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What Causes Intercostal Muscle Strain?

Intercostal muscles are muscles that present within the rib cage. Contain three layers of muscles: external, inner, and innermost layers. They combine to fill up the area in between the ribs. External intercostals muscles are the outermost layer. It lies directly under the skin originating from the lower border of the rib and runs obliquely and into the top boundary of the rib below.

It expands the chest wall surface during inhalation. Inner intercostals, the intermediate layer, originate from the costal groove near the inferior boundary of the rib above to the upper border of the rib below. They also help to collapse the Lung during expiration. Inner intercostals muscle crosses more than one intercostal space. It also helps the inner and external intercostals in their function.

Intercostal muscle strain differs according to the type and intensity of the injury. The strain of intercostal muscles causes rib/chest pain, upper back pain, and affects the breathing pattern. The person will have a short breathing pattern because of discomfort. It is an injury that affects the muscles between 2 or more ribs.

intercostal muscle strain

Mechanism of Injury

Intercostal muscle pressure doesn't happen with usual daily tasks. It occurs when the muscles are weakened. It can be caused by overexertion of muscles, direct injury from falling or cars and truck crash, or strike in sports such as hockey, or repetitive torso turning.

  • A direct blow to the rib cage: such as falling, automobile mishap, or trauma from contact sporting activities such as football, hockey. In which the intercostal muscles will stretch or tear as ribs are suddenly compelled to move apart.
  • Turning the torso: turning while training, from dancing, yoga poses, and also some sports such as tennis, golf. In which the ribs are moved apart from its usual place. Excessive torso turning may take place throughout sporting activities.
  • Reaching overhead: extended time of above tasks or lifting over shoulder undue stress on the muscles, as in painting the ceiling.
  • Recurring forceful activity: such as rowing, hitting a tennis sphere.

intercostal muscle strain from coughing

Intercostal Muscle Strain Risk Factors

  • Physical labor. Such as activities that consist of repeated turning, prolonged overhead tasks, constant weight lifting.
  • High-thrust sporting activities. Repetitive use of the arm, shoulder, and upper back puts tension on intercostal muscle mass.
  • Contact sporting activities. A strain occurs when a direct, sudden pressure strikes the top body.

intercostal muscle strain symptoms

Intercostal Muscle Strain Symptoms

Symptoms vary according to the level of muscle pressure, strength, and type of injury:

  • Severe unexpected pain in the upper back or rib cage. It can be a result of a direct blow or sudden pressure to the chest or unexpected increase in the exercise.
  • Muscle tension and stiffness cause muscles to respond to injury by tightening, creating upper back pain, and stiffness with activity.
  • Gradual worsening pain. Pain is aggravating within days or weeks if the intercostal muscular tissues are still under the tension of repetitive, steady pressure. This type prevails after sports such as baseball.
  • Difficulty breathing, with an intercostal muscle strain, the breathing pattern will be affected by pain. It will be a short, shallow breathing pattern to avoid pain. That may cause much less blood oxygenation.
  • Tenderness of the affected muscles and surrounding ribs.
  • Inflammation. A strained muscle may be associated with swelling and an increased level of sensitivity in the damaged area.
  • In some rare instances, swelling of intercostal muscles causes a blood clot around the muscle, triggering a hematoma.
  • Pain from intercostal muscle strain increases with coughing, sneezing, or breathing deeply.


intercostal muscles

Diagnosing Intercostal Muscle Strain

Diagnosing imaging X-ray, MRI not needed for the medical diagnosis of intercostal stress, but it's used to eliminate the possibility of rib fracture or internal organ injury.

Medical diagnosis is based on individual background and also physical exam:

  • Personal history. You will be asked about symptoms, when and how the pain started if there is a history of current trauma, your exercises.
  • Physical exam, palpation to specify the area of tenderness and swelling. Instructions to do active activities of the torso/trunk to understand to what level it affects the function and also movement.

Differential Medical diagnosis:

Intercostal muscle pressure may be mistaken for upper back pain. It is reasonably hypermobile, and injury is unusual. Upper back pain is caused by bad posture for a long time. It is a sharp burning pain that can spread out to the neck, shoulder, and also the discomfort is periodic. 

An intercostal strain is a result of trauma from the overexertion task. The individual can locate its area of discomfort. Unlike the pain from a lung disorder, it is tough to identify.


