How to Sleep With an Intercostal Muscle Strain

This research is supported by you, our readers, through our independently chosen links, which earn us a commission with no extra cost to you. Learn More

Written by: Alex Savy
Read 9 minLast updated on February 17, 2023

People who practice contact sports such as rugby or high-impact sports are more likely to have intercostal neuralgia. It's caused by activities that weaken or strain the muscles and ligaments in the chest, ribs, and abdominal region. Sleeping with this pain can be difficult.

The good news is that there are some things one can do to make things a little easier.

This article will provide information on the problem, the causes and symptoms, and some tips on how to sleep with an intercostal muscle strain

Subscribe to our Youtube Channel to watch out for new product reviews and guides in video format or follow us on Instagram.

Intercostal Muscle Strain: What Is It?

An intercostal muscle strain can be defined as pain or injury felt in the thorax region. Unlike when trying to sleep with piriformis syndrome, where the source of pain is in the hips, intercostal muscle strain is felt mainly in the chest region. It is caused by injuries to the muscles within the ribs and inflammation of the intercostal nerves.

Causes and Symptoms

There are several reasons why the ribs and chest hurt, preventing one from sleeping. Causes and symptoms to watch out for will be listed below:

Causes of an intercostal muscle strain

Intercostal muscle strain is a common reason for doctor visits for chest pain. This rib sprain often comes after a fall, overexertion, or trauma following an accident [1].


During pregnancy, the organs are pushed upwards, which can cause intercostal neuralgia in women due to this compression. In addition, the nerves of the ribs will be compressed because the intercostal spaces are reduced, irritating the spinal and intercostal nerves

Rib fracture or bruising

Rib fractures and bruises are often the result of motor vehicle accidents, falls, contact sports, or child abuse/brutality. They can also be due to severe coughing efforts [2]. When the ribs are affected, the nerves and muscles will be affected, hence, the pain.

Those trying to sleep with broken ribs have to contend with constant pain. Sleeping, in this case, can only be aided with medications, adaptive sleep surfaces, and accessories, and being in the right sleep position

Intercostal neuralgia 

These are benign or malignant tumors in the chest or abdomen pressing on the intercostal nerves. The pain can be so severe that sleep may be affected. 

Pain following an operation

Certain operations, such as coronary artery bypass grafting, can affect the rib cage. These can subsequently cause intercostal nerve damage, thus, the pain [3]. 

Stress, age, and lifestyle 

Intercostal pain can be felt due to muscle contractions caused by stress. The tensions created by stress will be transmitted to the back muscles. People with a sedentary lifestyle or seniors can also be affected by this type of problem. Anxiety and age can cause thin and weak muscles. And when the muscles are weak, the rib muscles are easily strained. 

Intercostal muscle strain 

The main symptom one will experience with an intercostal strain is pain in the rib cage. This pain can be in or around the rib cage and felt in the back and the front of the chest. Sometimes this pain can be bilateral and feel like a stab.

Pain can occur when breathing, laughing or sneezing. It can sometimes be felt uniformly along the length of the ribs. The pain will increase when the affected person exercises hard.

There may be other symptoms like:

  • A decrease in appetite
  • Fever 
  • Tingling numbness 
  • Abdominal pain
  • Sore arms or shoulders.

Rib pain on the left side can sometimes be confused with angina pectoris or heart pain. However, to be sure that the origin is not cardiac, it is essential to consult a doctor.

Finally, one can have much more severe symptoms such as:

  • Breathing difficulties
  • Acute abdominal pain
  • Paralysis or muscle atrophy
  • A cough with mucus that will persist over time
  • Pressure in the chest or a tearing feeling in the chest
  • Heart palpitations
  • Discomfort, loss of concentration, or confusion.

If you are experiencing intercostal muscle pain or any of the symptoms above, we recommend that you consult a doctor urgently to avoid more severe complications.

Simple Tips for Sleeping With Intercostal Pain 

Trying to sleep is always a problem for people with pain. And for people with chest and rib pain, this can be a nightmare. Below are some rules and tips to sleep with an intercostal muscle strain:

Inclined sleeping 

To sleep, one must breathe, which naturally induces pressure on the ribs and thus cause discomfort or pain that can affect sleep quality.

