Overview

The intercostal muscles are the thin muscles between the ribs. They help move the rib cage when you breathe, and they assist with twisting and bending. A strain — a stretched or partially torn muscle — usually happens with a sudden movement, a forceful cough, or a twisting load, and it can make breathing uncomfortable.

Intercostal strains are common and typically settle within days to weeks. The main job is to tell the difference from rib fracture, costochondritis and the more serious causes of chest pain.

Typical Pattern

Localized pain between two ribs, often on one side
Worse with deep breathing, coughing, sneezing or laughing
Reproducible tenderness when pressing on the spot
Worse with twisting, side-bending or lifting
Pain that is sharp at the start and settles into a dull ache

Why It Develops

The intercostal muscles are loaded every time you breathe and whenever the trunk rotates or bends. Common triggers include:

A sudden twist or reach
A forceful cough, sneeze or laugh
Lifting or pushing with the trunk rotated
Repetitive bending and twisting at work
Sport movements like rowing, swimming or throwing

How It Is Diagnosed

The diagnosis is mostly clinical: a clear movement-related onset, pain reproduced by pressing between the ribs, and pain that worsens with deep breathing or twisting, without features of rib fracture or other chest causes.

A clinician may consider imaging if there is direct trauma, a single very tender point over the bone, difficulty breathing, or symptoms that do not improve — to rule out a rib fracture or other chest wall injury.

Treatment

Short-term comfort: heat, simple pain relief and topical gels, guided by a pharmacist or clinician
Breathing exercises to keep the rib cage moving, even if deep breaths are uncomfortable
Avoid the aggravating movements at first — twisting, heavy lifting, coughing fits — then resume gradually
Gentle side-bending and rotation as pain settles
Progress to normal activity rather than resting completely for more than a day or two

Rib supports and strapping are not recommended; they restrict breathing and slow recovery. If the pain is not improving after a few weeks, an assessment is worthwhile.

When to Get Assessed

Arrange an assessment if pain persists beyond a few weeks, is worsening, or keeps returning with activity.

Seek urgent care if pain follows significant chest trauma, comes with difficulty breathing, coughing blood, fever, or severe pain that stops you from taking a full breath — those patterns need prompt evaluation.

References

AAFP. "Sudden Onset of Clicking Chest Pain." American Family Physician. 2009. https://www.aafp.org/afp/2009/0801/p287
Mott T, Jones G, Roman K. "Costochondritis: Rapid Evidence Review." American Family Physician. 2021. https://www.aafp.org/pubs/afp/issues/2021/0700/p73.pdf

This information is for education only and is not a medical diagnosis. InjuryAtlas does not replace an assessment by a qualified health professional. If you have severe pain, visible deformity, numbness, loss of function, or symptoms that are getting worse, seek medical care promptly.

Intercostal Muscle Strain