Intercostal muscle strain is a condition that appears as a tear and striking pain in the intercostal muscles between the ribs.
This rupture of intercostal muscles is due to sharp or sudden movements of the upper body which cause a stabbing pain and soreness in the ribcage. It is frequently seen in athletes, dancers, and people with a very active lifestyle.
Table of Contents
What Are Intercostal Muscles?
The intercostal muscles consist of several groups of muscles located between the ribs. There are in total, 11 groups of muscles on the right and left side. There are three layers of intercostal muscles attached to the upper and lower rib known as intercostal space.
These three layers include an outer layer known as external oblique, a middle layer called transverse intercostal muscles and inner layer known as internal oblique intercostal muscles.
The outer and inner intercostal muscle fibers run in opposite oblique direction and the middle muscle layer runs in the horizontal direction.
Functions Of Intercostal Muscles
1. They allow the inward and outward movement of the chest during respiration.
2. They help in forming the chest walls and stabilizing them.
3. They connect one rib to another
Intercostal Muscle Strain
The intercostal muscles can become strained due to very rapid movements or twisting of the torso. This can be very painful since the lungs are housed in the rib cage and the slightest strain can lead to a stabbing feeling in the chest while breathing.
The injury most commonly occurs after some vigorous activity that involves twisting of the torso – like lifting heavy objects, movements involving excessive rotation of ribcage or stretching the arms out excessively.
It can occur in any age or gender. However, it is most common in sportspersons, dancers and gymnasts.
Causes Of Intercostal Muscle Strain
The strain of muscle occurs when it is stretched or pressurized. This might happen during a strenuous physical activity that exerts an excess force on the rib cage.
Here are the most common causes for the intercostal muscles to strain:
1. Twisting Of The Upper Body
Injuries caused by excessive twisting of the torso stretches the intercostal space. Stretched intercostal space stretches the intercostal muscles and results in intercostal muscle sprain.
Any forceful physical activity which exerts a lot of pressure on the ribcage can result in Intercostal Muscle sprain.
2. Overstretching
It is possible to strain or even rupture the muscles in the ribs even during gentle stretching. In case of excessive stretching or pulling of the ribs, it can cause serious damage as the intercostal nerves might get trapped between the ribs and muscles.
This can lead to severe spasms and acute nerve pain along with the strain.
3. Forceful Swinging Of Arm
Swinging the upper arm causes rapid movement in the rib cage and pulls the intercostal muscles vigorously. Additionally, twisting of the lower body in the opposite direction while the upper arm is swinging results in intercostal muscle tear or twist.
4. Direct Impact On The Chest Wall
This can happen due to car accidents, injury while playing sports (football, karate, hockey), work injuries or a violent assault (fight).
5. Excessive Movement During Sports Activities
People who play games like badminton, tennis, throwing, basketball, etc often have to exert a lot of force with their bodies.
This causes a large impact to the rib cage and intercostal muscles during excessive movement of the torso leading to straining and tearing of muscles.
Other Causes That May Lead To Intercostal Muscle Injury Include
- Excessive physical training
- Poor postures during physical activities
- Fatigue and weakness
- Lack of proper rest after physical exercises
- Previous experience of injury in the lower back
Grading
The degree of straining of muscles is classified into three grades:
a. Grade I
It is characterized by a mild muscle strain wherein only few muscle fibers are damaged. The healing time is about two to three weeks.
b. Grade II
It is characterized by a moderate muscle strain wherein some more muscle fibers are involved, but the muscles are not ruptured. Healing time is about three to six weeks.
c. Grade III
It is characterized by severe injury and complete rupture of the muscles. Typically, surgical intervention is required to heal the torn muscles. Healing may take a long time i.e. up to three months.
Symptoms Of Intercostal Muscle Strain
The symptoms of intercostal muscle strain include acute pain, swelling, muscle tightness, tenderness, bruising and difficulty in breathing. The degree of these symptoms can vary from person to person according to the injury.
Hence, it is important to immediately visit a doctor in case of a muscle strain as it can be quite a serious condition in some cases.
