How to sleep with intercostal muscle strain: tips and exercises

Getting restful sleep is important for your overall well-being, but it can be challenging when you have an intercostal muscle strain. These muscles, located between your ribs, help move your chest as you inhale and exhale. When intercostal muscles become overstretched or strained, breathing and finding a comfortable sleeping position can feel more difficult.

It’s normal for your sleep to be disrupted as your body adapts and heals from an intercostal muscle strain, says Dominica Sourial, PT, DPT, a physical therapist at Hinge Health. When intercostal muscle strain prevents you from falling or staying asleep, your pain may feel worse.

While there's not one “right” way to sleep with intercostal muscle strain, making adjustments to your usual sleeping position and doing targeted stretches before bed can help you feel more comfortable.

Read on to learn how to sleep with intercostal muscle strain, with strategies and tips recommended by our Hinge Health physical therapists.  

Causes of intercostal muscle strain

The intercostal muscles are strong and resilient, but certain situations can pull these muscles and lead to a strain. These include:

• Overexertion. Doing more activity than your body is prepared for — say, shoveling snow, moving furniture, or carrying luggage — can strain these muscles.

• Sudden movements or twisting motions. Activities that involve quick turns or powerful twists, such as tennis or golf, can lead to discomfort in the intercostal muscles, says Dr. Sourial.

• Repetitive movements. Frequent coughing or sneezing when you’re sick, for example, can strain your abdominal and intercostal muscles. Doing certain upper body movements over and over again, like rowing or painting walls, can also lead to intercostal muscle discomfort.

• Trauma. A direct impact to the chest, such as being hit by a ball, experiencing a fall, or being in a car accident, can lead to intercostal muscle strain.

Symptoms of intercostal muscle strain

Muscle strain symptoms can vary, but most commonly include:

• Sharp pain in your chest, or your torso in the region of your rib cage. 

• Pain that worsens with movement. “It’s common to feel a dull, nagging ache when you’re at rest, but discomfort often increases when you stand up from a chair, take a deep breath, or cough,” says Dr. Sourial.

• Tenderness to touch.

• Swelling around the affected muscles.

Best sleeping positions for intercostal muscle strain

There’s not one best sleeping position for intercostal muscle strain. “The most important thing is finding what feels comfortable to you,” says Dr. Sourial. Small adjustments to your usual sleep position can help you stay supported and avoid extra strain. Try these tips to sleep comfortably with intercostal muscle pain.

For side sleepers 

Try to avoid sleeping on the side where you feel muscle discomfort, as this can add pressure to the sore area. Consider placing a pillow between your knees helps your back feel supported as you sleep. A neutral spine can allow your rib cage and intercostal muscles to be in a more relaxed position, which can boost your comfort. Hugging a pillow can also provide gentle support for your ribs. “Try to keep your knees comfortably stacked to help your body feel more at ease and minimize any movements that might increase discomfort,” says Dr. Sourial. 

For back sleepers

Try using a few pillows to boost your comfort throughout the night. You could try one under your head, another under your knees to help your body relax, and a body pillow to hug for added support in your upper body. If lying flat on your back is too uncomfortable, Dr. Sourial suggests sleeping in a semi-upright position by stacking several pillows or using a wedge pillow behind your back. This can help you settle in more comfortably and may make breathing easier as you rest.

For stomach sleepers

“Sleeping on your stomach can put extra pressure on your ribs and lead to twisting that may make intercostal muscle discomfort worse,” says Dr. Sourial. It’s best to avoid this position if you can as you heal. But if you’re most comfortable on your stomach, try to keep your body as flat as you can to reduce pressure on your chest and ease discomfort. This means avoiding the temptation to prop yourself up with multiple pillows under your hips or chest, which can increase twisting or uneven pressure along your ribs.

How to sleep with an intercostal muscle strain

Besides making your sleep position as comfortable as possible, you can: 

• Use supportive pillows. Pillows can help make sleep more comfortable by providing gentle support and relieving pressure from tender areas.

• Avoid weighted blankets. While weighted blankets are soothing, they can add extra pressure to your ribs. 

• Maintain a consistent sleep schedule. Going to bed and waking up around the same time each day helps your body establish a natural rhythm, making it easier to fall asleep and wake up feeling rested. Getting enough rest can also support your comfort and may help reduce sensitivity to pain.

• Practice relaxation techniques. Try gentle relaxation practices, such as mindfulness or meditation, to help your body and mind unwind before sleep. “If deep breathing feels uncomfortable, focus on slow, gentle breaths to support relaxation without straining your intercostal muscles,” says Dr. Sourial.

• Take over-the-counter (OTC) medication. Pain relievers such as ibuprofen (Advil, Motrin), naproxen (Aleve), and acetaminophen (Tylenol) can be helpful for intercostal muscle strain pain. It’s important to make sure that you are safely able to take these medications, based on your medical history.

• Apply ice and heat. For the first 48 hours following an injury, Dr. Sourial recommends sticking to ice, as that can help ease inflammation. After that, switching to heat can help boost blood flow to the area and speed up healing. Taking a warm bath before bed may help you fall asleep better, research suggests. 

• Create a comfortable sleep environment. Adopting good sleep hygiene habits, such as powering down screens at least one hour before bed, reading a relaxing book, and doing stretches and breathing exercises can help create a restful environment for sleep. Regulating your body’s internal clock promotes better sleep, which can reduce pain perception. Ear plugs, eye masks, blackout curtains, and sound machines are all examples of tools that can help improve your sleep. 

• Do gentle stretches before bed. Engaging in gentle upper body stretches, such as the ones below can help ease tension and prepare you for sleep.  

Stretching before bed can help ease intercostal muscle strain by relaxing your body, relieving tension, promoting blood flow to sore areas, and supporting better sleep. Try holding each stretch for 10-15 seconds and repeating 5-6 times each for the best effects, Dr. Sourial says.

The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.

When to see a doctor

Most intercostal muscle strains improve on their own with conservative treatments, Dr. Sourial says. But if your pain is severe, getting worse, or causing difficulty with daily activities, see a healthcare provider. It’s also a good idea to get care if you have:

• Pain after an accident or trauma — a doctor may need to rule out rib fractures

• Difficulty breathing or inability to take deep breaths due to pain 

• Rash, blisters, or skin changes 

• Fever or chills along with pain 

PT tip: Be mindful of your limits

Stretching is important, but it's important to not overdo it when you have an intercostal muscle strain, says Dr. Sourial. “Overstretching can aggravate the muscle strain, so ease up if movement causes discomfort greater than a three or four ona scale of 1 to 10.” 

How Hinge Health can help you

If you have joint or muscle pain that makes it hard to move, you can get the relief you’ve been looking for with Hinge Health’s online exercise therapy program.

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app when and where it works for you.

Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you.

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

References

1. Intercostal retractions: MedlinePlus Medical Encyclopedia. (n.d.). Medlineplus.gov. https://medlineplus.gov/ency/article/003322.htm

2. Haghayegh, S., Khoshnevis, S., Smolensky, M. H., Diller, K. R., & Castriotta, R. J. (2019). Before-bedtime passive body heating by warm shower or bath to improve sleep: A systematic review and meta-analysis. Sleep Medicine Reviews, 46, 124–135. doi: 10.1016/j.smrv.2019.04.008

3. Physiopedia. (n.d.). Intercostal Muscle Strain. Physiopedia. https://www.physio-pedia.com/Intercostal_Muscle_Strain

4. Hickam, D. H. (2019). Chest Pain or Discomfort. Nih.gov; Butterworths. https://www.ncbi.nlm.nih.gov/books/NBK416/