Mid & Upper Back

What It Is

Line drawing of the ribcage from behind, showing each rib meeting the thoracic spine, with close-up views of where the ribs join the vertebrae. — Where the ribs meet the mid-back — the small joints that can get stuck or irritated.

Rib strains are injuries to any of the muscles or tendons that attach to the ribs. The strain happens when muscle fibres are stretched too far or torn. A strain of the muscles between the ribs is called an intercostal muscle strain (Cleveland Clinic, 2020).

The intercostal muscles lie between the ribs and allow the ribcage to expand and contract so you can breathe (Cleveland Clinic, 2020). The external intercostal muscles mainly help you breathe in by expanding the ribcage, and the internal intercostal muscles mainly help you breathe out (Cleveland Clinic, 2025).

You can strain the intercostal muscles suddenly, or by doing certain movements over and over. Forceful or exaggerated twisting of the body, or lifting and stretching, can cause a strain, as can sports with repetitive movements, such as baseball, racquet sports or golf. A fall or a hard hit to the chest, such as in tackle football, can also strain these muscles, and so can repeated coughing, for example after a chest infection (Cleveland Clinic, 2020).

An intercostal muscle strain can be confused with a rib fracture. Broken or bruised ribs often do not need an X-ray and are usually left to heal on their own (NHS, 2024). Painful breathing can sometimes be a sign of something more serious, such as pneumonia or a blood clot in the lung, so it is important to have chest pain checked by a doctor rather than diagnosing yourself (Cleveland Clinic, 2020).

Intercostal Muscle Strain Anatomy

The chest has 12 ribs on each side of the body. Each rib is attached to the spine at the back and curves around towards the front of the chest. The top seven ribs attach directly to the sternum (breastbone); the eighth to tenth ribs attach to the cartilage of the rib above; and the eleventh and twelfth ribs are "floating" ribs because they are not attached at the front of the chest (Cleveland Clinic, 2024).

There are three layers of intercostal muscles: the external intercostals, the internal intercostals and the innermost intercostals (Cleveland Clinic, 2025).

Not a diagnosis — for more information, contact me or another trusted healthcare provider.

Treatment

Self-Care & Treatment

How to Treat an Intercostal Muscle Strain

Massage may help to ease tight muscles, and safe stretching exercises can help if the strain has been going on for a while (Cleveland Clinic, 2020). I can help with gentle hands-on work, breathing and stretching exercises, and a gradual return to sport. See the My Approach tab for how I work.

1. Rest

Stop playing sport and rest the area for 24 to 48 hours (Cleveland Clinic, 2020). If you carry on playing, you could injure the strained muscle further.

Bed rest is not advised. Try not to lie down or stay still for long periods; gentle activity such as walking around helps (NHS, 2024).

2. Ice

In the first day or so, an ice pack for 10 to 15 minutes a couple of times a day may help (Cleveland Clinic, 2020). Wrap the ice pack in a tea towel; never put ice directly on the skin (NHS, 2024).

3. Breathing and Coughing

Keep breathing normally and take slow, deep breaths regularly, and cough when you need to. Holding a small pillow against your chest when you cough can ease the pain (NHS, 2024; Cleveland Clinic, 2020).

4. Pain Medication

Cleveland Clinic (2020) suggests that over-the-counter painkillers, such as ibuprofen taken with food or paracetamol (called acetaminophen in the US), may help, but advises getting guidance from your doctor first, especially if you have kidney problems or another health condition. (This medicine information comes from Cleveland Clinic, not from me. Always check with a pharmacist or your family doctor or nurse practitioner before taking any medicine.)

Muscle strains usually take about 4 to 6 weeks to heal completely (Cleveland Clinic, 2020).

Tips

Warm up properly before any physical activity.
Avoid training excessively, as this can strain and tear the muscles around the ribcage.
Fast bowlers in cricket are prone to a "side strain", which mainly affects the oblique abdominal muscles near the lower ribs rather than the intercostal muscles (Humphries and Jamison, 2004).
Give yourself enough time to heal before returning to training or sport, and avoid sport or exercise that makes the pain worse (NHS, 2024).
Older age and an inactive lifestyle can make you more likely to strain these muscles (Cleveland Clinic, 2020).

Treatment

My Approach

Line drawing of the ribcage from the front with the dome of the diaphragm beneath it. — The ribcage and diaphragm — a sore rib joint often shows up first as a catch in a deep breath.

