Muscle News Vol I.29: Intercostals
Is the "Hurts-To-Laugh" Muscle Causing Pain in Your Side or Difficulty Breathing?
Have you ever had a pain or "stitch" in your side, maybe in the middle of a fit of laughter?  Do you ever have trouble taking a full breath or experience pain in the side while breathing, sneezing, or coughing?

While certainly any trouble or pain with breathing should be examined thoroughly by your doctor, there is a muscular cause that you might be able to take care of yourself assuming everything else checks out okay.

Trigger points in the muscles between your ribs can cause several surprising symptoms, including:
  • Rib pain
  • Side cramps
  • "Stitch in the Side" pain
  • Difficulty breathing or expanding your chest
  • Difficulty maintaining upright posture
  • Pain when breathing
  • Pain when lying on your side
  • Pain or difficulty when twisting your torso side to side
  • And pain while coughing, sneezing or even laughing!

These muscles are named the "Intercostals" because they are literally in between the ribs (yellow X's shown in the drawing).  They help to rotate the torso and most notably help to expand and contract the rib cage.

Because the rib cage contracts rapidly during laughing (as with coughing and sneezing), sharp pain can result if there are trigger points in the Intercostals.  For this reason, the Intercostals have earned the nickname "Hurts To Laugh" muscles.

How do these muscles become so tight and upset? 

There are a number of reasons, including heavy breathing such as during exercise or due to lung or asthma problems, slumped posture, prolonged coughing, or even a bra that is too tight.  Any of these and more causes can result in the Intercostals tightening up, becoming painful and restricting your rib cage expansion.

Luckily, relieving these trigger points is often straight forward and fairly simple. 

Follow the self-test and self-care tips below to identify and relieve trigger points in your "Hurts to Laugh" muscles, so you can Breathe Deeper and Laugh Longer with Less Pain!

*The information in this article is not intended to diagnose or treat any medical condition and does not substitute for a thorough evaluation by a medical professional.  Please consult your physician to determine whether these self-care tips are appropriate for you.
(2) Quick Self-Tests to Tell if You have Trigger Points in Your Intercostals:

Follow the instructions below to test whether myofascial trigger points in your Intercostals might cause difficulty or pain with breathing deeply.

TEST 1:  Trunk Rotation Test

             PASS                                 FAIL

Stand with your back to the wall, a couple feet away from the wall. Without moving your feet, turn your body and see if you can place both hands flat on the wall behind you.  A Passing result is when you can turn fully and place both palms flat on the wall.  A Failing result occurs when you cannot turn far enough to place your hands flat on the wall.

TEST 2:  Rib Cage Expansion

Another simple way to check for possible tightness and trigger points in your Intercostals is to feel whether your rib cage expands when you breathe deeply.  Place your hands on either the front or the sides of your rib cage and breathe deeply.  You should feel your rib cage expanding.  If not, or if one side expands more than the other, you might have trigger points in your Intercostals.

Simple Self-Care Remedies

Here are simple self-care tips for relieving myofascial pain and dysfunction in your Intercostals:

Step 1:  Warming Up with Moist Heat

To relax and warm up the fibers of the Intercostals, take a warm bath or shower or place moist heat such as a Fomentek bag over the area your ribs that is affected for 10-15 minutes. 

Step 2:  Compression

Using your self-care tool, press in between the ribs into the Intercostals.  


When you find a tender spot, as always, hold for 10 seconds while completing at least two full breaths in and out.  


Then continue searching for more tender spots until the entire length of the muscle is covered.  

You may also benefit from adding a stretch to your compression, as shown.  Place the arm over your head to stretch the rib cage and continue your compression.

Step 3:  Stretching the Intercostals

It is good to finish with a stretch.  As shown, lift one arm over the head and reach as far as is comfortable.  This will stretch the Intercostals on the same side as the arm.  Hold for 20 seconds and breathe throughout.  

Repeat 2-3 times on each side. 

Remember, you should always have trouble or pain with breathing evaluated by a physician.  Trigger points can exist in combination with other conditions and you don't want to miss serious illnesses such as pneumonia.  

Otherwise, if you perform these self-care tips, you will likely be able to breathe more deeply and laugh longer with less pain!  Enjoy!
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Link Highlights:

NAMTPT LOGO National Association  of Myofascial Trigger Point Therapists

Trigger Point Therapy Workbook for Chest and Abdominal Pain (e book) By Valerie DeLaune, L. Ac.

Trigger points may refer pain and other symptoms both in the local area and/or to other areas of the body, but since over 74% of trigger points are not located in the area where you feel pain, treating the local area does not resolve the problem most of the time.

The introductory chapter of this e-book includes general guidelines for self-help techniques and muscle care. Chapter 2 contains a diagram of a body divided into zones, with a list of muscles that may contain trigger points which are referring pain and other symptoms to each zone, so that you will know which subsequent chapters you need to read. The Appendix has extensive information on perpetuating factors that will cause trigger points to form in any of the muscles of the body.

In addition to abdominal pain, trigger points may also cause symptoms such as diarrhea, menstrual pain, nausea, vomiting, belching, testicular pain, frequent urination, and other symptoms that mimic pain from internal organ diseases. In the chest, pectoralis muscle trigger points may cause pain and a feeling of chest constriction that mimics angina, or even mimic the symptoms of a heart attack, but can also be caused by a heart attack and leave unresolved pain. Trigger points may also cause ectopic cardiac arrhythmias such as supraventricular tachycardia, supraventricular premature contractions, or ventricular premature contractions. Trigger points are common in the pectoralis minor muscle, and pain referral frequently gets misdiagnosed as carpal tunnel syndrome or thoracic outlet syndrome.

This e-book draws on the decades of research by Doctors Janet Travell and David G. Simons, combined with the 23 years of clinical experience of Acupuncturist, Neuromuscular Therapist, and author Valerie DeLaune, LAc.

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