There are over 600 skeletal muscles in the human body and under the right circumstances; any one of them can involuntarily contract, causing severe and even debilitating pain.
It’s called a muscle spasm and it’s not life-threatening, but it hurts enough to make anyone wonder if there is something seriously wrong.
Spasms in the intercostal muscles are less common than in major muscle groups, but because they can cause shortness of breath and chest pain like a heart attack, they are very concerning. What causes them?
Doctors say it’s complicated, but know there are several key risk factors.
Here’s what you need to know about the intercostal muscles, how spasms occur and how to treat and prevent them.
What are the Intercostal Muscles?
The intercostal muscles are located between the ribs and stretch from the middle of the chest to the middle of the back.
There is 11 pair on each side of the rib cage and each is composed of three layers: the external intercostal muscles, internal intercostal muscles, and the innermost intercostal muscles.
According to the National Heart, Lung and Blood Institute, their primary function is to lend flexibility to the chest wall to help with breathing.
When air is inhaled, the intercostal muscles lift the rib cage, allowing the lungs to expand. When the muscles relax, the rib cage falls and the air is expelled.
What are the Symptoms of Intercostal Muscle Spasms?
Spasms cause severe, but usually a short-lived pain. This is different than sprains or strains.
A sprain is an overstretching or tearing of a ligament — the fibrous tissue that connects bones together. Symptoms can last for weeks and include pain, swelling and difficulty moving the joint.
Strains involve overstretching or tearing a muscle or tendon — the band of tissue that connects muscles to bones.
Symptoms include pain, swelling and often, muscle spasm. This is important because if an intercostal muscle spasm is due to a strain, the discomfort may intensify and last longer, causing worrisome chest pain and pressure.
Most people with intercostal muscle spasms describe the pain as sharp or stabbing. It may be limited to the area between two ribs, but when the nerves along the muscles become irritated — called Intercostal Neuritis — it can cause referred pain, discomfort that is felt somewhere other than the site from which it originates.
According to Dr. William Morrison, the most common sites for referred pain are the middle and upper back and the upper chest wall.
If the spasms happen in the left side of the chest, the symptoms can be eerily similar to a heart attack. On the right side, they might be confused with gallbladder, liver, intestinal, or heart disease.
Some sufferers report spasms cause shortness of breath, especially when laughing, coughing, or breathing deeply.
This is usually due to pain in the affected muscles, but may be concerning because the symptoms are similar to a heart attack, pneumonia, and pulmonary emboli.
Other signs include a tender knot at the site of the spasm, localized swelling or bruising and difficulty twisting at the waist and shoulders.
What Causes Intercostal Muscle Spasms?
According to rayur.com, intercostal muscle spasms can be caused by a wide range of issues from dehydration and electrolyte imbalance to multiple sclerosis, but most are the result of acute injury or chronic anatomical issues including genetics, poor posture, obesity, and weak core muscles.
Causes of injury include sudden or repetitive twisting motions such as swinging a golf club or tennis racquet.
Trauma such as impact with a steering wheel in a collision, or activities that put a significant strain on the chest, like doing bench presses or push-ups, may also be to blame.
In some cases, today’s sedentary lifestyles are the problem. In this YouTube video, Dr. Alan Mandell explains how rib pain can occur as the result of sitting hunched over a desk all day, being overweight and having poor muscle tone in the back and abdomen.
Rarely, multiple sclerosis may be the of cause intercostal muscle spasms. According to WebMD, this is known as the MS hug.
Each person experiences this differently and while some people report pressure or a squeezing sensation around the ribs, others report more typical sharp or stabbing pain.
What tends to differentiate an MS hug from simple intercostal spasms is that it encompasses the entire span of the rib cage and is often described as wearing a girdle.
Similarly, muscle pain due to fibromyalgia, dehydration, and electrolyte imbalances are typically not limited to the intercostals.
According to WebMD, an unusual manifestation of shingles, caused by the chickenpox virus, may also cause pain in the rib area on either side of the body, but without producing the characteristic rash.
Most people describe shingle pain as burning, rather than sharp or penetrating, but because symptoms can be similar, doctors like to rule out shingles out in older patients.
How Can I Tell the Difference between Intercostal Muscle Spasms and a Serious Medical Issue?
Doctors don’t expect patients to know the difference between an intercostal muscle spasm and chest pain caused by a serious condition.
Dr. Christine Jellis of the Cleveland Clinic emphasizes the need for an immediate evaluation for new or severe chest discomfort, saying “As a physician, I would much rather let someone know that it’s nothing to worry about than have someone [come to us] too late and have permanent damage.”
If you’ve had a recent cardiac workup and are at low risk of a heart issue, Dr. Michael Berglund offers some common sense advice in this short YouTube video about how to tell the difference between a heart attack and chest pain caused by other common conditions.
How is an Intercostal Muscle Spasm Diagnosed?
According to Dr. Hoan Tran, the first step involves a full physical exam and diagnostics to rule out serious conditions.
Tests may include a chest x-ray to check for rib fractures and pneumonia, blood tests to look for autoimmune diseases, infections, or evidence of a heart attack and CT or MRI scans to check for masses and soft tissue injuries.
For those at high risk, cardiac testing such as an echocardiogram or stress test may be recommended.
