Intercostal muscle strain is an injury affecting the muscles between two or more ribs. Symptoms can include sharp, direct pain, stiffness, and mobility difficulties.

The intercostal muscles have different layers that attach to the ribs to help build the chest wall and assist in breathing. When an intercostal muscle gets twisted, strained, or stretched too far, it can tear, causing intercostal muscle strain.

In this article, we examine the signs of an intercostal muscle strain, and how to tell one apart from other upper body pains and injuries. We also look at the causes and treatment options for these strains.

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The signs and symptoms of an intercostal muscle strain can differ slightly, depending on their cause. However, as the intercoastal muscles are present in the trunk of the body and are essential for breathing, symptoms are localized to this area and often involve breathing.

Symptoms may include:

  • sharp upper back and rib pain
  • severe and sudden pain, particularly if caused by a blow to the chest or back
  • gradual worsening pain after repetitive movement, such as rowing, swimming, or other physical exercises
  • stiffness and tension in muscles, causing upper back pain
  • muscle rigidity when bending or twisting the upper body
  • worsening pain when coughing, sneezing, or breathing in deeply
  • spasms of the intercostal muscles
  • tenderness in the area between the ribs

Intercostal muscle strain vs. other upper body pains

Typically, injuries rarely occur to the upper back because it is relatively immobile. If this area is the cause of pain, it is often due to long-term poor posture. It can also be due to a severe injury that has weakened the sturdiness of the upper spine, such as a car accident.

People usually experience pain due to upper back injuries as a sharp, burning pain in one spot. The pain can spread to the shoulder, neck, or elsewhere in the upper body, and it may come and go.

Read on to learn more about possible causes of upper back pain.

Intercostal muscle strain is almost always the result of some event, such as overexertion or injury. In contrast, the initial source of pain from pneumonia or other lung disorders is difficult to pinpoint.

If the specific area of discomfort can be located, such as between the ribs, this indicates the pain is not coming from the lungs or the upper back. People often describe lung pain as sharp and spreading outward.

With a rib fracture, the pain is usually much more severe than that of intercostal muscle strain.

The following symptoms may signal a rib fracture:

  • feeling breathless
  • a protrusion or a sharp stabbing sensation in the rib area
  • an area around the ribs that is extremely tender to touch

A fractured rib is a medical emergency requiring immediate attention.

Routine activities are not usually the cause of intercostal muscle strain. These strains most often occur as the result of an injury or overexertion of the muscles.

Common causes include:

  • a direct blow to the rib cage, such as from a fall or car accident
  • an impact blow from contact sports, such as hockey or football
  • twisting the torso beyond its normal range of motion
  • twisting while lifting weights
  • forceful twisting, such as from golf or tennis
  • twisting from specific yoga postures or dance positions
  • reaching overhead, for example, when painting a ceiling
  • lifting any heavy object above shoulder height
  • prolonged overhead reaching
  • repetitive forceful movements, such as hitting a tennis ball

A sudden increase in physical activity can also lead to an intercostal muscle strain. This is the case particularly when a lack of exercise or poor posture may lead to weaker muscles.

The time to see the doctor depends on the severity of the injury. A mild injury may result in a low level of pain and stiffness that goes away within a few days.

It is advisable to see a doctor if the pain from a rib injury is severe, lasts for more than a few days, or interferes with sleep or daily activities.

If a traumatic injury, such as a fall or an automobile accident, has occurred, or breathing is difficult, immediate medical attention is necessary.

Diagnosing intercostal muscle strain involves a physical exam. The aim is to check for any limitations of movement and assess areas that are tender. For example, this may include a pulmonary exam, which can help with diagnosing problems in the trunk of the body. The doctor will also ask about any recent injuries or sports involvement.

A healthcare professional may order imaging tests, such as an ultrasound or MRI scan. This can help to rule out other injuries, such as a fractured rib.

Home treatment may be all that is necessary if the injury that causes an intercostal muscle strain is not severe and symptoms are mild. Home treatment options can include the following:

  • Applying an ice pack or cold pack, followed by heat therapy. Heat therapy options include a warm bath, heating pads, or adhesive heat wraps.
  • Resting and limiting all physical activity for a few days to allow time for the muscle strain to recover.
  • Taking pain medications to reduce swelling and pain. Over-the-counter medications that may help with intercostal muscle strain include acetaminophen or ibuprofen.
  • Splinting the area if breathing is painful by holding a pillow against the injured muscle. However, difficulty breathing means a person must seek medical attention right away.

In addition to the home remedies described above, the doctor may order the following:

  • muscle relaxants for severe pain and spasms
  • physical therapy (PT)
  • injection of lidocaine and corticosteroids to reduce pain and swelling if other treatments fail

Physical therapy

PT may involve various stretches and breathing exercises to help strengthen intercostal muscles. For example, this may include side bending and deep breathing.

If difficult or painful breathing occurs, deep breathing exercises can help improve a person’s shallow breathing. Long-term shallow breathing can lead to complications, such as pneumonia.

A person with intercostal muscle strain should not do any stretching exercise unless under the supervision of a physical therapist or other healthcare providers.

An individual should stop stretching immediately if it increases pain or makes symptoms worse.

How long an intercostal muscle strain lasts depends on the severity of the injury. Mild intercostal muscle strain commonly heals within a few days. Moderate strains may take 3–7 weeks to heal, and severe strains that involve a complete tear of the muscles can take longer.

In general, most intercostal muscle sprains and other rib injuries should heal within a 6-week time span.

Prevention of future muscle strains involves warming up and stretching before performing strenuous exercises. It is important not to overdo it when it comes to working out or taking part in sports.

Keeping muscles strong also helps with the prevention of intercostal muscle strain.