Musculoskeletal system

Intercostal muscle strain: causes, symptoms, diagnosis, and treatment

Any muscle in the body can develop a muscle strain and hurt us badly. Intercostal muscle strain is more painful in comparison to the muscle strains elsewhere in the body because these muscles are present in our chest region which is the home of many of the vital organs in the body like heart and lungs. Intercostal muscle strain is also called with the names of intercostal muscle sprain and intercostals muscle spasm.

The intercostal muscles are those muscles which are present in between our ribs or in the rib cage. They help in maintaining a normally healthy function of the ribcage. There are almost 11 groups of intercostal muscles on each side of the chest. They are present between the upper and the lower ribs in the intercostal spaces.

Each group of intercostal muscles contains 3 layers. They are called as external oblique, transverse middle, and internal oblique muscles. They help in keeping the ribs in the rib cage together or attached to each other and they also regulate the movement of the rib cage with breathing.

intercostal muscle strain

What are Causes of intercostal muscle strain?

There are many different causes of intercostal muscles. Some causes of the intercostal muscle strain are related to the sudden movements of the body in various directions and sometimes this spasm of the intercostals muscles can also be caused by trauma to the chest area. Let us look at some of the most common causes of intercostal muscle strain.

Trauma to the chest wall:

Sometimes, we can suffer from sudden trauma to our chest wall muscles when we are not expecting it at all. This can happen when we become victims of various accidents, like car accidents, motorbike accidents, accidents of buses, etc.

Trauma to the chest muscles in the intercostal regions can also occur when we are playing many different sports like basketball, football, hockey, skating, gymnastics, etc. It can also result from any street fights or when some person attacks you purposefully to harm you. In any type of trauma to the chest, an intercostal muscle strain can develop and hurt you very badly.

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Not doing warm up exercises:

Doing warm up exercises is absolutely necessary before taking part in any games or sporting activity. They help your body relax and tune to get into action in the sporting activity. But, if you neglect to do warm up exercises, your muscles will develop strains very easily even with a minor twist or sudden movement.

Over exerting yourself:

Each and every person has a limit in his ability to perform physical activity. You need to be really cautious about the level to which you can perform. You should never over exert your body to perform physical tasks or taking part in games or sports.

Overexertion can lead to weakness and fatigue. This can, in turn, make you lack adequate focus and concentration on the physical task you are performing. Ultimately, you might end up hurting or straining your muscles, just like the intercostal muscle strain.

Sudden stretching:

Stretching of the body and muscles is really good for your body. But, anything good thing needs to be done in moderation. If you overdo it or do it suddenly, it can harm you. Stretching suddenly and over stretching your chest muscles can strain the muscles between the ribs and lead to intercostals muscle strain.

This can happen when you are playing any sport or game where you need to stretch a lot like tennis, badminton, basketball, volleyball.

Suddenly twisting your chest muscles:

Sometimes you might twist your chest muscles beyond the limits acceptable to your body to function normally. You might overexert yourself. This can cause intercostals muscle strain. You can twist your intercostals muscle badly when doing various dance forms which require a lot of twisting like hip hop dances, breakdance, disco dance, etc.

Swinging of arm away from chest muscles:

Sometimes you might swing your arm forcefully, that too in a direction opposite t that f your chest muscles, particularly lower chest muscles. This can lead to entrapment of the intercostals muscles between your ribs.

A lot of pressure is exerted over the intercostals muscles in such movements. This can lead to the rupture of these muscles also. It also compresses the nerves supplying these intercostals muscles leading to severe nerve pain.

What are symptoms of intercostal muscle strain?

There are many symptoms of the intercostals muscle strain. Let us look at some of the most common symptoms.

