Intercostal Myalgia: Symptoms, Causes and Treatment


What is Intercostal Myalgia?

Intercostal myalgia is tenderness or pain in the muscles between the ribs. It is a common and harmless condition that is caused by tightening of the muscles in the chest wall. About half of the people who go to the doctor for chest pain are diagnosed with intercostal myalgia. The condition may be experienced as frightening because the person may fear the symptoms represents heart disease or lung disease.

Anatomography, CC BY-SA 2.1 JP https://creativecommons.org/licenses/by-sa/2.1/jp/deed.en, via Wikimedia Commons

Symptoms of intercostal myalgia

The main symptom is pain in the chest wall, either localized or more diffuse. The pain is often described as stabbing pain, and is usually not related to physical activity as is typical for heart disease, and may often be present at rest. The episodes of chest pain may often last for hours or days before fading away.

The person with intercostal myalgia is often tense and deep breathing may be painful. Pressing on the painful area may increase the pain. 

When seeking medical help for this type of pain the medical doctor will consider if it could be conditions such as

  • Cardiovascular disease
  • Fibromyalgia (read the blog post about how to treat Fibromyalgia here)
  • Rib fracture
  • Tietzes syndrome
  • Skeletal metastases
  • Pneumothorax

Causes of intercostal myalgia

The underlying cause of intercostal myalgia is not fully understood. However, it is most likely caused by tight intercostal muscles and an incorrect breathing pattern. 

When we are young we do not use the chest muscles for breathing in the same way as many adult people tend to do. Using abdominal muscles or the diaphragm during breathing is the recommended way of breathing. However, many adults tend to elevate the chest and shoulder when breathing in. This exerts a heavy load on the intercostal muscles and may cause pain.

Treatment of intecostal myalgia

Correcting the breathing pattern

Usually intercostal myalgia does not need to be treated. Often the person suffering from pain may benefit from relaxation exercises and correcting the costal breathing pattern to an abdominal breathing pattern. This is done by lying on your back and putting your hand on your abdomen. Here are some tips for mastering abdominal breathing

  1. Lie down on your back with your knees bent and your feet flat on the floor
  2. Place one hand on your chest and the other hand on your abdomen
  3. Inhale slowly and deeply through your nose, allowing your stomach to rise. Your chest should remain relatively still
  4. Exhale slowly through your mouth allowing your stomach to fall
  5. Continue to breathe in and out in this way for 5-10 minutes

When you master abdominal breathing lying down, you may try doing abdominal breathing sitting in a chair.

Other non-pharmacological measures

Regular physical activity and sufficient sleep may reduce intercostal myalgia. However, if you experience known triggers, such as mental stress or physical stress you may try to avoid the triggers.

A few people may develop chronic, recurrent symptoms. For these people cross-friction massage may be helpful, preferably by an experienced physical therapist. This treatment may have a more rapid effect if the symptoms have only lasted for a short time. For chronic symptoms cross-friction massage may have to be repeated during several sessions in order to have effect..

Worrying tend to increase muscle tension and worsen symptoms of intercostal myalgia.

In one study more than half of the participants still had episodes of intercostal myalgia after 6 months. The symptoms may often worsen during stressful phases of life.

Medications to treat intercostal myalgia

Medications are usually not necessary. However, NSAIDs (e.g. naproxen, diclofenak) may reduce acute muscular pain. With more severe pain, a combination of paracetamol and codein may help reduce the pain.

Conclusion

Intercostal myalgia is a common, harmless condition that affects the muscles between the ribs. The symptoms are episodes of either localized or more diffuse pain, that often last for hours or days. it often coincides with stressful periods of life, or an incorrect breathing pattern. The person may often worry that the pain is due to disease of the heart or the lungs. However, the pain is often present at rest, not typical for coronary heart disease. At examination the chest muscles are painful when pressed. Usually the pain is treated without medications through correcting the breathing pattern away from chest breathing to an abdominal breathing pattern. A few people may develop a more chronic condition and may benefit from cross-frictional massage.

References

  • Intercostal Myalgia – Norwegian Electronic Medical handbook
  • Interkostal Myalgia – Legevakthåndboken, www.lvh.no

Allan Fjelmberg, MD, MPH, DipIBLM

As a Norwegian based medical doctor certified in Lifestyle Medicine he currently serves as the medical director of Skogli Health and Rehabilitation Center, Lillehammer. Through consultations, presentations, articles and other public health-related activities, he motivates people to utilize the potential that a healthy lifestyle has both in prevention and treatment of disease.

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