Intercostal Muscles Trigger Points

Introduction

The intercostal muscles are small but essential muscles located between the ribs, responsible for breathing, rib movement, and torso stability. When trigger points develop in these muscles, they can cause chest pain, rib tightness, and difficulty breathing, often mimicking heart issues, lung problems, or costochondritis.

Name and Area

  • Name: Intercostal Muscles

  • Area: Located between the ribs, spanning from the upper to lower rib cage, divided into three layers:

    • External Intercostals: Assist in inhalation by expanding the ribcage.

    • Internal Intercostals: Assist in forced exhalation by depressing the ribs.

    • Innermost Intercostals: Support the ribcage during breathing and movement.

Indications

Intercostal muscle trigger points may contribute to:

  • Sharp or aching pain in the chest or ribcage (mistaken for heart or lung issues)

  • Pain that worsens with deep breathing or coughing (can mimic pleurisy or costochondritis)

  • Pain that extends to the side of the torso or upper back (can resemble nerve pain or rib dysfunction)

  • Tightness or stiffness in the ribcage, limiting breathing or trunk movements

  • Pain when lying on the affected side (common in side sleepers or post-surgical patients)

  • Pain that increases with twisting, reaching, or lifting movements

Pain from this muscle is often mistaken for cardiac issues, lung disorders, or rib fractures.

Muscle Action

  • External Intercostals: Expand the ribcage during inhalation, allowing the lungs to fill with air.

  • Internal Intercostals: Depress the ribcage during forced exhalation, helping expel air from the lungs.

  • Innermost Intercostals: Provide ribcage support and stability.

The intercostal muscles are essential for breathing, posture, and torso movement.

Signs and Symptoms

Individuals with intercostal muscle trigger points often report:

  • Pain in the ribcage or chest that feels like a "stitch" or sharp ache.

  • Pain that worsens with deep breathing, coughing, or sneezing.

  • Tightness in the ribcage that limits trunk mobility and breathing.

  • Pain that extends to the side of the torso or upper back (can mimic nerve pain or lung issues).

  • Discomfort when lying on the affected side (common in rib injuries or postural strain).

  • Pain that increases with twisting or lifting movements.

Pain worsens with deep breaths, coughing, twisting, or sustained postures.

Perpetuating Factors

Common causes of intercostal muscle trigger points include:

  • Repetitive twisting movements (golf, tennis, yoga, or overhead lifting)

  • Poor posture or prolonged sitting (leads to ribcage tightness and shallow breathing)

  • Chronic coughing or respiratory illnesses (asthma, COPD, pneumonia, or post-viral coughs)

  • Trauma to the ribcage (falls, car accidents, or impact injuries in contact sports)

Overuse from heavy breathing (common in runners, swimmers, and high-intensity athletes)

Trigger Point Referral Pattern

Trigger points in the intercostal muscles refer pain to:

  • The chest and ribcage (can mimic heart pain or costochondritis)

  • The side of the torso (mistaken for nerve compression or rib dysfunction)

  • The upper back and shoulder blade (can resemble postural strain or thoracic outlet syndrome)

Pain from these muscles is often confused with rib dysfunction, cardiac issues, or thoracic nerve pain.

Differential Diagnosis

Intercostal muscle trigger points may be mistaken for:

  • Heart problems (angina, heart attack, or pericarditis – due to chest pain and rib discomfort)

  • Lung issues (pleurisy, pneumonia, or pulmonary embolism – pain that worsens with breathing)

  • Costochondritis (inflammation of rib cartilage, causes tenderness in the ribcage and chest pain)

  • Thoracic radiculopathy (nerve compression in the mid-back, causing rib and chest pain)

  • Rib fractures or contusions (pain that worsens with movement or direct pressure on the ribs)

A thorough chest, ribcage, and respiratory assessment is necessary to rule out these conditions.

Associated Trigger Points

Intercostal muscle trigger points often co-exist with:

  • Serratus anterior (rib and side pain, affects deep breathing and shoulder stability)

  • Quadratus lumborum (lower back and rib pain, contributes to postural imbalances)

  • Latissimus dorsi (pain in the mid-back and side of the ribcage, common in overhead movements)

  • Pectoralis major (chest pain and shoulder tightness, can mimic cardiac symptoms)

Anatomy and Innervation

Muscle Origin Insertion Innervation
External Intercostals Lower edge of rib above Upper edge of rib below Intercostal nerves (T1–T11)
Internal Intercostals Inner surface of rib above Inner surface of rib below Intercostal nerves (T1–T11)
Innermost Intercostals Deep surface of rib above Deep surface of rib below Intercostal nerves (T1–T11)

The intercostal muscles are innervated by the intercostal nerves, which also control breathing mechanics and rib movement.

Patient Examination

A comprehensive examination should include:

  • Palpation: Identify tender nodules along the ribcage and between the ribs.

  • Breathing Pattern Assessment: Observe if the patient uses chest breathing instead of diaphragmatic breathing.

  • Rib Mobility Testing: Assess for tightness or restriction in rib movement during inhalation and exhalation.

  • Postural Analysis: Look for rounded shoulders, excessive thoracic kyphosis, or ribcage tightness.

Corrective Actions

Dry Needling

  • Dry needling can release trigger points in the intercostal muscles, reducing muscle tightness and improving breathing efficiency.

Manual Therapy

  • Trigger Point Release: Apply gentle sustained pressure along the ribcage and intercostal spaces.

  • Myofascial Release: Stretch and mobilize the ribcage, chest, and thoracic spine.

Stretching

  • Side Stretch: Stand and gently lean sideways to stretch the intercostal muscles.

  • Thoracic Extension Stretch: Use a foam roller or doorway stretch to open the chest and improve ribcage mobility.

Strengthening Exercises

  • Diaphragmatic Breathing Exercises: Helps train proper breathing mechanics and reduce ribcage tension.

  • Thoracic Rotation Drills: Improves spinal mobility and reduces stiffness in the mid-back and ribs.

  • Core Stability Work: Engages the deep core muscles to support the ribcage and spine.

Postural and Lifestyle Adjustments

  • Avoid slouching or prolonged sitting (take breaks to stand and stretch every 30–60 minutes)

  • Practice deep breathing exercises (reduces chronic rib and chest tightness)

  • Use proper sleeping positions (avoid sleeping in a twisted or compressed position)

Conclusion

The intercostal muscles play a crucial role in breathing, rib mobility, and torso stability, but trigger points in these muscles can cause significant chest, rib, and mid-back pain. By incorporating dry needling, manual therapy, stretching, and strengthening exercises, individuals can reduce pain, improve mobility, and prevent future dysfunction.

➡️ Learn more about Trigger Points

Sources:

  • Travell, J. G., & Simons, D. G. (1983). Myofascial Pain and Dysfunction: The Trigger Point Manual (2nd ed.). Williams & Wilkins.

  • Simons, D., & Travell, J. (1999). The Trigger Point Manual, Volume 2: The Lower Extremities. Williams & Wilkins.