhale air the internal intercostals move, and when you inhale it’s the external intercostal muscles that move the rib cage.1

Symptoms of Intercostal Muscle Strain

Any strain or injury to the muscles that connect your ribs can restrict these muscles and cause pain under your breast and around the chest. According to a chiropractic clinic, the pain can be mild to severe and can be the result of an injury, bad posture, or come on without any warning.2

Because the intercostal muscles and nerves are connected to your ribs, you may also feel pain in other areas of your chest. Of course, any kind of chest pain could be related to your heart. Therefore, if rib cage pain or chest tightness comes on suddenly and causes a pressing or squeezing feeling in your chest, you should seek medical help immediately.

According to the journal Current Sports Medicine Reports, intercostal muscle strains will usually cause pain when breathing, coughing, or moving your upper body. The pain may get worse when you breathe deeply and you may notice some swelling around the affected painful chest or back area.3

However, you may have pain that radiates to other parts of your upper body. For example, tight or sharp pain is often felt in your back just under your shoulder blades or you may have a tingling sensation in your back or chest.2

Expert in orthopedic surgery, Dr. Jack McPhilemy says that injury to the rib cage can cause severe pain that lasts a few days. After this time pain may be felt when coughing, stretching, or breathing deeply. With the proper rest and treatment, intercostal muscle strains should heal within a few weeks.4

Because the symptoms of pulled intercostal rib muscles are similar to the symptoms of a heart attack and other serious medical conditions, you should always make sure that a qualified doctor examines the root cause of chest pain. This is to rule out the possibility that chest pain is cardiac-related or a symptom of problems with your digestive system. Even if the chest pain or back pain has been caused by injury, a doctor should examine you for broken bones or internal organ damage.

Causes of Intercostal Muscle Strain

Let’s look at some of the main causes of intercostal muscle strain. Knowing what can cause strains, tears, and injury to your rib muscles can provide helpful information to know how to prevent damaging muscles in your chest.

Injury to your rib cage

Injury to your rib cage can also damage the muscles between your ribs. Depending on the severity of your injury, you may experience excruciating pain as well as damage to your ribs.

According to the Victoria State Government website, rib injuries sustained from automobile accidents or by falling can damage the intercostal muscles. This can cause bruising where the muscles have been damaged or it could even cause the costal cartilage to detach from the sternum.5

Athletes and sports men and women often suffer from intercostal strains, tears, and pulled muscles. For example, the journal Current Sports Medicine Reports states that intercostal muscle strains commonly affect athletes more than the general population. Among the types of sports that can result in damage to the rib muscles are rowing, swimming, and other sports that require intense upper body activity.3

Forcefully throwing an object

One way that your intercostal muscles can become strained is if you forcefully throw an object. The jerking arm motion to throw an object with force can damage muscles between your ribs or strain your rhomboid muscles and shoulder blade.

The American Journal of Sports Medicine reported that, in a study of baseball players, around 90% of all injuries were intercostal muscle strains. However, it wasn’t just injuries to the rib muscles and shoulder muscles that were sustained. The throwing actions and hitting motions also cause abdominal muscle strains.6

Twisting upper body

Twisting your body in an awkward way can put a lot of strain on your intercostal rib cage muscles that causes them to tear and be very painful.

Orthopedic surgeon, Dr. Jack McPhilemy says that twisting the body while running can strain your muscles so much that it feels like a knife being stuck into the ribs. Over-stretching the intercostal muscles can tear them meaning that they can’t expand and stretch as they should normally.4

Slipping rib syndrome

Another cause of intercostal muscle pain is when the cartilage on the lower ribs moves and causes pain in the chest or upper abdomen. This condition is called slipping rib syndrome. Injury to the rib cage is often to blame for damage to the lower ribs.

The Journal of Athletic Training reported that slipping rib syndrome is common among athletes who frequently use their arms in sports. It was found that bending, lifting, coughing, and even turning in bed can exacerbate the symptoms. If left undiagnosed, slipping rib syndrome can cause chronic chest pain for many months.7

Incorrect posture

You don’t always need to suffer a serious injury to strain your intercostal muscles. The prolonged strain on your rib cage muscles due to incorrect posture can cause a tight, painful feeling in your back just below your shoulder blades.

