Intercostal muscle strains are one of the common but ‘hidden’ injuries I see in General Practice and Sports Medicine work. This proves frustrating for a patient, because the pain is very real, yet there’s not much to see!

So first of all, what is an intercostal strain?

Well, the intercostal muscles are a group of muscles that lie between the ribs, and are an essential part of the ribcage function. These muscles enable chest expansion and contraction for breathing, in conjunction with the diaphragm, and they provide some stability to the chest wall. Like any muscle they can be strained – either ‘pulled’ or even ‘torn’. This results in pain in the ribcage, usually at either side. The pain is often sharp at first, but may subside into a dull ache. There may be weakness and/or muscle spasm.

How does intercostal muscle strain occur?

The injury commonly occurs after some vigorous activity that involves twisting of the torso – especially while lifting heavy objects or stretching the arms out excessively. This can occur in anyone, with vigorous coughing, sneezing or laughing, or with energetic repetitive movements involving rotation of the ribcage.

When it comes to sport, these injuries can be triggered by inadequate warm-ups, poor technique or posture, or excessive training that results in fatigue. I most commonly see this in fast bowlers in cricket, oarsmen in rowing, and throwers in athletics or ball sports.

What is the outcome?

It’s frustrating not to be able to give an accurate answer to this since recovery can take from a few days to several weeks depending on the severity of the strain. If any of the muscles are completely torn, it may even take three to six months before the muscle has recovered enough to resume previous levels of activity.

How to manage your injury:

• Protect the muscle from greater injury by avoiding the activities that make it painful, such as twisting the torso
• Avoid activities that involve heavier breathing
• Get moving as soon as the pain allows – not moving at all increases the risk of other complications such as chest infections, deep vein thromboses (DVT) and muscle wasting
• Ice applied to the painful area in the first 48 hours helps reduce inflammation. Do this for ten to fifteen minutes every two to four hours. Be careful not to allow the ice to contact bare skin to avoid cold burns. Heat is good for spasms and stiffness
• Painkillers are crucial in the early stages of recovery. Paracetamol is best since it has the least risk of side-effects. Anti-inflammatories (NSAIDs) have some risk of delaying healing in the first 48 to 72 hours, but should be used with caution. Mild opiates such as codeine can be combined with the paracetamol, but the stronger the painkillers, the greater risks of side-effects
• With time, you can return to physical activity if necessary under physiotherapy supervision.

The good news is that, with time, recovery will be complete, though occasionally scar tissue may give a ‘pulling’ sensation in the area of injury.

If you’d like to speak to a doctor about your muscle injury, call Dr Morton’s today on 012 123 123 123, or register for free!