Here are the symptoms of intercostal muscle strain in detail:
i. Pain
There is an intense localized pain in the strained muscles. Also, there is a sharp, shooting and stabbing pain in the chest region. The pain intensifies with movement, running, jumping, twisting, coughing or sneezing.
Usually, it is a self-resolving condition, i.e. if it is a mild strain, then the pain goes away in a day or two.
ii. Swelling
Severe swelling is observed over the strained intercostal muscles. Even the ribs around the area of injury experience swelling. Swelling is secondary to a subcutaneous hematoma (the swollen area is filled with blood) and also, there is inflammation of the muscles.
iii. Muscle Tightness
Along with pain and swelling, the muscles of the chest wall may feel tight. This tightness is localized in the area of the injury. Taking deep breaths may feel difficult and hence the patient may prefer to take shallow breaths.
It may also be hard to move the chest area and the arms due to the stiffness.
iv. Tenderness
There is often a tenderness over the ribs due to the injury. Whenever the ribs are touched or pressed, you may feel some tenderness in the rib cage.
It is accompanied by sharp pain in the chest wall and the patient feels unable to wear tight or fitting clothes because of the ache.
v. Bruising
The injury causes bruising of the side of the chest due to torn blood vessels. This is accompanied by soreness around the rib cage.
vi. Difficulty In Breathing
Because of the constant pain in the chest region, it becomes difficult to breathe for the patients. Hence, they prefer shallow breaths to lessen the pain.
Also, the stiffened chest muscles make breathing more difficult as they may feel extremely tight to allow enough air in. This condition of taking short shallow breaths is also called shortness of breath of dyspnea.
Diagnosis Of Intercostal Muscle Strain
An intercostal muscle sprain can be diagnosed by a thorough subjective and objective examination by a certified physiotherapist.
Further tests, such as an X-ray, MRI, CT Scan or ultrasound, may sometimes be required to confirm the diagnosis, determine the severity of the injury, monitor its healing and rule out other conditions.
A. X-ray Test For Diagnosis Of Intercostal Muscle Strain
An X-ray test may be required for the following purposes-
- To rule out rib fracture
- To rule out lung pathology as a cause of the pain
- Rule out rib dislocation
- Diagnose intercostal hematoma
- To diagnose intercostal muscle damage
- Detect thoracic spinal or foraminal stenosis
- Detect thoracic disc bulge or herniation
B. Ultrasound
To rule out hematoma, fracture and dislocation as a cause of pain
How To Get Rid Of Intercostal Muscle Strain?
Strained intercostal muscles can cause some serious discomfort to the patients as they feel intense stabbing pain in the chest due to even the slightest movement.
Hence, breathing becomes difficult as the inward and outward movement of chest muscles becomes a cause of acute pain.
Hence, therapy is helpful to restore function by relaxing the strained muscles so that the ribcage can expand and contract normally, without pain during respiration.
Home treatment and recovery options:
1. Adequate Rest
Giving proper rest and minimizing movement of the torso so as to not put an additional strain in the region is very important for the healing process of the torn intercostal muscles.
Complete bed rest for a few days would speed up the recovery of the injured muscles.
2. Light Stretching And Joint Manipulation
Complete rest for a long time can result in immobility and stiffening of the muscles which might make it difficult to regain your normal movement after the healing.
Therefore, light stretching and a few exercises are very important in restoring the normal functioning of the intercostal muscle.
3. Ice Packs
Applying ice packs over the affected area for a few minutes three to four times a day helps to alleviate pain and reduce swelling.
4. Hot And Cold Compress
Alternate hot and cold compresses are very helpful in recovery of the strained muscles. Use ice packs on the first day and hot packs on the next day, alternating between hot and cold treatments four times each day.
The ice packs will reduce the inflammation and swell quickly and the hot packs will promote blood flow to the area and expedite healing.
5. Deep Breathing
As pointed above, the acute stabbing pain in the chest during respiration causes the patients to resort to shallow breathing to minimize the pain.
However, this can cause pneumonia and slow down the process of healing due to the low supply of oxygen to the injured muscles.
Therefore, deep breathing is a must to recover from the injury. Breathe in slowly and open your lungs as much as you can. Hold your breath for a few seconds and then breathe out slowly. Follow this exercise at least once every hour to make sure that there is proper supply of oxygen to the strained muscles.