As part of the physical, physicians ask about any recent injuries or changes in activity. He or she will look for tenderness in muscles throughout the chest and back and will assess mobility.
In complicated cases, primary care physicians may refer clients to orthopedic specialists, chiropractors, or physical therapists.
How are Spasms Treated?
Initial treatment is typically conservative but depends on the cause of the spasms and the severity and duration of the symptoms.
New Health Advisor says rest, ice, moist heat, gentle stretching and non-steroidal anti-inflammatory medications, like ibuprofen, are common recommendations in cases of acute injury.
Elastic binders are available over-the-counter and when worn around the ribs, act as pain-reducing splints.
If the cause of spasms is related to broader issues such as genetics, body weight and deconditioning, interventions to address the root causes, as well as pain relief are important.
Unless there is a correctable, underlying issue, there are no surgical treatment options.
For cases that don’t respond to early conservative treatment, doctors often recommend physical therapy according to Livestrong.com.
A skilled therapist can not only assist with pain management, but she or he can also help patients gain flexibility, strengthen muscles that support the intercostals and design a home exercise plan to maintain long-term recovery.
Should I Worry About Complications?
It is unlikely that intercostal muscle spasms could cause permanent damage to the body, however, because the pain makes it uncomfortable to move, it can result in compensatory changes in gait and posture that may cause pain in other muscles.
Nerve irritation from spasms can result in delayed healing and if a long recovery jeopardizes long-term efforts to live a healthy lifestyle, weight gain and further deconditioning could occur.
Can Alternative Medicine Help?
In addition to conventional medicine, some people choose to add alternative therapies to their treatment regimen.
Doctors advise that stretching intercostal muscles could worsen pain and prolong recovery under some circumstances and recommend evaluation first, but several types of non-traditional healthcare including massage, chiropractic adjustments, and osteopathic manipulation can relieve persistent discomfort.
Massage may or may not be indicated in the rib area — a doctor should decide, but it can help with referred pain in adjoining areas of the body and contributes to overall comfort and wellbeing.
According to Dr. Mike Snyder of Snyder Chiropractic and Wellness, chiropractors can help by adjusting the spine at the point where the ribs attach.
This is especially helpful if tense muscles are contributing to pain, causing nerve impingement, or limiting mobility. Multiple treatments are often necessary.
Like medical doctors, osteopaths are physicians that treat conditions of the musculoskeletal system with manipulation.
They can also order tests, prescribe medications, perform surgery and treat a variety of health conditions.
Hands-on manipulation techniques are often less vigorous than chiropractic adjustments and services are usually covered by insurance.
How Can I Prevent Intercostal Muscle Spasms?
Some risk factors are not controllable. Anatomical issues in the spine and rib cage that make people prone to intercostal spasms are not preventable, but certain lifestyle choices make them less likely to occur.
Maintaining a normal weight is critical. When extra weight is carried in the abdomen, it puts additional strain on the spine and ribs, pulling them forward and making movement and respiration more difficult.
Over time, it can lead to degenerative changes in the spine that affect the way the ribs are positioned and make them more prone to injury and spasms.
Patients who are overweight are encouraged to start exercising slowly to prevent injury, but build up to a level that burns enough calories to promote weight loss.
Activities like yoga and Pilates are especially beneficial since they enhance flexibility. For weekend warriors with suboptimal core strength, plenty of easy warm-time before heavy exertion is a must.
According to the experts at WebMD, posture plays an equally important role. Hours spent slumped over a desk and long commutes are teaming up to keep people sitting longer than ever.
This causes significant stress in the muscles near the spine and in turn, affects the adjoining tendons, ligaments, nerves and intercostal muscles.
Mayoclinic.com recommends improving sitting ergonomics with a chair that supports the natural curves of the spine, sitting at a height that keeps the knees even with the hips and positioning computer monitors at eye level and within arm’s length.
Stretch breaks every hour help keep muscles loose and positioning frequently needed items in a way that avoids awkward stretching prevents muscle strain.
To reduce the potential for injury and minimize stress on the spine and ribs, PhysicalTherapist.com recommends exercise to specifically strengthen core muscles.
Core exercises help the muscles in the pelvis, lower back, hips, and abdomen to work together, improving the stability and flexibility of the thorax.
Any exercise that forces abdominal and back muscles to work together is considered a core exercise.
Sit-ups and crunches are traditional examples, but new equipment including exercise balls and calibrated weight training machines can make these difficult exercises easier for everyone.
For patients with chronic intercostal spasms, a therapy-directed program is ideal.
Finally, the same sound nutrition that is good for the rest of the body also improves muscle health.
A diet rich in fruits and vegetables offers the micronutrients essential for balanced electrolytes.
Eating high-quality protein daily ensures the body has a consistent supply of amino acids for building new muscle and complex carbohydrates provide muscle with a steady energy supply.
It’s natural to want to be informed and tempting to try managing rib pain at home, but Dr. Sharonne Hayes, a cardiologist for the Mayo Clinic relates “I know of one person who died and the last thing in their search bar was ‘heart attack symptoms.’”
For localized rib pain that doesn’t go away with common sense treatment, see your doctor, but always seek immediate help for new chest pain.