How to Identify and Treat an Intercostal Muscle Strain

What Is an Intercostal Strain?

An intercostal muscle strain (ICS) is a type of lower back pain that occurs when one or both of the muscles in your abdomen are stretched too far forward during exercise. These stretches may occur while sitting, standing up from a chair, bending over with heavy weights on your feet, or even while lying down.

The muscles involved in ICS are the rectus abdominis, external obliques, internal obliques, transversalis capitis and transversalis capitis. When these muscles are stretched beyond their normal range of motion they become tight and painful. They may also be called “lower back” or “abdominal” muscles because they lie behind your belly button. You will often see them referred to as the “six pack abs.”

Ischemic or “stressed” ICS results from repetitive stress injuries such as sports related knee, hip, shoulder and back injuries. Common causes include:

Overuse – Over time, you may develop a condition where the muscles are chronically shortened due to repeated activity. For example, if you regularly do pushups after every meal then your abdominal muscles will get longer than they need to be. They will get used to this length and begin to hurt when you attempt to stretch them.

Sudden overload – After a period of inactivity or decreased activity, muscles can become weak and “shortened.” If you then try to perform a highly aerobic activity like running, the muscles will immediately become sore and painful. This type of injury is usually temporary. You should not be sore for more than one week if you decrease the amount or intensity of your activities and do some light stretching exercises.

Pain on the right side of your lower back is most often caused by a condition called IBS or Irritable Bowel Syndrome. This syndrome causes sharp pains that usually occur during or after a bowel movement. The exact cause of IBS is unknown, but it should not be confused with inflammatory bowel disease such as ulcerative colitis and Crohn’s disease.

What is ICS?

The intercostal muscles are the ones that run between your ribs. These muscles stretch from your rib to your sternum (breastbone). Your intercostal muscles are important because they allow you to take a deep breath. Pain in the intercostal muscles often causes sharp, shooting pains in the middle of the chest area.

What are the symptoms of an ICS?

Most people who suffer from ICS complain of a sharp pain that occurs during exercise. The pain is usually felt between the ribs. This pain makes it difficult to take normal breaths. The pain can be so severe that some people cannot exercise at all without experiencing sharp pain.

How is an ICS treated?

Most treatment recommendations for ICS involve decreasing the activities that cause pain or taking non-steroidal anti-inflammatory drugs (NSAIDs) before exercising. Most doctors will not perform any invasive procedures unless absolutely necessary. In some cases, surgery may be necessary to release the tight intercostal muscles.

Exercises for ICS

If you have ICS, it is important to stretch the muscles between your ribs before performing any type of physical exercise. The best exercise to stretch the intercostal muscles is the “Breathing Exercise.” To perform this exercise:

Sit in a chair and bend forward while hunching your shoulders.

Breathe in deeply through your nose.

Hold your breath and count to five.

Breathe out through your mouth.

Repeat steps 3 to 5 three times.

It is important that you follow up the breathing exercise with a regular physical exercise like walking, swimming or light jogging. You should stretch before each exercise session and always remember to take deep breaths during exercise. If you continue to experience pain during exercise, you should consult a physician or physical therapist.

Sources & references used in this article:

Efficacy of methods of intercostal nerve blockade for pain relief after thoracotomy by FC Detterbeck – The Annals of thoracic surgery, 2005 – Elsevier

Continuous intercostal nerve block for pain relief after thoracotomy by S Sabanathan, PJB Smith, GN Pradhan… – The Annals of thoracic …, 1988 – Elsevier

Cryoanalgesia: a new approach to pain relief by JW Lloyd, JDW Barnard, CJ Glynn – The Lancet, 1976 – Elsevier

Effect of intercostal nerve blockade during operation on lung function and the relief of pain following thoracotomy by JE Galway, PK Caves… – BJA: British Journal of …, 1975 –

Postural relief of dyspnea in severe chronic obstructive pulmonary disease by JT Sharp, WS Drutz, T Moisan, J Foster… – American Review of …, 1980 –

No pain relief from morphine? by J Riley, JR Ross, D Rutter, AU Wells, K Goller… – Supportive care in …, 2006 – Springer

Cervical rib: a method of anterior approach for relief of symptoms by division of the scalenus anticus by AW Adson, JR Coffey – Annals of Surgery, 1927 –

Consequences of inadequate postoperative pain relief and chronic persistent postoperative pain by GP Joshi, BO Ogunnaike – … Clinics of North …, 2005 –