Rib Trigger Points

Treating rib trigger points can be a very rewarding way of relieving chest pain. The main place you’ll find trigger points here is in the intercostals – small muscles that occur in between each rib.

Rib trigger points can cause:

  • Pain felt locally in your ribs
  • Pain when you twist your torso
  • Pain while breathing or coughing

In this article you’ll discover:

  • What causes triggers in your ribs
  • How to find these trigger points
  • How to treat them

‘How can you self-treat a trigger point if it’s unreachable? I have a pain, which feels like a bad bone bruise under my lower left rib. I know it is under the rib because when I press lightly on the rib it doesn’t hurt. Pain is present when I twist to the right coming from the underlying muscle. How can I treat it though if it is under my rib?’

Finding Rib Trigger Points

You’ll need to search carefully to find these trigger points, as the intercostal muscles are in a thin band. These muscles work to raise and lower the ribs as you breathe in and out, and may help stabilize the ribs as you twist your body.

There are two layers of intercostal muscles in between each set of ribs. When you can get trigger points in these small superficial muscles, they cause pain locally in between your ribs.

Intercostal muscles. On the right side you can see the two layers of muscle, with the fibers running in opposing directions for added strength and stability

Trigger points can be set off by twisting beyond your comfortable range of movement. They can also be set off by extended periods of coughing, which can happen if you have an illness affecting your lungs.

Another cause of rib trigger points can be an impact injury where your ribs have been forced beyond their normal comfortable range. Finally, triggers can be set off post chest surgery.

These muscles are quite vulnerable, and when they go into spasm, they can stay in spasm for a long time, unless you treat them. If you have a rib trigger point, it can be painful every time you twist or bend. Triggers can also create a small spot of highly localized pain, which can be sharp and stabbing, especially when you cough.

Pain from trigger points here can sometimes be mistaken for pleurisy. If you’ve been treated for this, and the pain continues, it’s well worth looking for an active intercostal trigger point.

Rib Trigger Points in the Intercostal Muscles. The red areas show pain referral patterns.

When intercostal trigger points active, the pain they cause spreads along the band of muscle in between the ribs. The more active the trigger, the further this pain pattern spreads.

When you are looking for the triggers, gently press into the area between the ribs, and feel for an area which feels very tender. Additionally, when you press on an active trigger point, it may recreate the pain you’ve been feeling in your ribs.

This is how you know you’re directly on the trigger.

Treating Rib Trigger Points

Because they’re so small and thin, rib trigger points are best treated by using a myofascial stretch technique. You will need to be very accurate, and give yourself time to stretch afterward.

It’s also a good idea to look at the muscles which attach to the ribs. In the front of your body, the abdominal muscles attach to the lower edge of your lowest rib. These abdominal muscles are in three layers all running in different directions. In the back, the quadratus lumborum and the iliocostalis muscles attach to the lower ribs.

The muscles attach via very short tendons. There are many layers of muscles, and some of them run quite deep.  Sometimes, discomfort may be coming from the insertion of these muscles’s tendon into the ribs.

To relieve rib trigger points, you need to search in a band about 2 inches below where you feel your ache and you may also find triggers there. These abdominal muscles can refer pain up under the ribs.

If you find triggers here, another technique is to use the principles of ischemic pressure to switch them off. Follow this treatment by putting gentle heat on the area, from a wheat bag, heat pack or hot water bottle.

A skilled practitioner can also do treatments like dry needling or trigger point injections. However, they need to be very careful not to go to close to the lungs, as this can cause injury. If the pain you’re feeling also comes from a tendon, then acupuncture or a cortisone injection can be helpful.

Lastly, if you’ve had chest pain for a long time, it’s important to become aware of your breathing patterns. If you’re in the habit of continual stress breathing, changing to diaphragmatic breathing will relieve muscle tension and further relax your intercostal muscles.

To learn more about trigger point release and treatment, here’s where to pick up your free Trigger Point Manual and mini-starter course:

Sally March 17, 2010

Thank you so much. I have been treated 5 years w/epidurals, TP’s, and pain meds. I refuse to give up. Treatment related to degenerative disc. And there your website is with “Life After Pain. Praise God! I want to know if I am battling a specific disease, i.e. MS or another. I am not asking you to diagnose via web. Maybe you would know the specialty I need to have work-up?

Dr. Kuttner, I have had pain left at mid-scapula for 3wks nonstop. I did have the cortisone injection – but no relief. If I keep my left arm bracing my left side cheat while lying down can make the pain stop instantly. When I move my left arm, the pain is back. I am wondering if I need PA chest x-ray to rule out rib fracture or pursue an acupuncturist. Oh, a part of the scenario is I have a superficial feeling like a hand on top of the area.
At 4AM, I was awakened with horrific femur pain. My right femur felt like it was twisted with the bone at breaking point. Now, mid-afternoon, my right quad feels extremely weak with soreness. When these episodes occur, my husband has to help me move my leg. In the past the same leg has awakened me with it twisted inward and I could not straighten it. My husband has helped me many times with this leg.

Can you point to a specialty? I plan to devour everything on your website

Ahmed Mabrouk April 27, 2013

thank you for these information doctor it was really helpful

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