6. Epsom Salt Soaks
Epsom salts are magnesium salts that help to relieve muscle ache. Use one or two cups of Epsom salts in a tub of hot water and soak in it till the water cools down. It is very effective in reducing the pain considerably.
Medications For Intercostal Muscle Strain
Non Steroidal anti-inflammatory medications (NSAIDs) like ibuprofen or Advil help to reduce the swelling and pain without steroids or a prescription.
There are several other NSAIDs available for the pain which require a doctor’s prescription and are recommended in case of more severe intercostal tears.
In addition, muscle relaxants are prescribed by the doctors for muscle spasm and muscle ache. The most common muscle relaxants are Robaxine and Flexeril.
Interventional Therapy For Intercostal Muscle Strain
Intercostal Nerve Block (INB)
INB or intercostal nerve block is performed under X-Ray guidance. In this therapy, local anesthesia and corticosteroid are injected in the most painful area. This treatment helps to relieve pain and treat inflammation. Initially, three injections are given with two weeks interval. Later, one injection is administered every 8 to 12 weeks.
Exercises And Yoga For Strengthening Intercostal Muscles
Stretching exercises and yoga poses can help to improve the flexibility of your rib cage by stretching your intercostal muscles, lengthening the spine, releasing tension in the back and achieving a balance between the spine and the ribs.
a. Gomukha Asana Or Cow Face Pose
This pose is used to stretch the rib muscles. Sit down on the floor keeping both your feet stretched out in front of you. Put your right leg on top of your bent left leg and make sure that your right leg ankle is placed beside your left buttock.
Placing the knees one on top of one other, allow your buttock to balance on the floor firmly. Then stretch out your left arm slowly and bring it behind your back.
Quickly bring your right arm upward, fold it from the elbow joint and get it behind the head to hold your left hand. Keep your back, neck and head straight and remain in this position for a few seconds. Repeat the same for the other leg in a similar way.
b. Marichyasana Or Twisting Of The Torso
First sit on the floor keeping both your legs straight right in front of you. Now bend your right leg from the knee and place your right foot beside the left thigh. Meanwhile, keep the left leg intact on the ground stretched in front of you.
Next, wrap your left arm around the right knee while taking hold of a left hand with the right hand in the back.
While exhaling, press left the side of ribcage against the left knee. Turn your head and fixate your eyes over your right shoulder.
c. Parighasana Or Gate Pose
This pose is useful for side stretching to strengthen the intercostal muscles. It also lengthens your spine and stretches liver and spleen. Kneeling on a mat, stretch your right leg to your right side and place the right foot flat on the floor.
Keep your left knee aligned below your hip. Fully extend both arms to the right side by bending at the waist, palms turned down and touching the lower part of your right leg, while exhaling.
Then stretch and raise your left arm. Each time you exhale, extend your stretch by reaching lower down the leg with your right hand.
Recovery Time For Intercostal Muscle Strain
The recovery time for a muscle strain in the ribs depends upon the extent of damage done to the muscles. It can take about two to three weeks for a mild strain, three to six weeks for a moderate strain, and up to ten weeks in case of severe strain.
If there is a muscle tear, these injuries might require surgery and you can expect to recover within ten weeks. You may be advised against any kind of lifting, stretching or strenuous activity for a few weeks.
Complete bed-rest or quiet rest in a chair is very helpful if you want quick recovery. During this healing time, the doctor may suggest you some anti-inflammatory medications (Ibuprofen) and muscle relaxers to relieve muscle spasms.
Final Talk
Intercostal muscle strain is a condition in which the muscles between the ribs are injured due to excessive or sudden rapid movement of the torso. Hence, people with high physical activities are most likely to suffer from this condition.
It causes intense pain in the chest region along with difficulty in breathing. According to the severity of the injury, recovery may take anywhere between two weeks to ten weeks.
Avoiding further strain and taking proper rest are the keys to fast recovery from the injury.
Always make it a point to visit your doctor as soon as you recognize this condition so that proper treatment and medications can be administered to you to minimize the pain and swelling in the region and speed up the healing process.
