Intercostal myalgia is tenderness or pain between the ribs. It is a common and harmless condition caused by muscle tension in the chest wall.
Many people who seek medical attention due to chest pain are diagnosed with intercostal myalgia. Muscle pain in the chest can be frightening because the pain is located in the same area as vital organs such as the heart and lungs.
Symptoms of Intercostal Myalgia
The main symptom is pain in the chest wall, either localized pain or more diffuse. It is often described as stabbing chest pain and is usually not related to physical activity, which is more common with angina and heart attacks. The pain can therefore often be present at rest. Episodes of chest pain can last for hours or days before disappearing.
Furthermore, the pain between the ribs can increase with deep breathing. Pressure on the painful area can also increase the pain.
There are several conditions that can cause chest pain, and it is important to rule out serious illness. Examples of conditions that can cause chest pain include:
- Heart disease
- Fibromyalgia
- Rib fractures
- Tietze’s syndrome
- Esophageal disease
Causes of Intercostal Myalgia
The underlying cause of intercostal myalgia is not fully understood. However, the pain is most likely caused by muscle tension in the chest and incorrect breathing patterns.
When we are young, we don’t use the chest muscles for breathing, which many adults do. It is recommended to breathe with the abdominal muscles or diaphragm. However, many adults tend to raise their chest and shoulders when inhaling. This strains the intercostal muscles and can cause overload and pain.
Treatment of Intercostal Myalgia
Correcting Breathing Pattern
Usually, there is no need to treat intercostal myalgia with medications. It is often sufficient to correct the breathing pattern to breathe with the diaphragm/abdomen. This is done by lying on your back and placing your hand on your stomach. Here are some tips for mastering abdominal breathing:
- Lie on your back with bent knees and feet flat on the floor
- Place one hand on your chest and the other hand on your stomach
- Breathe slowly and deeply through your nose, so that your stomach rises. The chest should remain relatively still
- Breathe out slowly through your mouth so that your stomach sinks toward the floor
- Continue breathing in and out this way for 5-10 minutes
When you master breathing with your abdomen while lying down, you can try breathing with your abdomen while sitting in a chair.
Other Self-Help Measures
Regular physical activity and adequate sleep can reduce intercostal myalgia. If you experience known triggers, such as mental or physical stress, try to avoid or deal with these triggers.
A few people may develop chronic, recurring symptoms. For these people, transverse friction massage may be a useful approach, preferably by an experienced physiotherapist. This treatment may have faster effects if the symptoms have only lasted for a short time. For chronic symptoms, transverse friction massage may need to be repeated in several sessions to be effective.
Worry tends to increase muscle tension and worsen the pain in intercostal myalgia.
In one study, more than half of the participants still had episodes of intercostal myalgia after 6 months. Symptoms can often worsen during stressful phases of life.
Medications for Intercostal Myalgia
It is usually not necessary to use pain medication for intercostal myalgia. However, anti-inflammatory medications such as Naproxen, Diclofenac, or Ibuprofen can reduce acute muscle pain. For more severe pain a combination of Paracetamol and Codeine, can help reduce the pain.
Conclusion
Intercostal myalgia is a common but harmless condition affecting the muscles between the ribs. Symptoms are episodes of either localized or more diffuse pain, which can last for hours or days. The problems often coincide with stressful periods in life or incorrect breathing patterns. The pain can cause concern that it represents serious heart or lung disease. However, the pain is often present at rest, which is not typical for coronary heart disease. Upon examination, the chest muscles are painful when pressed.
Intercostal myalgia is usually treated by correcting the breathing pattern to breathe with the abdomen. Sometimes the pain can develop into a more chronic condition. In such cases, transverse friction massage or medications may be appropriate to consider.