  • As the nerves in the intercostal muscles are compressed, we tend to suffer from severe pain due to intercostals muscle strain.
  • The pain is very severe, sharp and present continuously.
  • If we palpate or press the region over the intercostal muscles with our fingers, it feels really painful to palpation. This is called tenderness.
  • The pain is so severe that even normal activities that we do effortlessly like breathing, coughing can become very painful and troublesome.
  • But, if left for few days, the pain of the intercostal muscle strain will resolve by itself in few days.
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  • Inflammation can be seen over the intercostal muscles which are affected by the sprain.
  • Inflammation over the affected region appears like a big swollen area.
  • Also, there can be a development of hematoma or accumulation of blood in the subcutaneous regions which can also lead to the swelling.
Difficulty breathing:
  • Due to the intercostal muscle strain, the affected person can’t breathe properly.
  • This is because the intercostal muscles are also called respiratory muscles and they play a vital role in maintaining healthy breathing of the human body.
  • The affected person can suffer from shortness of breath as he can’t complete the full cycle of inspiration and expiration.
  • This is because he can’t move his intercostal muscles with respiration due to severe pain, and stiffness of the muscles.
Tightness of the chest wall muscles:
  • The muscle of the chest wall become extremely tight or stiff.
  • The person suffering from intercostal muscle sprain can’t move his chest muscles to turn to his sides or to do any movement with chest wall muscles.
  • The pain and stiffness of the intercostal muscles are so severe that the affected person can’t even take a breath easily.

Diagnosis of intercostal muscle strain:

The symptoms of intercostal muscle strain are so severe that a clinician will be able to diagnose that you have some problem with your chest wall by taking a proper history from you. Your clinician will also perform a detailed physical examination to assess your symptoms.

While doing a physical exam with palpation, your doctor will notice that you have severe tenderness and swelling over the intercostals muscle area. He will also notice that you are not able to move your chest normally with breathing.

But, sometimes fractures or dislocation of the ribs, herniation of the thoracic spine and some other conditions also mimic intercostals muscle strain due to their symptoms like pain.

So, you will need to undergo an X-ray of the chest to rule out such conditions. Occasionally an MRI or magnetic resonance imaging might also be needed if your symptoms are highly suspicious for some conditions and a normal X-ray is not able to rule them out.

Very rarely, an ultrasound of the chest might be needed if your physician suspects that you might have any subcutaneous blood accumulation in your muscles, which is called a hematoma.

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Treatment of intercostal muscle strain:

Take rest:

As the intercostal muscle strain is caused by sudden movements like stretching, rotation of the arm, etc, you need to avoid all sorts of movements that hurt your intercostal muscles. You just need to take adequate rest until your symptoms subside.

Apply cold compresses:

Immediately after suffering from intercostal muscles train, you need to apply a cold compress to reduce the swelling and pain. Just take few ice cubes, wrap them in a cloth and apply it to the afflicted region. But, take care not to place them over the muscles constantly. Take small breaks between the cold compress application.

Hot water fomentation:

Hot water fomentation or using a hot water bottle to gently press over the intercostals muscle strain can also relieve the pain. But, this should not be used within the first 12 hours after developing the strain as it can aggravate the swelling.

But you can use it after 12 hours to get relief from pain and swelling or inflammation. You can also use hot water fomentation along with cold compress alternatively. Both are equally effective in relieving the symptom like pain and swelling.


You can take painkillers like NSAIDS or nonsteroidal anti-inflammatory drugs like ibuprofen, aceclofenac to reduce the swelling and pain. But, make sure to take a pantoprazole tablet before your meals to avoid gastritis or the acidity symptoms which are caused by side effects of the NSAIDS.

Alternatively, you can take tablets containing muscle relaxants like chlorzoxazone which will help in relaxing the muscles which have a sprain. They are preferable over the NSAIDS as they don’t cause any acidity symptoms.

Other treatments:

Sometimes your physiotherapist might also suggest applying a splint or brace to the affected intercostal muscles for faster recovery. You can also take the help of massage to get relief from the symptoms. But it needs to be done very gently.

You can do simple stretches to alleviate the symptoms based on the advice of your physiotherapist. You also need to take slow deep breaths to avoid sudden movements of the intercostals muscles and the associated pain.

You can soak yourself in a hot water bath to get relief from pain and feel relaxed. You can add some essential oils or Epsom salt in it for pain relief. Generally, you can recover in 4 to 6 weeks from the intercostal muscle strain if you follow all the advises properly and take good care of yourself.

Otherwise, your recovery can take months if you don’t follow instructions properly. Also, if your pain is very severe, you might also need to get an intercostal nerve block or INB by your doctor at regular intervals.

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