An intercostal strain is a pulled muscle between the ribs. It usually follows a sudden twist, a heavy lift, a bout of coughing or an unaccustomed burst of activity, and it causes sharp, localised pain in the chest wall that is worse with twisting, deep breaths and coughing. Most strains settle within a few weeks, but because chest pain has many causes, new chest pain should be checked medically before it is put down to a muscle.
Also known as intercostal muscle strain, pulled rib muscle, chest wall strain
Anatomy: where the problem is
Front view of the rib cage. Highlighted in the diagram: intercostal muscles.
Symptoms
- Sharp or pulling pain between the ribs, usually on one side
- Pain that is worse with twisting, reaching, deep breathing, coughing or sneezing
- Tenderness when pressing between the ribs
- Tightness or spasm in the muscles around the area
- Pain that came on with a specific movement or after a bout of coughing
Causes and risk factors
- A sudden twist or reach, especially when lifting
- Unaccustomed activity such as decorating, chopping wood or a new gym session
- Rowing, golf, tennis, cricket bowling and other twisting sports
- Prolonged or severe coughing
- A direct blow to the chest wall
What the evidence says helps
- Chest wall pain is diagnosed from the history and examination once heart, lung and other causes have been considered. Pain that can be reproduced by movement or by pressing on the area points towards a muscle or joint source.1
- Muscle strains generally heal over a few weeks with relative rest followed by a gradual return to activity. There are no good trials of specific treatments for intercostal strains, so advice follows general principles for muscle injuries.1
- As with rib injuries, keeping your breathing deep and comfortable, with pain relief if needed, matters more than resting completely.2
Things you can try at home
- Ease off the movements that set it off for a week or two, then build back gradually
- Use heat or ice for short-term relief, whichever helps
- Take pain relief if needed so that you can breathe and move comfortably: ask a pharmacist
- Keep breathing deeply, and support the area with a pillow or your hand when you cough
- Start gentle twisting and side-bending movements as the pain eases
- Return to sport in stages, starting at lower intensity
When to get urgent help
Contact your GP urgently, call NHS 111, or call 999 in an emergency if you have:
- Chest pain that spreads to the arm, neck, jaw or back, or comes with breathlessness, sweating, nausea or light-headedness: call 999
- Sudden sharp chest pain with breathlessness or coughing up blood: call 999
- Chest or upper back pain with a fever, a cough or feeling very unwell: get same-day medical help
- Constant pain that is worse at night, with unexplained weight loss or a history of cancer: see your GP
- Chest pain after a fall or blow with increasing breathlessness: call 999
How Apollo can help
We start with the questions and checks needed to decide whether your pain is likely to come from the chest wall, and we refer you for a medical assessment if anything does not fit. For a muscle strain, treatment can include gentle soft tissue work, mobilisation of the upper back and ribs, and breathing and movement exercises. We then guide a graded return to lifting, twisting and sport, and look at anything that contributed, such as a sudden jump in training.
No GP referral needed. Clinics in Sheringham, Coltishall and Norwich.
Related reading
Frequently asked questions
How long does a pulled rib muscle take to heal?
Mild strains often settle in two to three weeks. More significant strains can take six weeks or longer. Pain with deep breaths and coughing is usually the first thing to improve.
How can I tell a pulled chest muscle from a heart problem?
Muscle pain is usually sharp, in one spot, and worse when you twist, press on it or breathe deeply. Heart pain is more often a tightness or pressure that may spread to the arm, neck or jaw and come with breathlessness, sweating or nausea. If you are unsure, call 999.
Can I exercise with an intercostal strain?
Gentle walking is fine and helps. Avoid heavy lifting, twisting sports and hard breathing efforts until the pain has settled, then return in stages over a few weeks.
References
- Stochkendahl MJ, Christensen HW (2010). Chest Pain in Focal Musculoskeletal Disorders. Medical Clinics of North America 94:259-273. View source
- NHS. Broken or bruised ribs. NHS website, accessed November 2026. View source
This page is general information, not a diagnosis or a substitute for medical advice. If you are worried about your symptoms, speak to your GP or a registered healthcare professional. Content prepared from the sources above, November 2026.
