Intercostal Muscle Strain: Understanding Rib Pain, Healing, and Recovery

Key takeaways:

• An intercostal muscle strain occurs when the muscles between the ribs are overstretched or torn. Symptoms may include rib pain with movement, tenderness to the touch, difficulty breathing, and bruising or swelling.

• Activities that involve vigorous upper-body movements or sudden twisting -- such as shoveling or playing golf -- can cause an intercostal muscle strain. It can also be caused by trauma, such as a car accident or a hit to the ribs.

• Home treatment, such as rest, ice or heat therapy, and over-the-counter pain medication, can improve symptoms.

Table of contents

Causes

Symptoms

Diagnosis

Treatment

Bottom line

References

kasipat /iStock via Getty Images Plus

An intercostal muscle strain occurs when the muscles between the ribs are pulled, stretched, or torn. It may cause rib pain and discomfort with movement and breathing.

You have 12 ribs on each side, and your intercostal muscles attach between the ribs. When you breathe, your intercostal muscles move your ribcage up and down. They also help support your chest during activities. With an intercostal muscle strain, these muscles get pulled or partially torn.

This type of injury is fairly common. Chest pain results in more than 7 million visits to the emergency room each year in the U.S. Of those visits, up to 49% are diagnosed with musculoskeletal chest pain. The intercostal muscles are the most common muscles strained in your chest, followed by the pectoralis muscles.

Luckily, you can often manage an intercostal muscle strain at home. Here's what you need to know.

What causes an intercostal muscle strain?

Various activities, movements, or injuries can strain the intercostal muscles, including the following:

• Overuse: An increase in repetitive or forceful upper-body movements, such as painting the ceiling, heavy lifting, chopping wood, shoveling snow, or rowing

• Sudden twisting or turning: Fast twisting or turning motions, such as with baseball, golf, basketball, tennis, or dancing

• Trauma: Falling, a car accident, or being hit in the ribcage, which may occur in sports like football or boxing

• Repetitive coughing or sneezing: Repeated or forceful coughing and sneezing, which make the intercostal muscles contract suddenly and can lead to a strain

EXPERT PICKS: WHAT TO READ NEXT

• Breathing exercises: Different techniques can strengthen the intercostal muscles and relieve stress. Get started with these breathing exercises.

• Chest wall pain: An intercostal muscle strain might be confused with a bruised or broken rib. Learn how to tell the difference between the two.

• Can you break a rib from coughing? Yes, and here's what to do about it.

What does a pulled intercostal muscle feel like?

You can likely pinpoint the activity or incident that causes an intercostal muscle strain. Common symptoms include:

• Soreness to the touch: You may have muscle tenderness and pain when you touch the area between your ribs.

• Pain with movement: Stretching your arms overhead, coughing, sneezing, and twisting or turning can increase the pain.

• Difficulty breathing: You may have pain when taking a deep breath, resulting in shallow breathing or feeling out of breath.

• Difficulty sleeping: You may have pain with sleeping and have difficulty finding a comfortable position.

• Swelling and bruising: Depending on how severe your strain is, a muscle tear can result in swelling and bruising.

• Stiffness: You might notice muscle stiffness with turning, twisting, or reaching overhead.

What can intercostal muscle pain be confused with?

Several conditions that cause rib or chest pain can be confused with an intercostal muscle strain. These include:

• Rib fracture

• Clavicle fracture

• Costochondritis

• Pectoralis muscle strain

• Pleurisy

• Cardiac or heart issues

• Sternoclavicular (SC) joint injury

• Slipping rib syndrome

• Precordial catch syndrome

• Tietze syndrome

• Cervical disc disease

• Subluxated rib

• Fibromyalgia

• Referred pain from conditions in the lungs, esophagus, and heart

Diagnosing a torn intercostal muscle

A healthcare professional will consider several factors when diagnosing an intercostal muscle strain. These include what caused the injury, symptoms, where the pain is, and what makes it worse.

If you have chest pain, a healthcare professional will rule out serious conditions, such as heart issues or fractures. If you have chest pain that also goes down your left arm or up to your jaw, this could be a sign of a heart attack, which requires immediate medical attention.

You may need special tests, such as an echocardiogram and electrocardiogram, to rule out heart issues. An X-ray or MRI may be ordered to rule out fractures, especially if your pain started after trauma, such as a car accident.

An intercostal muscle strain often results from overuse or a vigorous activity involving twisting or turning. Your healthcare professional grades your muscle strain, depending on its severity.

• Grade 1: You have localized tenderness to the touch and increased pain with movement. There may be minor swelling but little to no bruising. There's minimal loss of function, with your range of motion or movement affected by just 10 degrees or less. You may have a small muscle tear.

