You sneezed, or reached into a high cupboard, or bowled one delivery that felt different from the rest, and now there's a sharp pain along your ribs. A full breath catches. Coughing is worse. You can put one finger on the sore spot. What you want to know is whether this is a muscle, a rib, or something to worry about.
Between every pair of ribs sit the intercostal muscles. An intercostal strain is one of them stretched or torn 10, and it's a recognised cause of chest wall pain after an injury 7.
The signs are consistent: pain, sometimes with bruising or swelling, that gets worse when you take a deep breath, cough, laugh, sneeze or move a certain way 13. A useful clue: pressing on the sore spot, or a particular movement, reproduces the pain. On its own, though, that isn't enough to rule out a more serious cause 7.
The sporting version: side strain in fast bowlers and throwers. In cricket and baseball there's a more specific injury with the same everyday name. It typically happens during a single delivery or throw, and usually stops the athlete on the spot 5. What tears is the internal oblique, pulling away from the undersurface of one of the lowest four ribs or their costal cartilages 1,6. Less commonly the external oblique or transversalis is involved instead 5. It usually shows up on the side opposite the dominant arm 2,5.
Why it happens isn't fully worked out: the authors of one clinical paper say the biomechanics aren't yet understood 5. But across 207 first-class fast bowlers, side strain was not associated with bowling arm, height, trunk side-bending range or side-bridge endurance 3. The only association was how much first-class cricket had been played. So the familiar "weak core, tight side" story isn't supported. Bowling volume is.
Several things live in the same patch of ribcage, and they aren't managed the same way.
The two most consistent clinical tests are simple: focal tenderness on pressing, and pain when you side-bend towards the painful side against resistance 5.
A strain is worked out from your story and an examination 10, and the research on sporting side strain says the same: the diagnosis is a clinical one 2. You'll be asked how it happened and what you're feeling, then checked for swelling, bruising, pain and muscle strength 10. In bowlers, the two findings that turn up most reliably are one tender spot when the area is pressed, and pain when you side-bend towards the sore side against resistance 5.
Scans are the exception. Even with a bruised or broken rib there's often no need for an X-ray 9. When one is ordered, it's to rule out a fracture, and an ultrasound is sometimes used to see the damaged area more clearly 10.
We won't pretend this is a solved problem. The 2017 review states plainly that there has been no research on the management of side strain 2. The above is informed clinical practice, not a protocol with trial evidence behind it.
You don't need a scan to diagnose an intercostal strain: that comes from your history and examination 7. Imaging earns its place ruling out a rib fracture, or characterising a sporting side strain: MRI can document the tear site, characterise its severity and monitor healing 1. Ultrasound is a genuine alternative: it can confirm the diagnosis, locate the tear and describe it 6.
Across 80 MRI scans in 57 fast bowlers, a visible tear was the only finding linked to a longer return: those players were eight times more likely to take over six weeks. The caveat comes from the same paper: the model predicted recovery time in only 53% of the group, and agreement between radiologists varied widely 4. A scan finding is one input, not a date.
both appear in the guidance as real options here 7,9. That's a conversation for your GP or pharmacist. Well Motion physiotherapists don't prescribe or administer medication.
A strained rib muscle, or a bowler's side strain, is managed along The Well Motion Recovery Path™. What moves you up a phase is what your trunk can do, not how many weeks have passed.
How long it usually takes. Chest and rib injuries do most of their healing within 6 to 8 weeks, and aches can last longer 13. That is general patient guidance, not a study of this muscle. In one cohort of first-class fast bowlers, mean return to play was 39 days and 44% needed more than six weeks 4.
Nobody has researched how to manage side strain, or what predicts a recurrence 2. What exists is research on bowling load:
Call triple zero (000) for an ambulance if your chest pain 8:
Any chest pain lasting more than 10 minutes at rest should be seen by a doctor straight away 8.
Worth a proper assessment rather than continued self-management:
If none of that fits, you're most likely dealing with a muscle that was asked to do more than it was ready for. That's a problem with a clear path: settle it, then rebuild it in the right order.
We start by listening: how it began, what makes it worse, and what it's stopping you from doing. Then we examine the area, explain what we find in plain English, and agree a plan with you. Your first visit is 40 minutes at Engadine and 30 minutes at our other clinics.
We see patients at Engadine, Mount Annan, Narellan and Appin, and at home through our mobile physiotherapy service. If you have private health cover, here's how health fund rebates work for physiotherapy.
Rib pain that's worse when you cough, sneeze or breathe deeply 13, and a tender spot where pressing reproduces the pain 7. In the sporting version, add pain on resisted side-bending towards the sore side 5.
Most of the healing happens within six to eight weeks, though aches can linger beyond that 13. Sporting side strains are less predictable: in first-class fast bowlers the mean return to play was 39 days, and 44% still needed more than six weeks 4. Those are group averages from elite cricket, not a promise about you.
Sudden pain during one delivery or throw, bad enough to stop you 5, usually on the side opposite your bowling or throwing arm 2,5, with one tender spot low on the ribs. Rib pain that crept up gradually fits less neatly, so get it assessed rather than assume.
Overwhelmingly one injury: the internal oblique tear at the lower four ribs described above 1,2. Across 207 first-class fast bowlers, over half had sustained at least one in their career, and 77% of first-time injuries happened to bowlers aged 24 or under 3.
For this injury there's no proven shortcut, and managing side strain hasn't been researched at all 2. Settle it early with relative rest, ice for the first few days and the pillow trick 9, then rebuild with graded strengthening and breathing work 7,13. The quickest recovery is the one that doesn't end in a recurrence 3.
The pillow trick helps at night too: hold a pillow firmly against the sore area when you cough 9. You may also be more comfortable sleeping propped more upright on extra pillows for the first few nights, then going back to your normal position 13.
A pulled or torn abdominal muscle, upper or lower. Sharp pain when you sit up, cough, twist or lift, usually traced back to a single hard effort.
Read moreSeparation of the abdominal muscles down the midline after pregnancy. Often noticed as a gap or doming through the middle of your belly, and a core that feels like it won't switch on.
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