How to Sleep with an Intercostal Muscle Strain

Intercostal muscle strains, which affect the muscles between your ribs, can make even the simplest things such as breathing or finding a good sleeping position feel frustratingly painful. But rest is key to healing, so finding ways to sleep better is an important part of recovery. 

This blog will explain what an intercostal muscle strain is, why it can make sleeping difficult and offer practical tips to help you get the restorative sleep your body needs. We talk to Charles Steger, a rehab physical therapist at INTEGRIS Health Jim Thorpe Rehabilitation, to learn more.

“Though intercostal muscle pain is rare, when they occur, it can be very painful and concerning. They can sometimes become strained due to sudden twisting or overuse during physical activities, excessive coughing or direct impact to the ribs,” Steger says.

“Common symptoms include sharp pain, difficulty breathing deeply and tender spots between the ribs. If you’re experiencing these symptoms, it’s best to speak to your health care provider to develop a treatment plan, which can include physical therapy or a referral to an orthopedist.”

What are intercostal muscles?

The basics: Intercostal muscles are a group of individual muscles located between the ribs that play an important role in respiration and maintaining the structure of the thoracic (chest) cavity. These muscles help expand and contract the rib cage during breathing, making them essential for proper lung function. 

Intercostal muscles are organized in layers and are divided into three groups based on their position and orientation.

• External intercostal muscles are the outermost layer and lift the ribs during inhalation.
• Internal intercostal muscles are primarily active during forced exhalation, such as when blowing out air or coughing, and work to pull the ribs downward and inward.
• Innermost intercostal muscles help stabilize the rib cage and sit deeper within the rib cage, separated from the internal intercostals by blood vessels and nerves known as the neurovascular bundle.

The primary role of the intercostal muscles revolves around breathing.

• When inhaling, the external intercostal muscles contract, raising the ribs and increasing the volume of the thoracic cavity.
• When exhaling, the internal and innermost intercostals contract, pulling the ribs downward and inward.

Protection of the thoracic cavity is also a key aspect of intercostal muscles.

• By providing structural support to the ribcage, the muscles prevent it from collapsing or being overly flexible.
• They also shield the lungs and heart by maintaining the integrity of the thoracic wall.

Beyond basic breathing, intercostal muscles are actively involved in various tasks.

• The muscles work forcefully during coughing and sneezing to expel air from the lungs.
• They also help when speaking or singing by stabilizing the chest.
• During exercise when the body demands more oxygen, the muscles work harder to increase the efficiency of breathing.

How do they become strained?

Sudden twisting or stretching can lead to small tears and subsequent pain or stiffness. 

• This can occur playing sports like tennis, golf or baseball.
• Stretching too far in yoga or reaching awkwardly – trying to grab something up high – can also result in injury.

Heavy lifting, especially without proper technique, can place excessive strain on these muscles. 

• Carrying around heavy objects engages the intercostal muscles to stabilize the ribcage and spine, and too much weight leads to overuse and becoming more prone to damage.

Trauma or impact to the chest can compress or overstretch the intercostal muscles, leading to pain and inflammation.

• Common examples include accidents, falls or injuries to the chest area from contact sports.

Engaging in repetitive motions that involve the upper body (painting, gardening or manual labor) can stress the intercostal muscles over time. 

• Movements like repetitive reaching or pulling are especially risky when done for prolonged periods without rest because they can lead to small tears in the muscle fibers.

Persistent coughing or sneezing forcefully contract the ribcage.

• If coughing persists – as with respiratory infections or allergies – the repetitive strain can overwork these muscles and cause pain.

Why is an intercostal strain so painful at night?

Key points: Sleeping with an intercostal muscle strain can be challenging due to the discomfort that typically worsens with certain positions or movements. Since the muscles are vital in breathing, they remain active (even at night), meaning they don’t get a true break while you breathe.

Because breathing requires your ribcage to move, the regular expansion and contraction of the chest during every breath can irritate inflamed or torn intercostal muscles. 

• The strain makes each movement – no matter how small – an ongoing source of tension or discomfort.
• Even slight twists or adjustments as you shift in your sleep can aggravate the tension.

When you lie down, particularly in certain positions, it can put additional pressure on the injured muscles and surrounding soft tissues. 

• For example, sleeping on your side or stomach may compress the strained area, leading to increased tenderness or even sharp pain.
• On your back, gravity alone can sometimes strain the ribs depending on your posture or mattress support, causing discomfort to flare up.

Sleeping with an intercostal muscle strain

At a glance: Depending on the severity of the strain, an intercostal strain can take anywhere from a few weeks (grade I strain) to several months (grade III strain) to heal. That means you will have to make temporary adjustments to your sleep routine. To get a good night’s sleep, focus on finding a comfortable position that minimizes pressure on the injured area. Typically, this involves using a pillow, either beneath your knees or on your side (depending on sleeping position).

Lying flat on your back is often the most comfortable position for people.

• This minimizes pressure on the ribs and allows the strained muscles to relax.
• Place a pillow beneath your knees to keep your spine in alignment and reduce tension on the chest and rib area.

Sleeping in an elevated position can help reduce strain on the injured muscles.

• Prop yourself up with a wedge pillow or stack several pillows to raise your upper body.

Side sleeping on the unaffected side is also an option.

• This keeps pressure off the strained muscles.
• Place a pillow against your chest or between your arms to support your ribs and prevent unnecessary twisting.

Additional tips

In addition to back or side sleeping, consider these tips.

• Avoid stomach sleeping, as this can compress the chest and exacerbate discomfort.
• Place soft pillows around your body to prevent rolling into positions that could worsen the strain.
• Use an ice pack for 15 to 20 minutes before bed if the strain is still causing significant swelling or sharp pain.
• Over-the-counter pain medication, such as ibuprofen or acetaminophen, can help ease discomfort as you sleep.
• Gentle stretching and deep breathing can also loosen and relax the muscles in the ribcage.

Next steps: If your intercostal muscle strain is making it hard to sleep, schedule an appointment with your primary care physician to inquire about next steps. They may refer you to a physical therapist to help restore movement and flexibility or an orthopedist for specialized treatment.

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