A strained intercostal muscle has stretched or torn fibres between the ribs, and because you use these muscles every time you breathe, it can hurt to cough, twist or take a deep breath. How I help depends on how bad the strain is.

If it's a mild strain and you can breathe, move and sleep reasonably comfortably, I treat it directly. If it's a severe strain or tear, a rib might be broken, or you're getting more short of breath, see a doctor first (see When to get emergency help). Once you've been checked, I provide supportive care alongside your medical team's advice, and please bring any X-ray or scan reports to your first visit.

I start by assessing how your ribs, mid-back and shoulders move, which movements and breaths bring the pain on, and how you sit, lift and twist. Chest pain can have other causes, so if anything doesn't fit a muscle strain, I'll ask you to get it checked.

Early On

Gentle work on the back, neck, shoulders and the other side of the ribcage, leaving the sore spot alone
Breathing practice to keep your ribs moving without straining the muscle
I'll show you how to use ice safely at home, and how to stay gently active

As It Settles

Lighter work closer to the injury, and trigger point work in the surrounding muscles
Gentle, low-velocity mobilisation of the mid-back and ribs, once a broken rib has been ruled out
Warm then cool applications to help circulation
Stretches for side-bending and turning, kept gentle and pain-free

Back to Full Strength

Cross-fibre and myofascial work for tight, stuck-down areas, then a gentle stretch
Trunk strength and rotation work, building to the demands of your sport, such as golf, racquet sports or cricket

If It's a Severe Strain

Easing the neck, shoulders and back that guard the area, and breathing practice
Working closer to the injury and rebuilding strength within your doctor's advice

Hands-on work on the chest wall muscles is only with your informed consent and a written consent form, and you can say no at any time.

What to Expect

Typical Course

Typical course: Visits are usually shorter and once or twice a week early on, then weekly, then spaced out, with a reassessment at about 4 weeks. Most mild strains heal in about 4 to 6 weeks; a severe strain or tear usually takes longer and follows your doctor's advice.

What I Focus On

Severity Check

Breathing & Rib Movement

Compensation Relief

Gentle Stretching

Graded Return to Sport

Please read

When to See a Doctor First

When to get emergency help

Call 911 or go to the emergency room at your nearest hospital if you have a chest or rib injury and (NHS, 2024):

It was caused by a serious accident, such as a car accident
You are getting more short of breath
The chest pain is getting worse
You have pain in your tummy or shoulder
You are coughing up blood

Sources

References

Cleveland Clinic (2020) How to cope with an intercostal muscle strain. Available at: https://health.clevelandclinic.org/how-to-cope-with-an-intercostal-muscle-strain (Accessed: 7 October 2026).
Cleveland Clinic (2025) Intercostal muscles. Available at: https://my.clevelandclinic.org/health/body/intercostal-muscles (Accessed: 7 October 2026).
Cleveland Clinic (2024) Rib cage. Available at: https://my.clevelandclinic.org/health/body/rib-cage (Accessed: 7 October 2026).
NHS (2024) Broken or bruised ribs. Available at: https://www.nhs.uk/conditions/broken-or-bruised-ribs/ (Accessed: 7 October 2026).
Humphries, D. and Jamison, M. (2004) 'Clinical and magnetic resonance imaging features of cricket bowler's side strain', British Journal of Sports Medicine, 38(5), e21. doi: 10.1136/bjsm.2003.005272. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC1724937/ (Accessed: 7 October 2026).

Massage therapy · Kitchener–WaterlooIntercostal Muscle Strain

What It Is

Intercostal Muscle Strain Anatomy

Self-Care & Treatment

How to Treat an Intercostal Muscle Strain

1. Rest

2. Ice

3. Breathing and Coughing

4. Pain Medication

Tips

My Approach

Early On

As It Settles

Back to Full Strength

If It's a Severe Strain

Typical Course

When to See a Doctor First

When to get emergency help

References

Related Conditions

Book a session

Massage therapy · Kitchener–WaterlooIntercostal Muscle Strain

What It Is

Intercostal Muscle Strain Anatomy

Self-Care & Treatment

How to Treat an Intercostal Muscle Strain

1. Rest

2. Ice

3. Breathing and Coughing

4. Pain Medication

Tips

My Approach

Early On

As It Settles

Back to Full Strength

If It's a Severe Strain

Typical Course

When to See a Doctor First

When to get emergency help

References

Related Conditions

Hyperkyphosis

Thoracic Spine Pain

Costovertebral Joint Sprain

Book a session