How to Cope with an Intercostal Muscle Strain

You finally said goodbye to bronchitis and its earth-shaking cough. But now, you’re left with rib muscle pain that taunts you with every breath. Or, maybe you were a little too enthusiastic about that new exercise program, and the muscles between your ribs won’t stop screaming in protest. What’s going on? You could be dealing with an intercostal muscle strain.

“Intercostal muscle strain can be scary if you don’t know its cause, and it feels quite intense,” says internal medicine specialist Janet Morgan, MD. 

So, what are intercostal muscles — and how do you strain them? Keep reading to learn more about this common condition and what you can do to alleviate the pain.

The intercostal muscles and causes of strain

Your intercostal muscles are the muscles between your ribs. They allow your ribcage to expand and contract so you can breathe. But if they stretch too far or tear, intercostal muscle strain is the end result.

You can strain the intercostal muscles suddenly or by doing certain movements over and over.

Common causes include:

• Coughing.
• Exercises or sports with repetitive movements, twisting, lifting or stretching.
• Injuries to the chest from a fall or hard hit.
• Twisting beyond your normal range of motion.

“Breathing can be painful, especially deep breaths,” says Dr. Morgan. “But what muddies the picture is that sometimes, painful breathing can be a sign of something serious, such as pneumonia or a blood clot in the lung. So we often end up doing X-rays to make sure there isn’t something else going on.”

Who’s most at risk for muscle strains in the chest?

Intercostal muscle strain is one of the most common causes of musculoskeletal chest pain. But age or a sedentary lifestyle can place you at higher risk. “Someone who’s older with thinner muscles could strain rib muscles a lot easier than someone who works out and has built up their muscles,” notes Dr. Morgan.

Intercostal muscle strain or pneumonia: how to tell the difference

Because intercostal muscle strain and pneumonia both cause chest pain, it can be hard to know the difference. But there are some telltale signs:

Dr. Morgan notes that intercostal muscle strain is more tender and painful when you touch the affected area. “Pain when you twist or bend over can also be a sign,” she notes. “But these symptoms aren’t a 100% guarantee that it’s an intercostal muscle strain, so still keep pneumonia in the back of your mind.”

Other symptoms of an intercostal muscle strain include:

• Pain when you breathe, cough or sneeze.
• Pain when you move the affected muscles.
• Swelling in the area.
• Muscle tightness and soreness.

Dr. Morgan urges you to avoid self-diagnosis, especially if the pain is severe. “I’d rather people have their provider make that call than assume they’re OK. We need to hear the whole constellation of symptoms to rule out something more serious, such as rib fracture or even cancer,” she says. “It’s important to check in with your provider via phone or a virtual visit to make sure nothing is missed.”

How to find relief from intercostal muscle strain pain

While you await your appointment, Dr. Morgan recommends these steps to take the edge off:

• Good old-fashioned rest: If you were working out hard, rest the area for 24 to 48 hours.

• Brace yourself: “If you have a cold, and coughing made you pull your muscle, sometimes taking a small pillow and bracing as you cough helps with the pain,” Dr. Morgan suggests.

• Turn up (or down) the temperature: “If your pain has started within the day, you can try ice or heat,” recommends Dr. Morgan. “Generally, with a strain, we start with ice packs for 10 to 15 minutes a couple of times that day. But let your body tell you what works best.”

• Over-the-counter pain relievers. “If your kidney function’s OK, and you don’t have an underlying condition or suspect COVID-19, try ibuprofen with food. Acetaminophen may help as well. But get some direction from your doctor first.”

• Yoga … maybe: Yoga can also help, but Dr. Morgan says those down dogs should be cleared by your doctor. “I worry that people may overdo it. Sometimes stretching can make it a little worse.”

Treatments for intercostal muscle strain

If home remedies and rest aren’t enough, your doctor may recommend:

• An ultrasound device: These wearable devices use ultrasound energy to help you heal.
• Ointments and emollients: “Use these under the direction of your healthcare provider because you have to be careful when combining them with heat,” says Dr. Morgan.
• Physical therapy: This may be the route to take if you’ve been dealing with an intercostal muscle strain for a while. “Physical therapists use tools that really help, such as safe stretching exercises and transcutaneous electrical nerve stimulation (TENS) units that they place on you.”

Even with your provider’s help, muscle strains of any kind take about four to six weeks to completely heal. But with patience and time, you’ll be pain-free before you know it.