Intercostal muscle strains are the most common type of musculoskeletal chest pain. The intercostal muscles are thin muscles that attach between the ribs. During breathing, the external intercostals elevate the ribs while the internal intercostals depress the ribs and decrease the volume of the thoracic cavity within the ribcage during breathing.
As with any other muscle, the intercostal muscles can become strained with sudden or repetitive force, causing pain, tightness, and difficulty with everyday activities.
This article discusses signs and symptoms of an intercostal muscle strain, its common causes, and how it is treated.
Getty Images / Khosrork
Signs and Symptoms of an Intercostal Muscle Strain
An intercostal muscle strain will produce pain and tightness in the chest and/or ribs that can increase in intensity with movement of the chest, arms, and torso, or with deep breathing. Chest pain with this type of muscle strain is localized over the intercostal muscles where they attach to the ribs. It can produce a sensation of sharpness, pulling, and increased pressure. With more severe intercostal muscle strains, swelling or bruising may occur.
Intercostal Muscle Spasm vs. Other Upper Body Pain
An intercostal muscle strain can be differentiated from other conditions that cause pain in the chest and/or ribs by assessing the type of injury, precise location of pain, and whether pain changes with physical activity. Other conditions that can cause pain in the chest and/or ribs include:
Traumatic injuries such as falls or direct blows to the chest or ribs can cause subluxations or fractures of the ribs or sternoclavicular joints, where the clavicle joins the sternum in the middle of the chest.
If this type of injury occurs, X-rays can be performed to determine if there is bone or joint injury. A physical examination of the ribs, sternum, and clavicle can also help determine if pain is experienced with physical touch to these areas, or if the pain is in the muscle.
Whether chest and/or rib pain worsens with exercise can also help differentiate between types of chest pain. An intercostal muscle strain, like injury to the ribs, sternum, or clavicles, will result in increased pain with upper body movements.
Other conditions like precordial catch syndrome, a condition that causes sharp stabbing pains in the chest, and costochondritis, or inflammation of the cartilage between the ribs, are more likely to cause pain with breathing. While costochondritis can also be worsened by strenuous upper body movement such as rowing or weight lifting, pain is typically localized at the second through fifth ribs, where they join the sternum.
Cardiac problems can cause increased chest pain with exertion after physical activity, but other signs of cardiac problems are often present and can help aid in a correct diagnosis. These include symptoms like shortness of breath, fatigue, dizziness, light-headedness, irregular heart rate and rhythm, and changes in blood pressure.
Common Causes of Intercostal Muscle Strain
The intercostal muscles are the most commonly affected muscle groups in musculoskeletal causes of chest pain. Intercostal muscle strains can result from a sudden increase in activity or increased exertion and physical demands of the chest and upper body that can result from:
- Heavy lifting with twisting of the upper body
- Exercises that involve repetitive twisting or stretching, especially if performed quickly
- Sports like rowing, golfing, and tennis that require repetitive upper body force
- Activities like painting a ceiling, chopping wood, or shoveling snow
- Forceful and repeated coughing
- Injury to the chest
When to See a Healthcare Provider
Intercostal muscle strains can be difficult to identify because chest pain can result from a variety of different causes. If your chest pain lasts more than three days, it is best to schedule an appointment with a healthcare provider to determine a diagnosis.
Intercostal muscle strains are generally not very serious, but other forms of chest pain can be. Seeing a healthcare provider can help rule out other conditions to confirm that your chest pain is only coming from a muscle injury. If you have experienced a fall or direct trauma to your chest, it is especially important that you see a medical professional to make sure no bones were fractured or dislocated.
Diagnosis
Before an intercostal muscle strain is diagnosed, other causes of chest pain may need to be ruled out. An electrocardiogram (EKG) and echocardiogram (echo) may be performed to examine your heart structure and function to determine if a cardiac problem is causing your chest pain.
