Rib and Chest Wall Muscle Strain

A sharp catch in the side of your ribs when you breathe in deeply, cough, sneeze or twist. It often follows a heavy coughing bout, a new gym exercise, a golf swing or reaching awkwardly overhead.

Chest wall strains are common and settle on their own. Because they’re chest pain, the first job is ruling out the things that aren’t muscular.

Call 995 if…

• Chest pressure, tightness or heaviness, especially with breathlessness, sweating, nausea, or pain spreading to the arm, jaw or back
• Sudden severe breathlessness
• You feel faint, or your heart is racing and irregular

See a doctor the same day for sharp pain on breathing in with breathlessness, a cough, fever, or coughing up blood, and for anyone with a raised clot risk after surgery, a long flight or in pregnancy.

Signs it is the chest wall

• Pressing on a specific spot reproduces the pain exactly
• It changes clearly with position, twisting or reaching
• You can trace it with one finger rather than a whole hand
• There’s a clear cause: coughing, lifting, a new exercise, a knock
• You otherwise feel well

That’s the general test for muscular pain: see is it muscle pain? Pain right where a rib meets the breastbone, tender to press, is often costochondritis. It’s harmless and slow to settle, sometimes taking weeks.

Using heat

Once you’re satisfied it’s muscular, heat suits it well.

Ribs have thin skin and little padding, so stay on the lowest setting with the cover on, 15 minutes, sitting or lying supported. Check the skin afterwards.

Don’t use it over a bruise in the first couple of days after a knock; see the 48–72 hour rule. Never over a rash: a band of burning pain before a rash appears may be shingles. The full list is in who should not use a heating pad.

The part people get wrong

Because deep breaths hurt, people breathe shallowly for days. That’s the one thing to avoid: it stiffens the chest and, after a rib injury, raises the risk of a chest infection.

Take a slow deep breath and hold it for three seconds, ten times, several times a day, even though it’s uncomfortable. Hug a pillow against the sore side when you cough.

Keep moving and keep your posture upright. Warmth first, then the breathing work: heat is the warm-up, not the treatment.

How long it takes

A simple strain eases over one to three weeks. Costochondritis and cracked ribs take longer, often six weeks or more, with a slow fade rather than a clear end point.

See a doctor if…

• It followed a significant fall or impact, particularly if you’re older or have thin bones
• You develop fever, a productive cough, or increasing breathlessness
• Pain is severe enough to stop you breathing deeply at all
• You have a cancer history, unexplained weight loss, or night pain
• It isn’t improving after three weeks. Stiffness across the ribs and spine in a younger adult, worse with rest, can be ankylosing spondylitis.

Also worth reading: heating pad for shoulder blade pain, which covers referred pain from the chest and abdomen, and upper back pain from desk work if the ache is more of a background one.

Clinically reviewed by: Nigel Chua (Hand Occupational Therapist) & Louise Yow (Physiotherapist). This article is general information, not a diagnosis. electricheatpad.com sells electric heat pads.