• Grade 2: You have substantial pain to the touch in a larger area. You may have moderate swelling and bruising. There's considerable pain with movement, which restricts your movement by 50%. You may have a larger muscle tear.

• Grade 3: You have a complete tear of the muscle fibers. Considerable pain to the touch usually develops 1 hour after the injury. You have swelling, significant bruising, and severe pain with movement. You may also have a bump or hematoma where the muscle tore. And your range of motion is limited by more than 50%.

Treatment options for strained intercostal muscles

Most intercostal muscle strains can be treated at home. Recovery time depends on the severity of the injury. Typically, grade 1 strains heal in 2 to 4 weeks, while grade 2 strains can take up to 2 months. Grade 3 strains often take 6 to 9 months or longer to heal.

The following treatment options may improve symptoms of an intercostal muscle strain.

• A short course of pain relievers: You can take over-the-counter (OTC) pain relievers like acetaminophen (Tylenol). Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin) or naproxen (Aleve), can help reduce inflammation and pain.

• Heat or cold therapy: For the first 48 hours, you should use an ice pack to reduce inflammation and help decrease pain. After that, switch to a heating pad to increase circulation, promote healing, and reduce muscle tension.

• Activity modification: Avoid doing any activities that increase pain, such as twisting or repetitive overhead movements. Gradually return to any sports as your pain and movement allow.

• Epsom salt bath: An Epsom salt bath may help promote healing. Epsom salt contains magnesium, a naturally occurring mineral salt that may decrease pain and inflammation. Although more studies are needed to verify effectiveness.

• Muscle relaxants: A healthcare professional may prescribe a short dose of muscle relaxants if you have muscle spasms.

• Physical therapy: A physical therapist can use treatments, such as transcutaneous electrical nerve stimulation or TENS, to help treat the pain. They can also instruct you on breathing exercises and other exercises to improve mobility and strength. They may also help adapt your chair or bed to allow you to function without pain as you heal.

• Corticosteroids and lidocaine injections: If you have severe or chronic pain, a specialist may inject the muscle with corticosteroids and lidocaine. This will help reduce pain, inflammation, and swelling.

• Breathing exercises: If you're taking shallow breaths due to pain, it's important to startbreathing exercises. They can help reduce your chance of getting lung infections or pneumonia. Breathing exercises may also improve circulation to your healing ribs and relieve stress.

The bottom line

An intercostal muscle strain is a common injury that results in rib tenderness and pain with movement. You may also have pain with breathing, as well as sleeping. Trauma from an accident or activities that involve vigorous upper-body moves or repetitive twisting can cause this injury.

Fortunately, intercostal muscle strains can often be treated at home. Rest, ice, pain medications, and breathing exercises may improve symptoms. Depending on the severity of the injury, it may take as little as 2 weeks or up to 9 months to heal. You can talk to a healthcare professional for a proper diagnosis.

References

Aibinder, W. R., et al. (2017). Sternoclavicular (SC) joint disorders. OrthoInfo.

Ayloo, A., et al. (2013). Evaluation and treatment of musculoskeletal chest pain. Primary Care: Clinics in Office Practice.

View All References (8)

expand_more

Grassi, A., et al. (2016). An update on the grading of muscle injuries: A narrative review from clinical to comprehensive systems. Joints.

Gröber, U., et al. (2017). Myth or reality-transdermal magnesium?Nutrients.

Hunter, M. P., et al. (2023). Pleurisy. StatPearls.

Khadavi, M. J., et al. (2015). Chest pain in athletes from personal history section (musculoskeletal causes). Current Sports Medicine Reports.

Moran, B., et al. (2017). Diagnostic evaluation of nontraumatic chest pain in athletes. Current Sports Medicine Reports.

Rosenberg, M., et al. (2024). Tietze syndrome. StatPearls.

Schumann, J. A., et al. (2024). Costochondritis. StatPearls.

Tang, A., et al. (2023). Anatomy, thorax, muscles. StatPearls.

GoodRx Health has strict sourcing policies and relies on primary sources such as medical organizations, governmental agencies, academic institutions, and peer-reviewed scientific journals. Learn more about how we ensure our content is accurate, thorough, and unbiased by reading our editorial guidelines.

Was this page helpful?

thumb_up_outlinedthumb_down_outlined

print_outlinedemail_outlined

Get the facts on Musculoskeletal Health. Sign up for our newsletter to get expert tips on condition management and prescription savings.

Email address

Subscribe

I would also like to sign up for a free GoodRx account

By signing up, I agree to GoodRx's Terms and Privacy Policy, and to receive marketing messages from GoodRx.