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Pulled muscle or cracked rib: Intercostal muscle strain: Signs, treatments, and remedies

Intercostal muscle strain: Signs, treatments, and remedies

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Intercostal muscle strain is an injury affecting the muscles between two or more ribs. Symptoms include sharp, direct pain, stiffness, and mobility difficulties.

The intercostal muscles have different layers that are attached to the ribs to help build the chest wall and assist in breathing. When an intercostal muscle gets twisted, strained, or stretched too far, it can tear, causing intercostal muscle strain.

In this article, we examine the signs of an intercostal muscle strain, and how to tell one apart from other upper body pains and injuries. We also look at the causes and treatment options for these strains.

Share on PinterestSymptoms of intercostal muscle strain may include sharp upper back pain, tension in muscles, muscle spasms, and severe and sudden pain.

The signs and symptoms of an intercostal muscle strain can differ slightly, depending on their cause. Symptoms may include:

  • sharp upper back and rib pain
  • severe and sudden pain, particularly if caused by a blow to the chest or back
  • gradual worsening pain after repetitive movement, such as rowing, swimming, or other physical exercises
  • stiffness and tension in muscles, causing upper back pain
  • muscle rigidity when bending or twisting the upper body
  • worsening pain when coughing, sneezing, or breathing in deeply
  • spasms of the intercostal muscles
  • tenderness in the area between the ribs

Intercostal muscle strain vs.

other upper body pains

The upper back is rarely injured because it is relatively immobile. If this area is the cause of pain, it is often due to long-term poor posture. It can also be due to a severe injury that has weakened the sturdiness of the upper spine, such as a car accident.

Pain due to upper back injuries is usually felt as a sharp, burning pain in one spot. The pain can spread to the shoulder, neck, or elsewhere in the upper body, and it may come and go.

Intercostal muscle strain is almost always the result of some event, such as overexertion or injury. In contrast, the initial source of pain from pneumonia or other lung disorders is difficult to pinpoint.

If the specific area of discomfort can be located, such as between the ribs, this indicates the pain is not coming from the lungs or the upper back. Lung pain is usually described as sharp and spreading outward.

When a rib is fractured, the pain is usually much more severe than that of intercostal muscle strain.

The following symptoms may signal a rib fracture:

  • feeling breathless
  • a protrusion or a sharp stabbing sensation in the rib area
  • an area around the ribs that is extremely tender to touch

A fractured rib is a medical emergency requiring immediate attention.

Share on PinterestA direct blow to the ribcage may cause intercostal muscle strain.

Routine activities are not usually the cause of intercostal muscle strain. These strains most often occur as the result of an injury or overexertion of the muscles.

Common causes include:

  • a direct blow to the rib cage, such as from a fall or car accident
  • an impact blow from contact sports, such as hockey or football
  • twisting the torso beyond its normal range of motion
  • twisting while lifting weights
  • forceful twisting, such as from golf or tennis
  • twisting from specific yoga postures or dance positions
  • reaching overhead, for example, when painting a ceiling
  • lifting any heavy object above shoulder height
  • prolonged overhead reaching
  • repetitive forceful movements, such as hitting a tennis ball

A sudden increase in physical activity can also lead to an intercostal muscle strain. This is the case particularly when muscles are weakened by a lack of exercise or poor posture.

The time to see the doctor depends on the severity of the injury. A mild injury may result in a low level of pain and stiffness that goes away within a few days.

It is advisable to see a doctor if the pain is severe, lasts for more than a few days, or interferes with sleep or daily activities.

If a traumatic injury, such as a fall or an automobile accident, has occurred, or breathing is difficult, immediate medical attention is needed.

Diagnosing intercostal muscle strain involves a physical exam. The aim is to check for any limitations of movement and assess areas that are tender. The doctor will also ask about any recent injuries or sports involvement.

An X-ray or MRI scan may be ordered if the doctor rules out internal injuries, such as a fractured rib.

Share on PinterestPhysical therapy treatment, such as foam roller stretches, may be recommended for intercostal muscle strain.

Home treatment may be all that is required if the injury that causes an intercostal muscle strain is not severe and symptoms are mild. Home treatment options include the following:

  • Applying an ice pack or cold pack, followed by heat therapy. Heat therapy options include a warm bath, heating pads, or adhesive heat wraps. Cold packs and heating pads are available for purchase online.
  • Resting and limiting all physical activity for a few days to allow time for the muscle strain to recover.
  • Taking pain medications to reduce swelling and pain. Some pain medications can be purchased over the counter or online, including acetaminophen or ibuprofen.
  • Splinting the area if breathing is painful by holding a pillow against the injured muscle. However, difficulty breathing means medical attention must be obtained right away.

In addition to the home remedies described above, the doctor may order the following:

  • muscle relaxants for severe pain and spasms
  • physical therapy (PT)
  • injection of lidocaine and corticosteroids to reduce pain and swelling if other treatments fail

Physical therapy

PT may involve various stretches to strengthen intercostal muscles, foam roller stretches, and deep breathing exercises.

If difficult or painful breathing occurs, deep breathing exercises are often ordered to improve a person’s shallow breathing. Long-term shallow breathing can lead to complications, such as pneumonia.

A person with intercostal muscle strain should not do any stretching exercise unless under the supervision of a physical therapist or other healthcare providers.

Stretching should be stopped immediately if it increases pain or makes symptoms worse.

Mild intercostal muscle strain commonly heals within a few days. Moderate strains may take 3 to 7 weeks to heal, and severe strains that involve a complete tear of the muscles can take longer.

In general, most intercostal muscle sprains should heal within a 6-week time span.

