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Common Conditions

Ribs Postural Strains


The ribcage supports the upper body, protects internal organs, including the heart and lungs, and assists with breathing. The ribcage consists of 24 curved ribs arranged in 12 pairs. Each pair is attached to a vertebra in the spine. At the front of the body, the first 7 pairs of ribs are attached directly to the sternum (breastbone) by cartilage known as costal cartilage. These ribs are often called ‘true ribs’. The next 3 pairs of ribs are not connected to the sternum. Instead, costal cartilage attaches these ‘false ribs’ to the last pair of true ribs. The remaining two pairs are not attached at the front of the body at all and are known as ‘floating ribs’. The ribcage is supported by ligaments and muscles, including the muscles between the ribs called intercostal muscles. These muscles allow the ribcage to expand when breathing in and drop when breathing out.

Intercostal muscle strain is an injury affecting the muscles between two or more ribs.

The intercostal muscles have different layers that are attached to the ribs to help build the chest wall and assist in breathing. When an intercostal muscle gets twisted, strained or stretched too far, it can tear, causing intercostal muscle strain.

Routine activities are not usually the cause of intercostal muscle strain. These strains most often occur as the result of an injury or overexertion of the muscles. Common causes include a direct blow to the rib cage such as from a fall or car accident, an impact blow from contact sports such as hockey or football, twisting the torso beyond its normal range of motion, twisting while lifting weights, forceful twisting, such as from golf or tennis, twisting from specific yoga postures or dance positions or repetitive forceful movements. A sudden increase in physical activity can also lead to an intercostal muscle strain. This is the case particularly when muscles are weakened by a lack of exercise or poor posture.

The signs and symptoms of an intercostal muscle strain can differ slightly depending on their cause. Symptoms may include sharp upper back and rib pain, severe and sudden pain, gradual worsening pain after repetitive movement, stiffness and tension in muscles, muscle rigidity when bending or twisting the upper body, worsening pain when coughing, sneezing or breathing in deeply, spasms of the intercostal muscles and tenderness in the area between the ribs.

Physical therapy for intercostal muscle strain starts once the inflammation is reduced. Treatment will focus on manual therapy, pain relief modalities, stretching, strengthening exercises, posture and deep breathing exercises. Stretching should be stopped immediately if it increases pain or makes symptoms worse. If in doubt, seek professional advice.