A rib muscle injury can be more difficult to treat than a pulled muscle in other areas. There are three layers of muscles located between each rib -- the external intercostal muscles, internal intercostal muscles, and innermost intercostal muscles. Any of these layers can be pulled, producing a rib, or intercostal, muscle strain. A direct blow to the chest, sudden twisting of the upper body or sudden forceful movement of the arm can cause an acute strain that begins abruptly. Repetitive movements of the chest or arms, such as those caused by rowing, baseball throwing or frequent coughing, can cause a chronic strain that begins gradually. Every time you breathe, the rib muscles move, further irritating these muscles. Treatments generally include rest, local cold or heat and medications. Massage, epsom salt baths, injections and physical therapy may be tried as well.
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Any movement of the chest can stretch the rib muscles, increasing inflammation and pain. Large movements of the arms will often stretch these muscles as well. Avoiding activities that cause pain and resting in a chair or bed are useful treatments, especially in the first couple days when inflammation is at its peak. After that, movement and activities can be gradually increased as tolerated.
Cold or Heat
In the first couple days after a rib muscle strain, applying cold to the area helps reduce inflammation. This will decrease pain and swelling. Chilled reusable gel packs, a plastic bag filled with ice or a bag of frozen vegetables may be used. After the initial 2 days, heat is more appropriate. It will stimulate blood flow to the area to promote healing and help relax the injured muscle, which often goes into spasm. Warm compresses, heating pads, warm damp towels or warm baths are good sources of heat. Cold and heat treatments are typically applied for 15 to 20 minutes up to 4 times each day.
Rib muscle strains can be very painful, especially during the first couple days. While rest reduces the majority of voluntary motion, pain associated with breathing cannot be curtailed. Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Motrin, Advil) or naproxen (Aleve), are often beneficial. They help reduce inflammation and improve pain. For people who cannot take NSAIDs, acetaminophen (Tylenol) is a good alternative. If pain is not adequately controlled with these over-the-counter medications, doctors may prescribe muscle relaxants or stronger painkillers.
Gently massaging the injured rib muscle may provide some pain relief. A warm bath containing Epsom salts -- 1 to 2 cups added to a bathtub full of water -- may also reduce rib muscle pain. However, Epsom salts contain magnesium, which may be absorbed into the body during the bath. Speak to your doctor before trying these baths, as they may not be safe for everyone.
Injecting the injured muscle with a local anesthetic or corticosteroid is an option for pain poorly controlled by other methods. Referral to a physical therapist may also be considered. Therapists can provide instruction on deep breathing exercises to help prevent a chest infection and other exercises to help strengthen the rib muscles and prevent future strains. They may also use modalities to promote healing and reduce symptoms, such as ultrasound, cold laser or electrical stimulation.
Warnings and Precautions
Wrapping the chest is not recommended, as it can interfere with breathing, which may lead to a chest infection such as pneumonia. As chest pain may be caused by a large number of conditions, including rib fractures, back problems and heart disease, see your doctor to be sure that you have a rib muscle strain. Seek immediate medical attention if other symptoms occur with your pain, such as shortness of breath, weakness, sweating, heart palpitations, dizziness or lightheadedness. Also seek immediate medical attention if your chest pain is a pressure-like sensation or extends to other areas such as your arms or jaw. Most rib muscle strains will heal within a few days to a couple of months. See your doctor if your pain persists beyond this or if it is getting worse at any time.
Reviewed and revised by: Mary D. Daley, MD