According to doctors at Sayer Clinics, sitting for long periods of time at a computer or office desk can put extra strain on your intercostal muscles. In time, this can cause inflammation, muscle spasms, and pain in the intercostal rib cage muscles. The result is chronic middle back pain and/or chest pain that can interfere with driving (when you have to turn your head to reverse) or sleeping because laying on your front is very painful.8


Another, less common reason for straining an intercostal muscle is by sneezing violently. The sudden jerking motion in your chest can cause a mild to severe strain in one or more of the muscles between your ribs.

The journal Annals of Thoracic Surgery reported on a person who constantly sneezed because of a lower respiratory tract infection. The man damaged his rib cage muscles after a bout of violent sneezing.9


Apart from sneezing that can cause shooting chest pains and a ribcage injury, chronic coughing has been known to result in damage to the muscles between the ribs.

The Journal of Surgical Technique & Case Reports reported on a case where a man suffered an intercostal hernia because of a chronic cough.10

Natural Treatments for Intercostal Muscle Strain

There are many natural ways to treat intercostal muscle strain and help get rid of the pain quickly. First aid procedures can help to reduce the severity of the symptoms from the initial injury, and massage techniques can help to loosen the affected area and return mobility to your upper body.

R.I.C.E. method for muscle strain

A tried and tested first aid method for muscle sprains and strains such as intercostal muscle strain is to apply ice and compression to the affected area. This is referred to by the acronym R.I.C.E. which stands for Rest the affected area, Ice the sore muscles, Compression to stop swelling, and Elevation to reduce swelling and speed up healing.

How to use:

As soon as you can after the initial injury to your intercostal muscles, you should use the RICE method to relieve muscle pain and ease the strain. This is what doctors from WebMD recommend doing to promote muscle healing:11

  1. Rest the injured or sore area by refraining from any activity that could strain the rib muscles even more.
  2. Apply an ice pack or cold compress to the affected intercostal muscles to reduce swelling. Put ice in a sealed bag and wrap in a towel. Apply for 20 minutes and repeat 3 times a day.
  3. If possible compress the affected ribcage with a compression bandage to prevent swelling. Don’t use for any longer than 72 hours.
  4. Keep your upper body elevated to reduce swelling.

If you still have pain after 48 hours and the swelling has gone away, you can apply a heat pack. Doctors advise that heat helps to increase blood circulation to the affected area and speeds up the healing time. Heat can also be used to improve flexibility to muscles before exercising.12

You can find more information on using heat or cold to treat muscle injuries.


Once the acute symptoms of the initial injury have reduced, you can apply massage techniques to ease intercostal muscle pain. Deep muscle massage increases blood flow to the injured area and improves flexibility in muscles, ligaments, and tendons.

Many chiropractors recommend massaging to relieve muscle strains and improve movement in sore muscles. This helps to release tension from restricted muscles. Along with performing massage on your intercostal muscles, chiropractors will also focus on easing the surrounding muscles that may also have been affected by the injury.

Although you can practice some easy massage techniques at home to relieve back pain and muscle strain, you may need to visit a professional masseur to get relief from chronic back pain.

Eat more ginger

Another way to help treat muscle inflammation between your ribs is to eat more ginger. Ginger is a delicious medicinal herb that also has anti-inflammatory healing properties. Supplementing your diet with ginger can help to relieve and prevent muscle pain.

For example, the Journal of Pain reported that ginger reduces muscle pain caused by exercise. It was found that taking ginger daily helped to reduce painful symptoms of muscle strains that are sustained after exercising.13 In fact, there is some evidence that ginger is as good as non-steroidal anti-inflammatories for relieving pain.

Exercises for Strained Intercostal Muscles

To help strengthen your back and upper body, it’s important to exercise your intercostal muscles to keep them flexible and increase their strength. This will greatly reduce the risk of injuring your rib cage muscles while taking part in sports.

Shoulder blade squeezes

The National Health Service recommends shoulder blade squeezes to help recover quicker from the intercostal chest and back muscle injuries.14 Shoulder blade squeezes are helpful to exercise your rib muscles while sitting at a desk. This is what you should do:

  1. Sit with your back straight.
  2. Squeeze your shoulder blades together as tightly as you can to moderately stretch the intercostal muscles.
  3. Hold for 2-3 seconds and then repeat 10 times.
  4. If you feel any pain or your symptoms are worse after, you should stop the exercise.


Another recommended exercise to strengthen your intercostal muscles in your rib cage is to rotate your upper body. This is what you should do to exercise your rib muscles:

  1. Sit with your arms folded across your chest.
  2. Gently rotate your upper body from side to side.
  3. Repeat the exercise 10 times and use daily to keep your upper body flexible.

