What is an intercostal muscle strain?

intercostal space Muscle strains are the most common type musculoskeletal chest pain. The intercostal muscles are thin muscles that attach between the ribs. During breathing, the external intercostal muscles elevate the ribs, while the internal intercostal muscles press down on the ribs and reduce the volume of the thoracic cavity within the ribcage during breathing.

Like any other muscle, the intercostal muscles can become tense with sudden or repetitive force, causing pain, tightness, and difficulty with daily activities.

This article discusses the signs and symptoms of an intercostal muscle strain, common causes, and how to treat it.

Signs and symptoms of an intercostal muscle strain

An intercostal muscle strain can cause pain and tightness in the chest and/or ribs that increase with chest, arm, and trunk movement or deep breathing. Chest pain from this type of muscle strain is located on the intercostal muscles, which attach to the ribs. It can produce sharp, tugging and increased pressure sensations. For more severe intercostal muscle strains, swelling or bruising may occur.

Intercostal muscle spasms and other upper body pain

Intercostal muscle strains can be differentiated from other conditions that cause chest and/or rib pain by assessing the type of injury, the precise location of the pain, and whether the pain changes with physical activity. Other conditions that can cause chest and/or rib pain include:

  • Rib fracture or subluxation
  • sternoclavicular joint subluxation
  • Clavicle fracture
  • costochondritis
  • pectoralis major strain
  • precordial catch syndrome
  • Cervical or thoracic radiculopathy due to nerve compression
  • fibromyalgia
  • heart problems

Traumatic injuries such as a fall or a direct blow to the chest or ribs can lead to subluxation or fracture of the ribs or the sternoclavicular joint, which connects to the sternum in the middle of the chest.

If this type of injury occurs, X-rays may be done to determine if there is bone or joint damage. A physical examination of the ribs, sternum, and collarbone can also help determine if the pain is felt when the body touches these areas, or if the pain is in a muscle.

Whether chest pain and/or rib pain worsens with exercise can also help distinguish the types of chest pain. Intercostal muscle strains, such as injuries to the ribs, sternum, or collarbone, can lead to increased pain with upper body movement.

Other conditions, such as precordial catch syndrome, a condition that causes sharp, stabbing pain in the chest, and costochondritis, or inflammation of the cartilage between the ribs, are more likely to cause breathing pain. While costochondritis can also be exacerbated by strenuous upper body exercise, such as rowing or weight lifting, the pain is usually located in the second to fifth ribs, which are attached to the sternum.

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Heart problems can cause chest pain that is exacerbated by exertion after physical activity, but there are often signs of other heart problems that can help in a proper diagnosis. These symptoms include shortness of breath, fatigue, dizziness, lightheadedness, irregular heart rate and rhythm, and changes in blood pressure.

Common causes of intercostal muscle strains

Among the musculoskeletal causes of chest pain, the intercostal muscles are the most commonly affected muscle group. Intercostal muscle strains can result from a sudden increase in activity or increased strain and physical demands on the chest and upper body, which can be due to:

  • Upper body twist lift
  • Exercises that involve repetitive twisting or stretching, especially those performed quickly
  • Exercises that require repetitive upper body strength, such as rowing, golf, and tennis
  • Activities like painting ceilings, chopping wood, or shoveling snow
  • severe and repeated coughing
  • chest injury

When to see a healthcare provider

Intercostal muscle strains can be difficult to identify because chest pain can be caused by a number of different causes. If your chest pain persists for more than three days, it is best to schedule an appointment with a healthcare provider to determine the diagnosis.

Intercostal muscle strains are usually not serious, but other forms of chest pain can be serious. Seeing a health care provider can help rule out other conditions to confirm that your chest pain is only from muscle damage. If you suffer a fall or direct trauma to your chest, be sure to see a medical professional to make sure there are no fractures or dislocations.


Other causes of chest pain may need to be ruled out before an intercostal muscle strain is diagnosed. An electrocardiogram (EKG) and an echocardiogram (echo) can be done to check the structure and function of your heart to determine if a heart problem is causing your chest pain.

Neurological tests involving range of motion of the spine, upper body strength, sensation, and reflexes may also be performed to screen for any neurological problems, such as nerve root compression that may cause chest pain.

In the absence of signs or symptoms of cardiac or neurological disease, intercostal muscle strain can be diagnosed based on subjective medical history. This includes a description of symptoms, onset and frequency, and a physical examination of the chest muscles and surrounding structures. With an intercostal muscle strain, there is localized pain and tenderness that increases as the intercostal muscle stretches or contracts.

