Intercostal Muscles – Pain & Trigger Points

The intercostal muscles lie between your ribs and support your respiration. If they are overloaded or carry active trigger points, they can cause chest pain.

Trigger points are very small nodules in the muscles.

However, you can take action yourself. With a self-massage it’s possible to deactivate them.

Even if you have never heard of it, just keep on reading and learn more about it.

I’ll explain, on one hand, how to massage yourself, on the other, …

  • which ailments might be caused by these muscles.
  • where they are located.
  • which functions they provide.
  • how to palpate them.

1. Pain Patterns, Symptoms & Differential Diagnoses

1.1 Pain patterns

Tensions in the intercostal muscles result in local pain and sensitivity to pressure.

Trigger points also cause local chest pain, which can radiate forward.

The further back a trigger point is located, the higher the probability that it will radiate forward.

1.2 Symptoms and movement restrictions

In addition to the pain described above, other problems may occur if trigger points are present

1.2.1 Pain whilst lying down

It’s not possible any more for you to lie on the side, because the intercostales are too sensitive and the pain is too strong.

1.2.2 Pain during deep inhalation

If you inhale deeply, you will feel pain in your chest, which will be intensified by physical activity.

1.2.3 Restricted vital capacity

The intercostal muscles support your breathing. Trigger points may result in the fact that they can no longer “properly” perform contraction.

This means that you breathe less air and your vital capacity decreases.

1.2.4 Restricted rotation and mobility of the thoracic spine

Tensions in these muscles can cause limited rotation of the thoracic spine in one or both directions.

This is due to their anatomical insertions at the transverse processes of your spine, as well as due to their function. Learn more in the chapters “Origin & Approach” and “Function”.

Don’t worry if you don’t understand this. The most important for you is to know that this is the way it is and how you can loosen the muscles – and you will learn this without any problems.

1.2.5 Pain when raising the arm

When you raise your arm, your ribs are pulled apart and your intercostal muscles are stretched.

If there are trigger points in the muscles, these get extended against their “will”, which can lead to a pain stimulus that prevents you from raising your arm.

1.2.6 Pain when bending sideways

The same goes for flexion of your spine to the side (lateral flexion). During this action, the ribs are pulled apart on the opposite side of the flexion.

This results in pain due to the same reason explained in the previous chapter.

1.3 Differential Diagnoses

Chest pain is usually harmless, but this may not always be the case. Go to your doctor to rule out serious illnesses.

The following list shows an excerpt of diseases that can cause similar pain as trigger points in the intercostal muscles.

  • Shingles, also known as herpes zoster
  • Fibromyalgia
  • Myocardial infarction
  • Tumor
  • Tietze syndrome
  • Radiculopathy of the thoracic spine

2. Origin & Insertion

The intercostal muscles are subdivided into internal and external muscles.

  • Musculi intercostales externi
  • Musculi intercostales interni

The layer of the externi is situated above the layer of the interni, their fibers run crosswise.

The muscles are located between two ribs, thus covering the space between them.

3. Functions

These muscles function as respiratory muscles and as rotators of the thoracic spine.

Breathing: Contraction of the intercostal muscles causes the thorax to expand upwards and sideways. Thus, they aid in inhalation by creating a negative pressure (influx of air into the body).

At rest, only the muscles in the area of the first two ribs are active, which changes as breathing becomes stronger. Deeper breathing causes gradually activation of the muscles of the lower intercostal spaces.

Rotation of the thoracic spine: The intercostal muscles are also involved in the rotation of the thoracic spine – i.e. when you twist your torso.

For such a rotation, the intercostal externi on one side of the chest and the intercostal interni on the other get active simultaneously.

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4. Intercostal Muscles – Trigger Point Activation

Trigger points in the intercostal muscles can be caused by different factors.

Examples:

  • Muscular overloads
  • External forces
  • Diseases
  • Trigger points in other muscles

4.1 Muscular overloads

A good example of how these muscles possibly get overloaded is a chronic cough. Due to the constant deep inhalation, the muscles are strained and possibly develop trigger points.

4.2 External force

(Strong) external force applied on the area of the ribs can lead to the activation of trigger points in the intercostal muscles.

  • Punch against the chest
  • Rib fracture
  • Operations in the area of the ribs and the chest

4.3 Diseases

A herpes zoster may create trigger points in the area of the ribs. In a lot of cases, they remain even after the herpes has subsided.

4.4 Key trigger points

Trigger points in the pectoralis major often lead to pain in  chest and ribs, which favors the activation of trigger points in the muscles of the affected area.

5. Palpation

You can easily feel these muscles by pressing your thumb into the area between your ribs.

This is where your intercostal muscles are situated. You perceive them as soft tissue.

6. Self-massage

For the massage, I recommend using your thumb or your fingers.

As a massage technique, choose from the ischemic compression, precise massage strokes or the pressure-motion technique.

  • Press your thumb into the area between your ribs, at the level where you perceive problems.
  • Examine the entire area between the two ribs for sensitive points – starting from your sternum following the line of your rib all the way back to the lateral side of your ribcage.
  • Massage each of these sensitive points a few times.
  • Move with your thumb from just before to just after the spot.
  • Move the skin over the muscle, but do not slide over the skin.

Trigger points are usually located in the middle third between two ribs. It’s very rare if you find them further in front or behind.

Right at the front, trigger points are located exclusively in the area directly next to the sternum. The anterior areas of the intercostal muscles and ribs that do not attach to the sternum are usually free of such points.

References

  • Calais-German, Blandine. Anatomy of Movement. Seattle: Eastland Press, 1993. Print
  • Davies, Clair, and Davies, Amber. The Trigger Point Workbook: Your Self-Treatment Guide For Pain Relief. Oakland: New Harbinger Publications, Inc., Print
  • Simons, David G., Lois S. Simons, and Janet G. Travell. Travell & Simons’ Myofascial Pain and Dysfunction: The Trigger Point Manual. Baltimore, MD: Williams & Wilkins, 1999. Print.
  • Schünke, Michael., Schulte, Erik, and Schumacher, Udo. Prometheus: Lernatlas der Anatomie. Stuttgart/New York: Georg Thieme Verlag, 2007. Print