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Common Conditions

Nerve Irritation (Intercostal Neuralgia)


Intercostal Neuralgia is a rare condition that causes pain along the intercostal nerves. Intercostal nerves are located between the ribs which are long, slender bones that curve around the chest to create the rib cage. The top 10 ribs on both sides of the body attach to the thoracic (mid back) spine and breastbone (sternum). The bottom 2 ribs attach to the spine, but not the breastbone. These ribs are sometimes called the “floating” ribs. The intercostal areas between the ribs contain muscles and nerves. These intercostal nerves can become damaged or inflamed due to a variety of diseases, disorders and conditions, resulting in intercostal neuralgia.

Intercostal Neuralgia is often associated with injury or inflammation of the nerves, muscles, cartilage and ligaments in the rib cage and middle spine area. Common causes of intercostal neuralgia include pregnancy, tumours, chest or rib injury, surgery to the chest or organs in the chest cavity, and shingles. Shingles can also attack nerves in the chest and upper back.

This condition may produce sporadic episodes of acute pain or pain that is dull and constant. The pain is often described as stabbing, tearing, sharp, spasm-like, tender, aching or gnawing. It typically feels like the pain wraps around the upper chest in a band-like pattern. The pain may intensify during exertion or with sudden movements involving the upper chest such as coughing or laughing.

Physical therapy can help with Intercostal Neuralgia. Treatment for pinched nerves includes manual therapy, stretching and joint mobilization to improve alignment, mobility and range of motion of the thoracic spine. Use of mobilization techniques also helps to modulate pain. Stretching and strengthening exercises to restore joint mobility, range of motion, and strengthen muscles of the back and abdominals to support, stabilize and decrease the stresses placed on the spinal joints, discs and neck will also be prescribed. Neuromuscular re-education will be incorporated to improve posture, restore stability, retrain the patient in proper sleeping, sitting and body mechanics to protect the injured spine. Modalities including the use of ultrasound, electro-therapy stimulation, ice and others will be used to decrease pain and inflammation of spinal structures. If in doubt, seek professional advice.