Prevention of future muscle strains involves warming up and stretching before strenuous exercises are performed. It is important not to overdo it when it comes to working out or taking part in sports.

Keeping muscles strong also helps with the prevention of intercostal muscle strain.

Causes, home remedies, and prevention

Muscle aches can occur in adults and children. Causes include stress, dehydration, and underlying medical conditions.

Common causes of muscle aches include:

  • overexertion
  • trauma to an area of the body
  • viral infections

Muscle aches, also known as myalgia, can be felt in any area of the body that has muscles. Depending on the cause, the discomfort may be mild or extremely severe.

The most common causes of muscle aches include:


Share on PinterestStress can cause muscle aches, as well as headaches and shaking.

Stress makes it harder for the body to fight off disease. In people who are unwell and stressed, the muscles may ache as the body struggles to combat inflammation or infection.

Symptoms of stress include:

  • heart palpitations or an increased heart rate
  • high blood pressure
  • headaches
  • shaking
  • chest pains
  • feeling breathless or hyperventilating

People can try to combat stress by learning relaxation techniques and removing themselves from stressful situations where possible.

Nutritional deficit

A person may experience muscular aches and pains because they are not getting the proper nutrition from their diet.

Vitamin D plays a particularly important role in ensuring that the muscles function correctly. Vitamin D helps with the absorption of calcium, and a deficiency can lead to hypocalcemia.

Hypocalcemia is a condition in which the blood calcium level is low, which can affect the bones and organs in addition to the muscles.


A person who is dehydrated may experience muscle aches.

Drinking enough water is vital to keep the body functioning properly as it can quickly begin to shut down without adequate fluids. Dehydration causes essential bodily functions, such as breathing and digestion, to become more difficult.

People should be aware of how much water they are drinking. The recommended amount is 6–8 glasses of water each day. If hot weather or exercise causes a person to sweat more than usual, they will need to drink more than this.

Sprains and strains

Strains, sprains, and other injuries can cause muscle pain and discomfort.

People may find that a particular area of the body becomes stiff and achy if it is injured. Pulling muscles can also cause muscle soreness.

Some sprains and strains do not need treatment, but a person should rest, take over-the-counter (OTC) pain relievers, or use heat packs to ease the symptoms.

However, if the injury is causing significant pain, restricting normal movement, or not improving with time, it is advisable to make an appointment with a doctor.

Sleep deficiencies

A lack of sleep can have a severe impact on the body.

Sleep allows the body to rest and recuperate, and a person’s muscles may ache if they do not get enough sleep.

A lack of quality sleep can also make people feel sluggish and slow. It can affect people’s ability to think clearly and make it harder for them to carry out everyday tasks.

Too much physical activity

Overdoing exercise can lead to stiff, sore muscles.

The following factors can make a person more susceptible to muscle aches and pains when exercising:

  • being unused to exercise
  • trying a new exercise
  • exercising more intensely or for longer than usual
  • failing to warm up or stretch properly

Infections, diseases, and hereditary conditions

Many different medical issues can cause muscle aches. Conditions that most commonly affect the muscles include:

  • anemia
  • arthritis
  • chronic fatigue syndrome
  • claudication
  • dermatomyositis
  • influenza, known as flu
  • fibromyalgia
  • lupus
  • Lyme disease
  • multiple sclerosis (MS)
  • pneumonia
  • mononucleosis, often called mono

Share on PinterestA fever and dizziness can be symptoms of muscle aches.

Some people who have muscle aches may notice the following symptoms alongside the soreness and discomfort in their muscles:

  • stiffness and weakness in the affected area
  • fever
  • a rash
  • a bite mark
  • dizziness
  • difficulty breathing
  • signs of infection, such as redness and swelling

Some of these symptoms, such as a very high fever or difficulty breathing, will require immediate medical attention.

If the cause of the ache is a strain, an injury, tension, or stress, people will usually feel discomfort in a particular area.

When aches occur throughout the entire body, this is more likely to be due to an infection, medication, or underlying illness.

Home remedies are often sufficient to relieve aches resulting from minor injuries, too much exercise, or stress.

Many people can treat their symptoms using the R.I.C.E method, which involves:

  • Rest: Rest the affected area and discontinue the activity that caused the injury.
  • Ice: Use an ice pack or bag of frozen peas to help relieve pain and reduce swelling. Apply ice to the area for 15–20 minutes three times a day.
  • Compression: Use a compression bandage to help reduce swelling.
  • Elevation: If possible, elevate the feet to minimize inflammation.

Other helpful home remedies include:

  • using OTC pain relievers
  • carefully stretching out the affected muscles
  • taking part in activities that encourage relaxation and reduce stress, such as yoga and meditation

Share on PinterestA doctor should assess severe and ongoing muscle aches.

Muscle aches and pains that are severe or do not resolve may be a symptom of an underlying condition that requires medical assessment and treatment.

A person should see a doctor if they:

  • notice any signs of infection, such as redness and swelling
  • have a tick bite
  • develop a rash
  • believe that medication is causing the muscle pain

It is crucial to seek immediate medical assistance if muscle pain occurs alongside:

  • difficulty breathing
  • difficulty swallowing
  • feeling dizzy
  • a stiff neck and high fever
  • muscle weakness
  • an inability to move the affected area
  • vomiting
  • a reduction in urine volume or sudden water retention

People may be able to prevent aching muscles from occurring due to tension, stress, and intense physical activity by doing the following:

  • stretching before exercising
  • exercising regularly to keep muscles toned
  • warming up before exercise and cooling down afterward
  • taking regular breaks if sitting for extended periods

Most causes of muscle aches are benign, but persistent aching may require medical care.