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Graded Muscle Strain

Muscle strains are graded according to the severity of the injury according to the following criteria:

  • Grade 1: The muscle strain presents with localized pain and tenderness that is aggravated by exercise. If swelling or bruising occurs, it is very minor. Disability was minimal, with no significant impact on function, limiting range of motion to 10 degrees or less.
  • Grade 2: The localized pain and tenderness of the pulled muscle is more pronounced, with moderate swelling, bruising, and stretching or tearing of muscle fibers. The loss of range of motion was less than 50% and function was significantly affected. There is considerable pain when the muscle contracts.
  • Grade 3: Complete tear of muscle fibers, resulting in loss of more than 50% of range of motion, severe pain on palpation, significant loss of strength, and severe swelling, bruising, and hematoma formation (extravascular blood pooling).


Depending on the severity of your intercostal muscle strain, your healthcare provider may prescribe different treatment options to help manage your symptoms.

muscle relaxant

Muscle relaxants are a class of drugs that reduce pain and intercostal muscle spasms by blocking nerve pathways to reduce muscle contractions.

Corticosteroids and lidocaine injections

If the spasm of the intercostal muscles causes significant pain and difficulty breathing, corticosteroids or lidocaine can be injected into the intercostal muscles. These drugs can help reduce pain and inflammation, and block nerve signals at the injection site.

physical therapy

Your healthcare provider may recommend physical therapy to help restore the range of motion and function of the intercostal muscles and correct upper-body strength imbalances that can lead to strains. A physical therapist can help you understand proper body mechanics and exercises to prevent further irritation and injury.

Non-prescription drugs

Over-the-counter (OTC) pain relievers such as nonsteroidal anti-inflammatory drugs (NSAIDs such as ibuprofen Advil and Motrin and naproxen Aleve) can help relieve pain and inflammation.

hot and cold therapy

Cold therapy to the affected area can help reduce pain intensity and swelling (if present), while heat therapy can help relieve tension and muscle tightness.

breathing exercises

The intercostal muscles move the ribs to expand and contract the ribcage with breathing. Breathing exercises that gently expand and contract the ribs can help relieve intercostal muscle spasms. Placing a pillow in front of your chest to support your ribs can also help reduce discomfort during deep breathing.

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Epsom salt soak

Bathing with Epsom salts can reduce muscle pain and inflammation caused by muscle strains.Epsom salts contain magnesium, which can help prevent n-Methyl-d-aspartate (NMDA) receptors are involved in the perception of pain.

Outlook and Prevention

An intercostal muscle strain is a common injury caused by pressure on the chest and usually heals within a few weeks. In order to prevent intercostal muscle strains, proper warm-up and participation in sports are important to prevent sudden stress on the chest.


An intercostal muscle strain is a strain of the intercostal muscles in the chest between the ribs. Intercostal muscle strains are the most common source of musculoskeletal chest pain and can be caused by violent coughing, sudden twisting, or repetitive strenuous movements of the chest and upper body, as well as activities such as brushing ceilings, chopping wood, or shoveling snow.

Intercostal muscle strains can vary in severity, but they usually heal well within a few weeks by avoiding aggravating activities and allowing the intercostal muscles to rest and heal.

VigorTip words

If you experience chest pain for more than three days, be sure to make an appointment with your doctor to determine the underlying cause. While intercostal muscle strains are usually not serious and heal on their own over time, chest pain can be caused by a number of different causes. Self-diagnosis can be dangerous, and it’s best to have your health assessed by a trained medical professional.

Frequently Asked Questions

  • How long does it take for an intercostal muscle strain to heal?

    Muscle strains usually take three to four weeks to heal, but if the strain is severe, it can take several months.

  • What does an intercostal muscle strain feel like?

    A strained intercostal muscle can produce a sharp tug on the chest and/or ribs.

  • How is an intercostal strain tested?

    Intercostal muscle strain can be identified by a physical examination that reproduces pain on palpation (by palpation) of the intercostal muscles and movements to stretch or contract the muscles when other forms of chest pain have been successfully ruled out.

  • How to sleep with an intercostal muscle strain?

    Sleeping with a pillow against your chest helps support your chest and abdomen to reduce discomfort. If your intercostal muscle strain is on one side of your body, it is most comfortable to lie on your other side to relieve pressure on the affected area.