Written by the Phoenix Rehab physiotherapy team.Clinically reviewed by Louise Yow, Principal Physiotherapist and Director, AHPC A1300363H.Last reviewed 2 October 2026.
An intercostal muscle strain is a pulled muscle between two ribs. It causes sharp rib pain on one side that catches when you breathe in, cough, sneeze or twist, and the spot between the ribs is tender to press. Most mild strains settle in two to three weeks. Bigger ones can take four to eight. Chest pain with breathlessness, sweating or pain into the arm or jaw is not a muscle strain. Call 995.
What it feels like
Pain along the line of one rib, usually at the side or the back of the rib cage, sometimes at the front. A deep breath catches it at the same point every time. Coughing and sneezing are the worst of it, and many people start holding a pillow against the ribs to cough. Turning in bed, reaching up to a shelf and putting on a seatbelt all find it.
What causes it
A coughing fit after a cold. A golf swing, a badminton smash or a rowing workout after weeks off. A long reach overhead, or a twist while lifting a box. Sometimes a knock to the side of the chest.
How long does an intercostal strain take to heal?
A mild strain usually settles in two to three weeks. A moderate strain takes four to eight. The pain on breathing goes first, the pain on twisting next, and the tenderness to press last. If it is still catching at the same point after eight weeks, it is worth having it looked at, both to check it really is the muscle and to rebuild the movement it has taken away.
How to sleep with an intercostal strain
Lie on the side that does not hurt, or on your back propped up on two pillows. A pillow hugged against the sore side helps when you turn over, and the same pillow pressed against the ribs makes coughing and sneezing more bearable.
What helps, and what we work on
- Stage 1, Calm & Protect: the twist or reach that set it off stops. Breathing stays full. Shallow breathing to avoid the pain leaves the ribs stiff.
- Stage 2, Move & Mobilize: side-rib breathing and gentle upper back rotation, so the rib cage moves again on both sides.
- Stage 3, Rebuild & Strengthen: the trunk holds still against load, then turns against it.
- Stage 4, Return & Perform: swings, smashes and strokes come back on a counted ladder.
Rib pain on the left or right side: what else it could be
A strain is reproduced by pressing between the ribs and by moving. Pain that is not, is a question for a doctor. On the left, chest pain is checked for the heart first, every time. Pain under the right ribs that comes after meals, or with nausea or fever, can come from the gallbladder or liver. Rib pain after a fall can be a fracture. See also costochondritis, which hurts at the front beside the breastbone.
When to see a doctor first
Call 995 for chest pain with breathlessness, sweating, nausea, or pain spreading into the arm or jaw. Go to the emergency department now if you are short of breath after a fall onto the ribs. See a doctor the same day if you are coughing blood or have a fever. See a doctor soon if pressing and moving do not reproduce the pain, or if it wakes you every night regardless of position.
Rib pain after a fall or a blow to the chest is a different matter. Read rib fracture first.
Where are you with this right now?
1. It is settling on its own
If breathing in hurts less each week and only the twist and the press on the spot still find it, you are on the right road. Keep breathing fully and bring the sport back gradually. You do not need us for this, and we would rather say so.
2. It has stopped improving
Two months on, the first golf swing or the first smash still catches at the same rib. You breathe shallow without noticing and sleep on one side only. That is stiffness and lost rotation, rest will not give it back, and both can be measured side to side. Every first visit is one 45-minute Assessment & Treatment, $230, nett, no GST. If it has been months, the Stalled Recovery Review is three appointments over three weeks with the same therapist, $690.
3. You have had surgery, or you have a date
After rib fixation or chest surgery, the stages are set with your surgeon. See physiotherapy after surgery. All of it runs on the four stages of the Phoenix Recovery Protocol.
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