An intercostal muscle strain can occur from any number of injuries, including:

  • A direct blow to the rib cage, such as from a fall or car accident, in which the ribs are forced apart suddenly and the intercostal muscles stretch or tear. Blows that occur from contact sports, such as football or hockey, may cause intercostal muscle strain from one-time or repeated jolts to the torso.
  • Twisting the torso beyond its normal range can pull the ribs farther apart than normal and cause the intercostals to overstretch or tear. Excess twisting may occur from sports such as tennis or golf, or from twisting while lifting. Less forceful twisting can also strain the intercostal muscles, such as certain yoga postures or dance positions.

    See Golf and Back Pain

  • Reaching overhead, as when painting a ceiling or lifting above the shoulders. Prolonged overhead reaching can cause the intercostals to remain extended longer than is typical, putting undue stress on the muscles and causing injury.
  • Repetitive, forceful motions, as one might experience during rowing, tennis, or batting or pitching. These motions and repeated stressors can gradually overstretch and tear the intercostal muscles.
  • Simply doing the above actions does not always lead to intercostal muscle strain. The likelihood of an intercostal strain increases when the muscles are weakened, either from overusing the muscles to the point of burnout, from atrophy due to lack of exercise, or from chronic poor posture.

Intercostal Muscle Strain Risk Factors

The following activities can also increase the risk of straining an intercostal muscle and causing upper back pain:

  • Physical labor, which typically requires many movements that can injure the intercostals, including frequent heavy lifting, repeated bending or reaching, and/or excessive twisting of the torso. Safe lifting techniques are essential for preventing a range of injuries, including intercostal strain.
  • Contact sports in which the upper body is hit with sudden, direct force, including but not limited to football, hockey, or rugby.
  • High-thrust sports, such as baseball/softball pitching and tennis, in which high force in the arm, shoulder, and upper back muscles is used repeatedly, putting undue pressure on these muscles and increasing the risk for strain. 1 Gerrie BJ, Harris JD, Lintner DM, McCulloch PC. Lower thoracic rib stress fractures in baseball pitchers [abstract]. Phys Sportsmed. 2016;44(1):93-6. These high-thrust motions may include pitching, batting, or swinging a tennis racket or golf club.

    See Sport Injuries, Back Injuries, and Back Pain


Always take the appropriate precautions before taking part in the above activities, or talk to a doctor before starting a new exercise to lessen the risk of injury.

  • 1 Gerrie BJ, Harris JD, Lintner DM, McCulloch PC. Lower thoracic rib stress fractures in baseball pitchers [abstract]. Phys Sportsmed. 2016;44(1):93-6.

Dr. Hoan Tran is a neurosurgeon specializing in minimally invasive spine surgery and brain surgery. Dr. Tran is a practicing spine surgeon at Franciscan Sports, Orthopaedics & Spine Health Center in Tacoma, WA. He also serves as an adjunct professor at Pacific Northwest University and as a preceptor for the Physician’s Assistant Program at the University of Washington.