  • It's better to position the bed slightly inclined to limit the pressure on the ribs when breathing.
  • If it is not possible to incline the bed, sleepers can place their pillows in a way to position them in a slightly inclined position. This also helps to keep the neck in a comfortable position.

Sleeping  position

The sleeper can also be more comfortable sleeping on their side – on the side where there's no pain, just like when trying to sleep with meralgia paresthetica. Sleeping on the back or side is the best position to sleep with an intercostal muscle strain. This will help breathe more easily as there will be no pressure on the chest. 

Also, by laying on the side or back, there will be no compression in the thorax, pushing against the affected ribs and muscles. 

Tight chest muscles often cause difficulty breathing, so sleeping in a position that relieves these muscles can help breathe more easily.

Sleeping on the stomach should be ruled out, even with pillows.  Resting the chest down can become a problem because more pressure will be on the ribs and chest region. 

Anti-inflammatory drugs

Before going to bed, one can also combat the discomfort of rib pain by taking anti-inflammatory medications such as ibuprofen or aspirin. These medications will soothe any pain one may feel in the ribs.

The doctor may also prescribe anti-inflammatories containing antihistamines to help the patient better fall asleep.

Breathing exercises

The simple act of breathing can be painful when one has rib pain. Therefore, taking shallow breaths, even if they are temporarily more comfortable, are not recommended.

Shallow breathing can interfere with the healing process. Moreover, shallow breathing can cause pneumonia [4].

During the healing phase, it will be essential to continue to breathe deeply. This will fill the lungs with air, expanding the chest and working the intercostal muscles. 

Sufferers can also ask their doctor for breathing exercises to help them relax and unwind before going to sleep.

Using a proper pillow

Using a pillow can support the head and neck for those who want to sleep on their back. Affected sleepers can also place a pillow under or between their knees to prevent and reduce the pain associated with the upper back. 

An appropriate mattress

A mattress that is too soft or too hard can cause back pain. Therefore, a medium-firm mattress is often the best choice for people with back pain as it may be more comfortable. In addition, a firm mattress provides support and comfort, which can help relieve pain. 

People with an intercostal muscle strains can therefore consider using a memory foam mattress. Memory foam conforms to the body and relieves pressure points. This can help reduce the pain and improve sleep quality. However, note that heavy sleepers can end up with hip pain after sleeping on a mattress that is too soft. But a medium-firm mattress should still work for people weighing 130 to 230 pounds.


What sleep position is best for people with intercostal muscle pain?

Side and back sleeping are the best positions to sleep with an intercostal muscle strain. When sleeping on the stomach, unnecessary pressure is put on the back, ribs, and spine. The muscles in the back will then contract and become even sorer.

How long does an intercostal muscle strain take to heal?

The moderate intercostal muscle strain can take four to five weeks to heal. However, the severe forms of this strain, where there may be complete muscle breakdown, usually take a little longer.


To sleep with intercostal pain, the most effective techniques are to sleep in an inclined position, use anti-inflammatory drugs prescribed by the doctor, and do breathing exercises. A memory foam mattress, supported by pillows under the head and knees, also helps. 

Fortunately, patients with intercostal muscle pains are fully healed within weeks. However, sleep is an essential part of healing and managing intercostal pain. Therefore, patients are to ensure they get enough rest each night. 

Just a moment before you go, do you have intercostal muscle pain? How have you been able to sleep with an intercostal muscle strain? Tell us in the comment section!


  1. Sherry Christiansen on January 10, 2020. What is an intercostal muscle strain? Retrieved from
  2. "Broken or bruised ribs."05 January 2021.  Retrieved from
  3. Mailis, A., Umana, M., & Feindel, C. M. (May 1, 2000). Anterior intercostal nerve damage after coronary artery bypass graft surgery with use of internal thoracic artery graft. Retrieved from
  4. Beth Axtell (March 7, 2019). How to Identify and Treat an Intercostal Muscle Strain. Retrieved from

Leave a comment