Last reviewed by Dr. Raj MD on January 12th, 2022.
There are twelve vertebrae in the thoracic spine. Each of them is connected to a pair of ribs. The one that is connected directly to the chest bone is the upper seven ribs. Hence, they are called true ribs.
The remaining five ribs are called false ribs or floating ribs because they aren’t directly connected to the sternum. These ribs are held by intercostal muscles and located in between the ribs. The function of the intercostal muscle is to move and stabilize the chest wall. (1, 3)
For some reasons, the intercostal muscles can become strained. The strain is categorized into three. These are the following:
- Grade I – Mild strain and only a few muscle fiber is affected. It would take two to three works for the strain to completely go away.
- Grade II – A moderate muscle strain causing extensive damage to the muscle fiber. It takes three to six weeks for the muscles to completely heal.
- Grade III – A severe strain with a complete rupture of the intercostal muscles. It would take several months for the strain to completely heal. (2, 4, 5)
Image 1: An anatomical view of the internal and external intercostal muscle.
Picture Source: www.epainassist.com
Photo 2: A view of the different grading system for muscle strain.
Image Source: www.muscle-pull.com
Intercostal Muscle Strain Symptoms
- A stabbing, sharp pain when breathing
- Pain and soreness around the ribcage
- Deep breathing can aggravate the pain
- Twisting and side bending can cause severe pain
- The patient will complain of sudden tearing pain in the rib area
- The ribs are tender to touch and can be felt over the ribs
- There is a painful bruising
- The patient is unable to wear tight upper body clothing because of the pain and discomfort in the rib cage.
- There is hematoma (swelling filled with blood)
- The patient complains of muscle tightness, which is severe in the injured ribs
- The patient finds it difficult to take a deep breath
- The patient has difficulty moving the arms and chest area (1, 4, 6, 7)
Intercostal muscle strain causes
- Blow to the chest wall – A direct blow to the chest can strain the rib muscles. Circumstances that can lead to a direct blow to the chest wall are:
- Car accident
- Sports-related injury
- Work-related injury (5, 10)
- Twisting of the body (upper part) – If you twist your body over its limit, it can cause intercostal muscle strain.
- Forceful swinging of the arm – Swinging the arm with great force can stretch the ribs, especially if you twist the lower half of the body away from the arm swing.
- Prolonged coughing/asthma – You can get intercostal muscle strain from coughing, especially if you have asthma or your coughing has been going on for a long time. (5, 6)
Diagnosing intercostal muscle strain
A patient complaining of intercostal muscle pain left side along with intercostal muscle inflammation and spam is subject to diagnostic procedures to rule out the exact condition of the patient and any underlying causes. A physiotherapist will conduct a thorough subjective and objective examination of the patient. Diagnostic procedures are ordered such as x-ray, CT scan/ultrasound, and MRI. (6, 8)
Intercostal Muscle Strain Treatment
Immobilized the affected part of the ribs
It is important to keep the affected ribs rested. Do not exert too much effort, especially on your upper body. This treatment approach is ideal for patients with moderate to severe intercostal muscle strain.
Apply hot and cold compress
On the first day of the intercostal muscle strain, you should apply an ice pack on the affected part and then alternating with hot packs. The heat will promote the proper circulation of blood in the affected area while the cold pack reduces swelling and inflammation. Alternate hot and cold compress should be done at least three to four times a day. (7, 9, 10)
Deep breathing exercises
Patients are strongly advised to incorporate deep breathing as a part of the intercostal muscle exercises. Slowly breathe in to open your lungs and hold your breath for a few seconds and slowly breathe out. Do this at least once every hour to prevent pneumonia. Not breathing the right way could result to further complications as the injured muscles are not receiving adequate amount of oxygen. Patients with intercostal muscle strain are discouraged to smoke as it increases the possibility of pneumonia and other lung-related disease. (2, 3, 4)
Epsom Salt Soaks
An intercostal muscle strain can be relieved using Epsom salt soak. It is a magnesium salt proven effective in alleviating muscle pain. All you need to do is to fill your tub with hot water and add two cups of Epsom salt. Soak in the tub. Do not get out of the water until the water cools.
Some forms of exercise are needed to restore the mobility of the joints, strengthen the muscles of the back, improve the range of motion, and decrease the stress on the spinal joints, neck, and disc. A neuromuscular re-education is also important in order to improve the posture of the patient and restore the body’s stability. (4, 7)
Other treatment approach
Depending on the severity of the condition, various modalities can be added such as cold laser to reduce the pain and inflammation. If the pain is intense, the patient should take pain relievers such as paracetamol. Non-steroidal anti-inflammatory drugs should only be taken under the supervision of the doctor because they can delay the healing in patients with intercostal muscle strain.
Patients with intercostal muscle strain should avoid doing things that can further complicate the condition. As long as you can, you should get your body moving. Not moving increases the risk of muscle wasting, chest infection, and even the possibility of developing deep vein thrombosis.
The recovery period for intercostal muscle strain varies depending on the severity of condition. For mild cases, the recovery period usually takes to weeks. For moderate strain, it would take around four to six weeks. Severe cases can take months to heal. Well, it depends on the extent of the injury and the treatment modalities used. If you feel like something is unusual in your intercostal muscle, then you need to see your doctor right away. Early detection is the key to successful treatment. (6, 8, 9)
- Manual of Sports Medicine edited by Marc R. Safran, Douglas McKeag, Steven P. Van Camp