What are symptoms of intercostal muscle strain? Causes, tips, and guidance

What are symptoms of intercostal muscle strainIntercostal muscle strain is pain or discomfort in the muscles located in between our ribs. Strain to this location of the body can be the result of forceful movements, particularly ones that result in a sudden twist of the torso. A particularly forceful movement can tear the intercostal muscles.

The intercostal muscles are composed of several groups of muscles that run between the ribs, helping to form and move the chest wall. They are also involved in the mechanical action of breathing, as it requires expansion and contraction of the chest to facilitate breathing.


The intercostal muscles are composed of several groups of muscles that run between the ribs, helping to form and move the chest wall. They are also involved in the mechanical action of breathing, as it requires expansion and contraction of the chest to facilitate breathing.

Intercostal muscle strain can happen at any age and to anyone, however, those participating in sporting activities or those involved in activities that involve sudden movements of the torso are at greatest risk.

Intercostal muscle anatomy

Intercostal muscles can be broken down into three layers. These include:

  • External intercostal muscles
  • Internal intercostal muscles
  • Innermost intercostal muscles

These groups have their own blood supply and nervous innervation. The external intercostal muscles are responsible for forced and quiet inhalation, as they can help raise the ribs and expand the chest cavity. The internal intercostal muscles are responsible for forceful exhalation, as they help to depress the ribs and decrease space in the chest cavity. The innermost intercostal muscles are separated from the internal intercostal muscles by a grouping of nerves and blood vessels known as the neurovascular bundle.

Intercostal muscle strain causes

A blow to the chest:

Due to forceful physical contact to the rib muscles. This can happen with car accidents, sporting injuries, due to occupational hazards, or from an assault.

Twisting of the upper body:

Can lead to overstretching the intercostal muscles and put pressure on the rib cage. Practices such as yoga postures, certain dance moves, wrestling, or simply turning your torso suddenly can all lead to intercostal muscle strain if not careful.

Arm swinging force:

Swinging your arm too far can stretch the ribs toward the arm that is swinging. When this arm swinging is combined with the twisting of the lower half of the body, it can lead to intercostal muscle strain or tears.

Over stretching:

The act of stretching of the torso pulls the ribs apart. If this is done too forcefully and your muscles are prone to be injured, you may strain the intercostal muscles even with gentle stretching. Overstretching may even lead the ribs to stretch far enough to cause the intercostal nerve to become trapped between the ribs and muscles. This can lead to spasms and nerve pain.

Intercostal muscle strain symptoms


Often located on the side of the chest and in the lower area of the ribs. Pain may develop suddenly and be described as being sharp and shooting, often with a pulling sensation.

Pain is often constant and severe and intensifies with movement, twisting, coughing, and sneezing.


A generalized weakness over the affected area that is often accompanied by painful bruising. Intercostal muscle tenderness often leads to the inability to wear tight clothing and even making it painful to turn over in bed.


A sign of injury that accompanies pain, swelling is usually present in more severe cases of intercostal muscle injury. A swollen area with blood is often referred to as a hematoma.

Muscle tightness:

Due to severe pain, muscle may become constricted or tight in an attempt to restrict movement. This may make it difficult to take deep breaths or move the chest and arms.

Shortness of breath:

Pain due to intercostal muscle strain can make it hard to breathe. In effect, breaths tend to become shallow with short breath taken to help avoid pain.

Intercostal muscle strain diagnosis

Once a doctor is presented with a possible intercostal muscle strain, the first thing acquired is a detailed history of preceding events. This will also include all relevant medical history to help get a better idea of the injury’s origin.

Next, a physical exam will be carried out to see if the area is sensitive to touch and how great your range of motion is affected. Depending on the severity of your particular injury, your doctor may or may not feel an x-ray of the ribs is required.

A grading system is often used to help address the level of severity:

  • Grade 1: Mild strain
  • Grade 2: More extensive damage
  • Grade 3: Complete rupture of muscle

Coping with intercostal muscle strain at home

Immobilize the ribs: Accomplished by wrapping the chest with bandages, slightly compressing the ribs. This is not to be done too tight as it may restrict breathing. Wrapping should only be done for the first couple of days.

Alternate hot and cold: For the first 48-hours of intercostal muscle strain, exclusively use a cold pack on the affected area for 20 minutes at a time. After that, you can start to alternate between hot and cold packs in 20-minute intervals. This to reduce inflammation and swelling as well as promote blood flow to the area to increase healing.

Deep breathing: Despite intercostal muscle strains being painful, practicing slow deep breathing can be an effective method for lowering the risk of infections.

Try Epsom salt soaks: Also known as magnesium salts, this product can be found at your local grocery store or pharmacy. Epsom salts can easily be added to a warm bath and are known for its pain relieving properties.

Intercostal muscle strain treatment

Conservative therapy is the treatment of choice for intercostal muscle strain, as it is all that can be done to boost the healing process, relieve pain, and prevent injury recurrence. There are several types of interventions that can be undertaken, with the following being the most common interventions.

Anti-inflammatory medication: This may include aspirin or NSAIDs (non-steroidal anti-inflammatory drugs). These drugs help to reduce pain and inflammation.

Ice application: Helps to reduce pain and swelling of the affected area. Is it recommended to apply ice packs in 20-minute intervals at least three to four times a day.

Joint manipulation and mobilization: Aids in the restoration of normal function of the intercostal muscles while at the same time reducing the strain and relaxing the muscle.


Rest: Refrain from doing any sort of strenuous activity, especially the ones that resulted in the intercostal injury to begin with. Rest will help the healing process and hasten recovery.

Recovery time for intercostal muscle strain

Your recovery will depend on the level of severity of your particular case of intercostal muscle injury. It will take about two weeks for a mild strain to heal and six to seven weeks for a moderate injury. Severe injuries resulting in muscle ruptures may take eight weeks or longer for complete recovery.

To speed up this process as much as possible, it is a good idea to not do any lifting or strenuous exercise during this time. The use of pain relievers will also help you function normally.

Author Bio

Emily Lunardo studied medical sociology at York University with a strong focus on the social determinants of health and mental illness. She is a registered Zumba instructor, as well as a Canfit Pro trainer, who teaches fitness classes on a weekly basis. Emily practices healthy habits in her own life as well as helps others with their own personal health goals. Emily joined Bel Marra Health as a health writer in 2013.



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