Intercostal Muscle Strain

by / Tuesday, 16 July 2019 / Published in Blog, Orthopedic

Intercostal muscle strain is an injury affecting the muscles between the ribs. These muscles help build the chest wall and assist in breathing by lifting the rib cage and thereby expanding the chest cavity. An intercostal muscle strain occurs when an intercostal muscle gets twisted, strained, or stretched too far.

Signs and symptoms and the intercostal muscle strain may include sharp upper back pain, tension in muscles, muscle spasms, and severe and sudden pain. This pain may be gradually worsening in some cases, especially on repetitive movements, such as rowing, swimming, or other physical exercises. There may be associated with stiffness, spasms, and tension in muscles, causing upper back pain, along with tenderness in the overlying skin.

A fractured rib is a medical emergency and must be immediately diagnosed and treated

Intercostal muscle strain may be confused with upper body pain, which is likely due to strain from poor body posture, but it can also be due to a severe injury that has weakened the sturdiness of the upper spine, such as a car accident. These types of injuries cause sharp, burning pain that is well-localized, but it can spread to the shoulder, neck, or elsewhere in the upper body. On the other hand, intercostal muscle strain is usually secondary to overexertion or injury. This condition is also to be differentiated from parenchymal lung or pleural pain which is usually sharp and spreading outward. Also in the differential can be a fractured rib, which is invariably more painful with associated breathlessness, likely with protrusion or a sharp stabbing sensation in the rib area, and extreme point tenderness. A fractured rib is a medical emergency and must be immediately diagnosed and treated.

The most common cause of intercostal muscle strain includes a direct injury to the rib cage. Routine activities do not usually cause intercostal muscle strain. Other common causes include: an impact blow from contact sports, twisting the torso beyond its normal range of motion, twisting while lifting weights, forceful twisting, such as golf or tennis, twisting from specific yoga postures or dance positions, reaching overhead, for example, when painting a ceiling, lifting any heavy objects above shoulder height, prolonged overhead reaching, and repetitive forceful movements, such as hitting a tennis ball. A sudden increase in physical activity can also lead to an intercostal muscle strain, particularly when muscles are weakened by a lack of exercise or poor posture.


After such an injury has occurred, it may be necessary to see a doctor if the symptoms are severe. In case of a mild injury, the symptoms are self-limiting, but if the pain is severe, lasting for more than a few days, or interferes with sleep or daily activities, then it is necessary to see a doctor. If the injury has led to difficulty in breathing, immediate medical attention is needed.


Diagnosing intercostal muscle strain is based on history and physical exam. The examination will reveal the limitations of movement and areas of tenderness. An X-ray or MRI scan may be ordered if the doctor rules out internal injuries, such as a fractured rib.

Treatment is based on the severity and extent of the injury and includes physical therapy, ice packs followed by heat therapy, along with rest and limiting all physical activity for a few days to allow time for the muscle strain to recover. Splinting the area may be necessary if breathing is painful. If there are severe spasms, then muscle relaxants may also be prescribed.