What are the intercostal muscles?
Three layers of intercostal muscles fill the spaces between neighbouring ribs. They lift and lower the ribcage during breathing and stabilise the chest wall when you twist, push and pull. A strain is a stretch or partial tear of the muscle fibres. Because these muscles move with every breath, even a small strain can be painful, and pain on breathing can make people worry about their heart or lungs. Strains elsewhere in the chest wall are covered in our guide to chest muscle strain.
Symptoms of an intercostal strain
- Sharp or stabbing pain between the ribs, on one side of the chest or upper back.
- Pain that increases with deep breaths, coughing, sneezing or laughing.
- Pain when twisting, bending sideways or reaching overhead.
- Tenderness when pressing the area between the ribs.
- Muscle spasm or tightness.
- Shallow breathing to avoid pain.
- Bruising or swelling if there was a blow.
Causes
- Sudden twisting movements, such as in golf, tennis, baseball or rowing.
- Lifting heavy objects while twisting.
- Reaching overhead repeatedly, such as painting a ceiling.
- Prolonged or violent coughing or sneezing, for example during a chest infection.
- Falls or direct blows to the ribs.
- Sudden increases in training intensity.
Other causes of intercostal pain
- Costochondritis: inflammation where the ribs join the breastbone, tender at the front of the chest.
- Rib fracture or bruising: after a fall or impact, with severe pain on breathing.
- Intercostal neuralgia: burning or shooting pain along a rib from nerve irritation, for example after shingles or surgery.
- Shingles: burning pain on one side, followed by a rash.
- Pleurisy: sharp pain on breathing with fever or breathlessness.
- Heart or lung problems such as angina, heart attack or a blood clot, which need emergency care.
How it is diagnosed
A clinician asks how the pain started and examines the chest wall. Pain that is reproduced by pressing a specific spot and by twisting, with no breathlessness or other symptoms, supports a muscle strain. Heart rate, blood pressure, oxygen levels and listening to the lungs help rule out other causes. X-rays are used if a rib fracture or lung problem is suspected; ultrasound or MRI is occasionally used for significant tears in athletes. An ECG may be done if heart pain is possible.
Treatment and self-care
- Rest from aggravating activities for a few days, but keep moving gently.
- Ice wrapped in a cloth for 15 minutes in the first 48 hours, then heat to relax the muscle.
- Take pain relief as advised so you can breathe deeply and cough properly.
- Hold a pillow against your chest when coughing or sneezing.
- Take several slow, deep breaths every hour to prevent chest infections from shallow breathing.
- Sleep propped up or on the uninjured side if more comfortable.
- Avoid strapping the chest tightly, which restricts breathing.
Exercises and return to sport
- Deep breathing: slow breaths into the lower ribs, 5–10 times, several times a day.
- Gentle side bends away from the painful side, within comfort.
- Seated rotations with arms crossed, small range first.
- Thoracic extension over the back of a chair.
- Progressive strengthening of the trunk and shoulders once pain allows, such as band rows and side planks.
- Return to twisting sports gradually, starting with gentle swings or strokes.
Recovery time
Grade 1 strains (mild) usually heal within one to three weeks. Grade 2 strains (moderate, partial tear) may take three to six weeks, and grade 3 (complete tear, rare) longer. Pain often improves before the muscle is fully healed, so returning to heavy lifting or sport too soon can cause re-injury. A physical therapist can guide a step-by-step return. If pain is not improving after two to three weeks, or is getting worse, see a doctor to rule out other causes. For general principles of treating muscle injuries see our guide to muscle strain treatment.
Three common situations
- Rib pain after a week of coughing: intercostal strain is common after chest infections; if you also have fever, breathlessness or coloured phlegm, see a doctor about the infection itself.
- Golfer with sharp pain after a big swing: rest from golf for one to two weeks, then return with half swings and build up.
- Chest pain while lifting at the gym: if pain is clearly reproduced by pressing and twisting and there are no other symptoms, a strain is likely; any pressure-like pain, breathlessness or sweating needs emergency assessment.
Key points to remember
- Intercostal strains cause sharp rib pain with breathing, coughing and twisting.
- Most heal within one to six weeks.
- Keep breathing deeply and moving gently while it heals.
- Chest pain with warning signs needs emergency care.
Questions about intercostal muscle strain
These answers are general information and do not replace an examination or individual medical advice.
How do I know if it is a pulled muscle or my heart?
Muscle pain is usually sharp, linked to movement and breathing, and tender to press. Heart pain is more often pressure-like, may spread to the arm or jaw and comes with breathlessness, sweating or nausea. If in doubt, seek urgent assessment.
How long does a torn intercostal muscle take to heal?
Mild strains take one to three weeks; moderate tears three to six weeks; severe tears longer.
Should I use heat or ice?
Ice can help in the first two days after the injury; after that heat usually eases muscle spasm.
Can coughing cause an intercostal strain?
Yes. Prolonged or violent coughing is a common cause, especially during chest infections.
Can I exercise with an intercostal strain?
Gentle walking and breathing exercises are helpful. Avoid twisting sports and heavy lifting until pain has settled and movement is comfortable.
Sources
This guide is for general information and does not replace medical advice. How a problem is diagnosed and treated depends on your examination and medical history. If you think you have an emergency, contact your local emergency services.