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intercostal muscle strain treatment



Recovery relies on the severity of the injury. The time varies from a couple of days to 8 weeks in the majority of cases. However, in some cases, it lasts longer and causes upper back pain. The very first advice is relaxing for a few days as well as applying ice back in the very first two days of discomfort to remove the swelling.

Try holding a cushion to stabilize the injured, painful area throughout deep breathing as well as coughing.

Medical Management:

  • Pain relief medication. These include acetaminophen to disrupt discomfort signals sent to the brain as well as reduce overall discomfort levels.
  • Muscle relaxant medications. In acute severe discomfort for a short term effect to reduce muscle tension and spasm.
  • Anti-inflammatory medicines.


why do my ribs hurt

Physical Treatment

Physical treatment starts as soon as the swelling is decreased. It will concentrate on pain relief modalities, stretching under guidance, strengthening exercises for endurance, improving posture, and also breathing exercises.

While deep breathing workout, the patient is instructed to use diaphragmatic breathing, holding a cushion supporting the painful area.

Tight muscles can cause muscle discrepancy. Stretching under the guidance within the limit of pain such as roller stretch, some yoga exercise, or upper back expansion can help. However, if the strain is triggered by overstretching of the muscle, the extra stretch may aggravate pain and cause muscle weakness. This needs to be managed by a strengthening program.

A strengthening workout if there's muscular tissue discrepancy. Try thoracic expansion exercises with breath-holding for a couple of seconds, breathing out gradually, or backward weight training exercise. These have shown to improve thoracic kyphosis and reduce intercostal muscular tissue pain.


external intercostal muscles

Home Treatment or how to cope until your doctor's appointment

If you assume you have injured your ribs' muscles, make an appointment with your physician. They can determine which muscle has been strained and make sure you have not wounded some other structure in your chest.

Your medical professional will give you a complete therapy plan. However, in the meantime, prevent turning and reaching movements that make the pain even worse. You can likewise try these approaches for relief:

  • Over-the-counter painkillers

While you wait to see your medical professional, you can take over the counter anti-inflammatories like ibuprofen (Advil) or naproxen (Aleve), or primary pain relievers like acetaminophen (Tylenol). Follow the package instructions for how much and also how often to take these medications.

You need to additionally make sure that you're not overmedicating by taking several medications that contain pain relievers. These can include medicines for colds or menstrual aches. Talk to your medical professional before taking over-the-counter medicine along with your regular drug.

  • Hot and cold treatment

Cold therapy can assist reduce your pain and also decrease swelling of the muscle mass. Use an ice bag to the injured area for 20 minutes at a time, several times a day for the first two days. You can use an ice bag, a cold gel pack, a plastic bag with ice wrapped in a towel, or perhaps a bag of frozen veggies.

After the very first two days, you might intend to begin utilizing warm on the damaged ribs. Warmth can help loosen and also loosen up the muscular tissues so you can do your physical treatment. You can use warmth for 20 minutes at once with a hot pad or a cozy damp towel.

Learn more about heat and ice treatment HERE

  • Epsom salt soaks

As part of your heat treatment, you might want to take a cozy bath with magnesium sulfate (Epsom salts). You can discover Epsom salts at your neighborhood medication shop or online. Just add about 2 cups to your bathroom, and soak for 15 or more minutes.

The liquified minerals soak up through your skin and might slightly increase your blood levels of magnesium. Magnesium is an essential mineral for muscle function. Although the small amount of magnesium absorbed from your bath is unlikely to do anything to help your stretched muscles. However, the warm bathroom can help you relax.

  • Breathing exercises

Breathing with an intercostal muscle strain is painful. However, taking only shallow breaths - instead of full, deep breaths - can result in infection and pneumonia. Deep breathing exercises can, likewise, be a type of meditation to decrease stress.

Attempt to do a few mins of breathing workouts every hour. As an example:

  1. Hold a pillow against your hurt muscles.
  2. Breathe in slowly and also as deeply as you can.
  3. Hold the breath for a couple of secs.
  4. Breathe out slowly.
  5. Repeat ten times.

Once you see your doctor, they may send you home with a spirometer, a plastic tool that offers you a visual clue to how deeply you should breathe.

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