Intercostal muscle strain is tear or rupture of intercostal muscles due to rapid movements that bend or twist the upper body suddenly resulting in sharp, stabbing pain during breathing or a persistent soreness or ache in the ribcage.
The intercostal muscles are composed of several muscles known as the internal intercostals muscles, external intercostals muscles, subcostal muscles and the transverse thoracic muscles. The primary function of the intercostals muscle is to allow the up and down movement of the chest muscle during inspiration and expiration in the process of breathing. It functions also in stabilizing and forming the chest walls.
These muscles can become strained due to rapid movements that bend or twist the upper body suddenly. The disability and rate of recovery depends on the muscle strain grading, which indicates the degree of injury involved.
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. It is most commonly seen in fast bowlers in cricket, oarsmen in rowing, and throwers in athletics or ball sports.
Symptoms commonly reported are either a sharp, stabbing pain when breathing to a ever-present, painful ache or soreness located around the ribcage. The pain is aggravated by deep breathing, side bending and twisting.
Mild case of intercostal muscle strain may still allow the affected individual to continue with the daily activities. The pain felt is usually bearable that movement is still possible. The symptoms however may increase when resting or when the patient is cooling down.
In severe cases of intercostal muscle strain, daily activity is often affected and the pain is usually debilitating. Athletes and other individuals with severe case of intercostal muscle strain usually have to refrain from engaging in sporting activities for some period of time or at least until the strain has recovered fully.
Sporting activities such as rowing, bowling, running, jumping and throwing also increases the sensation of pain.
A thorough subjective and objective examination from a physiotherapist is usually sufficient to diagnose an intercostal strain. Further investigations, such as X-rays are usually done to ensure that there is no fracture of the ribs, and MRI, CT Scan or ultrasound, are sometimes required to confirm diagnosis, rule out other conditions, determine the severity of injury and monitor healing.
Initial treatment for an intercostal strain must remain conservative at the onset to avoid aggravating the condition. Emphasis will be on rest, reducing the inflammation, load and stress on the affected area. Once the initial inflammation has been reduced, a program of stretching and strengthening will be initiated to restore flexibility to the joints and muscles involved, while improving strength and stability to the spine.
Intercostal muscle strain usually recovers fully over the course of four to six weeks if proper physiotherapy is applied and if muscle strain is mild. Severe muscle strain on the other hand, requires longer period for a full recovery. 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.