Another rotation technique for keeping your intercostal muscles toned is to rotate your lower body while laying on your back. This is how to perform the exercise:

  1. Lay on your back with your arms by your side and your knees elevated so that your legs are in a triangle position.
  2. Gently take your knees from side to side as far as you can go. Stop if you feel pain.
  3. This should give your rib cage muscles a mild to moderate stretch.
  4. Repeat 10 times.

Foam roller stretch

Another way to strengthen your upper back and prevent muscle pain in your intercostals is to use a foam roller to stretch your back muscles. This is how to do the back exercise:

  1. Lay on your back with the foam roller directly under the length of your spine and your head supported.
  2. Breathe normally and keep your back and neck relaxed. Stop if you feel any pain.
  3. Hold the position for up to 1 1/2 minutes as long as you are comfortable.

How to Prevent Intercostal Muscle Strain

Many injuries to your rib cage that happen because of straining and stretching can be prevented by using some simple techniques. Also, if you have an office job, it’s important to keep your back flexible during the workday and hold a good posture.

Improve posture

Keeping a good posture is something that most people can do and the benefits to your intercostal muscles are tremendous.

According to doctors from the National Health Service, sitting correctly at your desk can help to prevent muscle strains and spasms in your back. This is also one of the best ways to lower your risk from suffering chronic back pain.15 Here are some helpful tips to prevent restricting your intercostal muscles by bad posture:

  • Sit so that your back is straight and properly supported.
  • Adjust your chair so that your knees are slightly lower than your hips and you can use a keyboard with your arms straight and level with the floor.
  • Keep your computer screen at eye level.
  • Don’t cradle your phone between your ear and shoulder to prevent tensing your intercostal muscles.
  • Take regular breaks and practice shoulder blade squeezes a few times during the day.

Warm up before exercising

To avoid straining your intercostal muscles and getting pain in your rib cage after exercising, it’s very important to warm up before exercising.

The journal Sports Medicine reports that many muscular injuries can be prevented by warming up before engaging in sports or strenuous physical activity. Researchers found that warm up and stretching exercises in the 15 minutes before physical activity greatly reduce incidents of muscle strains, tears, and injury.16

Don’t overuse muscles

It is also important to avoid straining your muscles beyond their capacity to avoid unnecessary strains and muscle tears.

Doctors from the Cleveland Clinic report that improper lifting or overstretching the back muscles can cause a chronic strain or tear that can take a long time to heal. Strengthening your back and abdominal muscles can increase the load that your muscles can handle and prevent back injury and its associated symptoms.17

Intercostal Muscle Strain – When to See a Doctor

With proper rest and treatment to allow your muscles to recover, intercostal muscle strains should heal within a few weeks. However, sometimes chronic back pain and chest pain requires medical attention.

Also, because severe intercostal muscle strains can cause chest pain symptoms similar to a heart attack, you should always speak to your doctor about chest pain.

According to Dr. William Blahd on WebMD, you should seek emergency medical help if you have back or chest pain with one or more of the following symptoms:18

  • A squeezing pain in your chest that may or may not radiate to your left arm.
  • Feeling dizzy or lightheaded.
  • Shortness of breath.
  • Nausea or vomiting.
  • Chest or back pain that radiates to either arm, your neck, or jaw.
  • The trauma to your rib cage has injured your spine.
  • You have tingling or loss of feeling in one or both of your legs.

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Article Sources:

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  2. PortChiro. Rib pain, costochondritis.
  3. Curr Sports Med Rep. 2009 Mar/Apr; 8(2):0-6.
  4. WebMD. Strained intercostal muscle.
  5. BetterHealth. Rib injuries.
  6. Am J Sports Med.2012 Mar;40(3):650-6.
  7. J Athl Train. 2005 Apr-Jun; 40(2): 120–122.
  8. SayerClinics. Postural computer neck with rib pain.
  9. Ann Thorac Surg.2013 Jul;96(1):301-2.
  10. J Surg Tech Case Rep. 2013 Jul-Dec; 5(2): 106–108.
  11. WebMD. RICE.
  12. MarshfieldClinic. Treating pain with heat or cold compress.
  13. J Pain.2010 Sep;11(9):894-903.
  14. NHS. Chest injury advice sheet.
  15. NHS. How to sit correctly.
  16. Sports Med.2007;37(12):1089-99.
  17. ClevelandClinic. Back strains and sprains.
  18. WebMD. Upper and Middle Back Pain.

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