Intercostal Muscle Strain
What Is It, Causes, Signs, Symptoms, and More
Editors:Alyssa Haag,Ian Mannarino, MD, MBA,Kelsey LaFayette, DNP, ARNP, FNP-C
Illustrator:Jessica Reynolds, MS
Copyeditor:Stacy Johnson, LMSW
What is an intercostal muscle strain?
An intercostal muscle strain is an injury to the intercostal muscles between the adjacent ribs. There are three layers of intercostal muscles: the external intercostal muscles, the internal intercostal muscles, and the innermost intercostal muscles. The innermost intercostal muscles are located on the ribs' surface and help compress the ribs and stabilize the ribcage. The internal intercostal muscles are superior to the innermost intercostal muscles and run from the posterior to the anterior rib cage. They depress the ribs during expiration and help stabilize the rib cage during physical activity. Lastly, the external intercostal muscles, the outermost layer of the intercostal muscles, run from the anterior to the posterior rib cage. They are responsible for the movement of the ribs during breathing and elevate the ribs during inspiration.
When a strain occurs, any layer of the intercostal muscles can be overstretched, pulled, or even partially torn, resulting in pain and difficulty breathing. Intercostal muscle sprain is a self-limiting medical condition, although measures can reduce pain and inflammation.
What causes an intercostal muscle strain?
An intercostal muscle strain can be caused by overuse or repetition. Examples include lifting heavy objects or participating in sports, such as golf or tennis. Trauma to the chest, sudden twisting movements, reaching overhead, or repetitive forceful movements can similarly cause muscle strain. Poor posture can lead to muscle strain when standing or sitting for an extended period. Intercostal muscles are more prone to strain if the muscles are weak and not adequately conditioned for the activity (e.g., rowing, tennis, golfing, batting, or pitching). Lastly, dehydration can lead to muscle fatigue and increase the risk of muscle strain.
What are the signs and symptoms of an intercostal muscle strain?
The signs and symptoms of intercostal muscle strain may include pain in the chest or rib area; feeling short of breath; limited range of motion of the upper torso; and muscle spasms of the intercostal muscles. The pain can be sharp or dull and worsen when an individual breathes, moves, coughs, or sneezes. Swelling and bruising may occur when the strain is severe. Other symptoms of intercostal muscle strain include swelling or tenderness in the area where the muscle is strained.
How is an intercostal muscle strain diagnosed?
An intercostal muscle strain is typically diagnosed through a thorough medical history and a physical examination. During the medical interview, the healthcare provider may ask about the location and severity of the pain and other associated symptoms one may be experiencing. They may also ask about a history of trauma from falling or a motor vehicle accident, twisting of the upper body associated with the onset of pain, and any sports played that could have contributed to the pain. During the physical examination, the provider may gently press on the affected area and test the range of motion. Imaging tests, such as an X-ray or MRI, may also be ordered to rule out other possible causes of the pain, such as a rib fracture or other injury.Intercostal muscle strains are graded based on severity, with grade one being the mildest and grade three being the most severe. A grade one muscle strain is a mild injury involving a small number of muscle fibers. Daily activities are typically not significantly affected in this grade of muscle strain. A grade two muscle strain is a moderate injury that involves a more significant number of muscle fibers. This grade of muscle strain may affect daily activities and require more extensive treatment. Lastly, a grade three muscle strain is a severe injury involving a complete muscle tear, potentially requiring surgery and a more extended period of physical rehabilitation.
How is an intercostal muscle strain treated?
An intercostal muscle strain is treated primarily by prevention, which may include minimizing the risk of muscle strain while engaging in various activities. Muscle strain prevention may consist of stretching before and after physical activity; staying hydrated; and using proper form and technique when lifting or performing other physical tasks.
When a muscle strain occurs, treatment may include rest, applying ice or heat, and over-the-counter pain and anti-inflammatory medications, such as ibuprofen, naproxen, or acetaminophen. These methods help reduce inflammation and discomfort. In severe cases of intercostal muscle strain, physical therapy or other medical treatment, such as injections, may be necessary. A physical therapist can help develop a list of exercises and other techniques to help reduce pain, improve mobility, and strengthen the affected muscles.Mild intercostal muscle strains commonly heal within a few days, whereas moderate strains may take three to seven weeks. Severe strains involving a complete tear can take even longer to heal.
What are the most important facts to know about an intercostal muscle strain?
An intercostal muscle strain is an injury to one or more muscles that run between the ribs. The intercostal muscles help to expand and contract the chest during breathing. Strains of these muscles can result in pain and discomfort with breathing, moving, or coughing. Intercostal muscle strains are often caused by overuse or overstretching of the muscle or by trauma, such as a direct blow to the chest or rib cage. Intercostal muscle strains can range in severity from mild to severe. Mild strains may cause discomfort but do not significantly affect daily activities, whereas severe strains can be painful and require more extensive treatment. Rest and physical therapy are the main treatments. A healthcare provider may recommend exercises to help strengthen and stretch the affected muscles. To prevent intercostal muscle strains, it is vital to warm up and stretch properly before physical activity, use proper technique when lifting heavy objects, and avoid overstretching or overexerting oneself.
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Resources for research and reference
Baker, B.A. An Old Problem: Aging and Skeletal-Muscle-Strain Injury. J Sport Rehabil. 2017 Apr;26(2):180-188. doi: 10.1123/jsr.2016-0075. Epub 2017 Jan 17. PMID: 28095141; PMCID: PMC6345250.
Christensen, H.W., Vach, W., Manniche, C., Haghfelt, T., Hartvigsen, L., Høilund-Carlsen, P.F. Palpation for muscular tenderness in the anterior chest wall: an observer reliability study. J Manipulative Physiol Ther. 2003;26(8):469-475. doi:10.1016/S0161-4754(03)00103-9
Gregory, P.L., Biswas AC, Batt ME. Musculoskeletal problems of the chest wall in athletes. Sports Med. 2002;32(4):235-250. doi:10.2165/00007256-200232040-00003
Gundersen, A., Borgstrom, H., McInnis, K.C. Trunk Injuries in Athletes. Curr Sports Med Rep. 2021;20(3):150-156. doi:10.1249/JSR.0000000000000819
Saumarez, R.C. An analysis of action of intercostal muscles in the human upper rib cage. J Appl Physiol (1985). 1986;60(2):690-701. doi:10.1152/jappl.1922.214.171.1240
Yoo, W.G. Effect of a combined thoracic and backward lifting exercise on the thoracic kyphosis angle and intercostal muscle pain. J Phys Ther Sci. 2017 Aug;29(8):1481-1482. doi: 10.1589/jpts.29.1481. Epub 2017 Aug 10. PMID: 28878487; PMCID: PMC5574339.