A neurological examination involving the range of motion of your spine, strength of your upper body, sensation, and reflexes may also be performed to screen for any neurological issues like nerve root compression that can cause chest pain.
If no signs or symptoms of cardiac or neurological conditions are present, an intercostal muscle strain can be diagnosed from a subjective medical history. This consists of the description, onset, and frequency of your symptoms, along with a physical examination of the chest muscles and surrounding structures. With an intercostal muscle strain, localized pain and tenderness will be present and will increase with stretching or contraction of the intercostal muscles.
Grading Muscle Strains
Muscle strains are graded based on the severity of injury according to the following criteria:
- Grade 1: Localized pain and tenderness at the strained muscle is present and aggravated by movement. If swelling or bruising is present, it is very minimal. Disability is minimal without a significant impact on function, limiting range of motion by 10 degrees or less.
- Grade 2: Localized pain and tenderness at the strained muscle is more substantial with moderate swelling, bruising, and stretching or tearing of muscle fibers. Loss of range of motion is less than 50% and function is significantly impacted. Considerable pain with muscle contraction occurs.
- Grade 3: Complete tear of muscle fibers resulting in more than 50% loss of range of motion, severe pain with palpation, significant loss of strength, and severe swelling, bruising, and formation of a hematoma (collection of blood outside vessels).
Treatment
Depending on the severity of your intercostal muscle strain, your healthcare provider may prescribe different treatment options to help manage your symptoms.
Muscle Relaxants
Muscle relaxants are a class of medication that can be prescribed to decrease pain and intercostal muscle spasm by blocking nerve pathways to decrease muscle contraction.
Corticosteroids and Lidocaine Injections
If an intercostal muscle spasm causes significant pain and problems breathing, an injection of a corticosteroid or lidocaine may be administered into the intercostal muscles. These medications can help decrease 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 your intercostal muscles, and correct strength imbalances of your upper body that may have led to a strain. A physical therapist can help educate you on proper body mechanics and exercises to prevent further irritation and injury.
Over-the-Counter Medication
Over-the-counter (OTC) pain medication like non-steroidal anti-inflammatory drugs (NSAIDs, such as the ibuprofens Advil and Motrin and the naproxen Aleve) can help relieve pain and inflammation.
Hot and Cold Therapy
Cold therapy to the affected area can help decrease pain intensity and swelling, if present, whereas heat therapy can help relieve tension and muscle tightness.
Breathing Exercises
The intercostal muscles move the ribs to expand and contract the chest cavity with breathing. Breathing exercises that allow the ribs to gently expand and contract can help ease intercostal muscle spasm. Holding a pillow into your chest to brace your ribs can also help decrease discomfort with deep breathing.
Epsom Salt Soaks
Taking a bath with Epsom salts can decrease muscle pain and inflammation from muscle strains. Epsom salts contain magnesium, which can help block N-methyl-d-aspartate (NMDA) receptors involved in the sensation of pain.
Outlook and Prevention
Intercostal muscle strains are common injuries that result from stress to the chest and typically heal within a few weeks. To prevent intercostal muscle strains from occurring, proper warm up for exercising and participation in sports is important to prevent sudden stress at the chest.
Summary
An intercostal muscle strain is a strain to the intercostal muscles of the chest, which are between the ribs. Intercostal muscle strains are the most common source of musculoskeletal chest pain and can result from forceful coughing, sudden twisting, or repetitive forceful motion of the chest and upper body with sports, exercises, and activities like painting a ceiling, chopping wood, or shoveling snow.
Intercostal muscle strains can range in severity, but they typically heal well within a few weeks by avoiding aggravating activities and allowing the intercostal muscles to rest and heal.
A Word From Verywell
If you experience chest pain for more than three days, it is important that you schedule an appointment with your doctor to determine the underlying cause. While intercostal muscle strains are generally not very serious and heal on their own with time, chest pain can result from a variety of different causes. Self-diagnosing can be dangerous, and it is always best to have a trained medical professional assess your health and wellbeing.
