With an intercostal strain, a few changes can make nights easier while the pulled muscle between your ribs settles. Breathing in and lying down can both hurt, so getting comfortable isn't always straightforward. The strain usually starts after exercise or a knock, and most strains feel better after about two weeks.
Sleeping with an intercostal strain in brief
For a more comfortable night, sleep propped up or on the side that doesn't hurt. Use ice rather than heat for the first 2 to 3 days, and take paracetamol or use ibuprofen gel for pain relief. Keep breathing normally. Sudden chest pain that spreads, or comes with sweating, sickness or breathlessness, needs an immediate call to 999.
Intercostal muscles move your ribcage as you breathe
Your intercostal muscles sit between your ribs and help move your ribcage with each breath. An intercostal strain is a pulled muscle in that space: NHS sprains and strains guidance defines a strain as an overstretched or torn muscle.3
According to NHS chest pain guidance, a chest strain typically starts after a chest injury or chest exercise. It can get worse when you breathe in and feel better when you rest the muscle.2 That pattern alone isn't enough to identify the cause. Chest wall muscle injuries are one cause of chest pain; many such injuries can be diagnosed by a GP from your history and an examination (Ayloo, 2013).1
Support your ribs and manage pain before bed
Getting your pillows and pain relief ready before bed makes settling down easier.
- Pillows stacked to prop your upper body up
- A spare pillow within reach to hug when you cough
- Ice on the sore area for up to 20 minutes, wrapped in a tea towel, in the first 2 to 3 days
- Pain relief taken before you settle, to the packet instructions
- No hot bath, alcohol or massage for the first couple of days
Sleep propped up for the first few nights
Raising your upper body with pillows lets you rest more upright, as NHS rib injury advice recommends for the first few nights.4 Start there. Once lying flat feels comfortable, try your back. You can also lie on the side that doesn't hurt, with pillows behind you to help stop you rolling onto the sore side.
Keep a pillow nearby to hug when you cough
Holding a pillow against your chest gives you support when you need to cough, which the NHS recommends for rib injuries. Keep one within reach. I'd put it beside me before getting comfortable, rather than have to get up for it when a cough starts.
Hold a pillow against your chest when you need to cough.
Breathe normally and keep movement gentle
Keeping your breathing normal is part of NHS rib injury advice, even when you're sore. Take slow, deep breaths through the day too. Once pain no longer stops you moving, keep moving gently, following NHS strain guidance. Avoid strenuous exercise such as running for up to eight weeks, even if you're managing gentle movement comfortably.
Use ice rather than heat for the first 2 to 3 days
Wrapping ice in a tea towel protects your skin while you cool the sore area. Use it for up to 20 minutes every 2 to 3 hours during the first 2 to 3 days, following NHS strain guidance. Hot baths and heat packs both count as heat: avoid heat, alcohol and massage for the first couple of days.
Wrap ice in a tea towel and use it for up to 20 minutes at a time in the first 2 to 3 days.
Time pain relief before you settle down
Taking pain relief before bed can help you get to sleep without waiting until you're uncomfortable under the covers. NHS strain advice includes paracetamol or ibuprofen gel, and a pharmacist can advise on what's suitable for you. Follow the packet instructions for timing and doses; bedtime isn't a reason to take an extra dose.
When chest pain needs urgent help
Most chest pain isn't serious, but it can be a sign of a heart problem, so know the warning signs in NHS chest pain guidance.
Call 999 if:
- you get sudden pain or discomfort in your chest that does not go away, the pain can feel like squeezing or pressure inside your chest, burning or indigestion
- you get pain that spreads to your left or right arm, or your neck, jaw, stomach or back
- you have chest pain and you feel sweaty, sick, light headed or short of breath
You could be having a heart attack. (NHS)
If you're not sure it's a strain, see a GP; the NHS advises against diagnosing chest pain yourself.
Questions people ask about sleeping with an intercostal strain
Sleep propped up at first, then try your back or the side that doesn't hurt. Let comfort guide the change rather than deciding you must lie flat by a particular night. If you normally sleep on the sore side, don't force your usual position just because it's familiar. Getting comfortable matters more than keeping that habit while you're sore.
Use ice for the first 2 to 3 days, and avoid heat and massage for the first couple of days, as the NHS advises. A hot bath counts as heat. If soaking in the bath is your usual way to relax before bed, skip it during those early days, even if it usually helps you settle.
Most strains feel better after about 2 weeks; NHS advice is to avoid strenuous exercise for up to 8 weeks. Those are different milestones: feeling better doesn't mean the muscle is fully healed. Don't use a comfortable night as your only reason to return to running. It's understandable to want your routine back, but recovery deserves more time than that.
