Rib Pain: Causes of Intercostal Neuralgia and What to Rule Out | Bangbae

Sharp pain along the ribs may be intercostal neuralgia, but heart and lung conditions must be ruled out first.

Intercostal neuralgia is pain caused by irritation or injury to the intercostal nerves that run between the ribs, and it typically appears in a band along the ribs. If a sharp rib pain flares up with every breath and has you worried, this guide covers the causes, the conditions to rule out, and how it's treated.

The intercostal nerves run from the back to the front of the chest

Starting from the spine, the intercostal nerves follow the spaces between the ribs (the intercostal spaces) around the back and sides to the front of the chest. Because they carry sensation from the chest and help control the muscles used in breathing, irritation of these nerves tends to cause pain with every movement.

Five causes of intercostal neuralgia

Cause	Examples
Muscle or joint problems	Tight intercostal muscles, dysfunction of the thoracic spine or rib joints
Shingles (important)	Pain may appear before the skin rash, with severe pain on one side
Trauma	Rib bruises, strong impacts such as car accidents
Posture	Slouching, sitting for long periods
Overuse	Excessive coughing, sudden exercise

Worse when you breathe? Check the key symptoms

Stabbing pain along the line of the ribs
Pain increases when you breathe in
Coughing or sneezing makes it worse
A specific spot hurts when pressed
Twisting your body intensifies the pain

It usually occurs on only one side.

Which conditions must be ruled out?

Conditions that cause pain similar to rib pain must be ruled out. The main ones are heart conditions such as angina, lung disease, rib fractures, and shingles. If chest pain is severe or lasts a long time, don't assume it's intercostal neuralgia; get evaluated by a medical professional.

You should also seek care if the pain keeps getting worse, if a skin rash appears with it (possible shingles), or if it hurts so much that breathing is difficult.

Treatment and daily care

Most intercostal neuralgia improves with conservative treatment.

Physical therapy: Heat, electrical, and ultrasound therapy reduce muscle tension and pain.
Medication: Anti-inflammatory pain relievers, plus nerve pain medication if needed.
Manual therapy: Restores mobility of the thoracic spine and ribs and helps relax muscles and correct posture.
Exercise therapy: Thoracic stretches, breathing exercises, and posture-correction exercises; straightening a rounded upper back is especially important.
Injection therapy: For severe pain, an intercostal nerve block may be performed.

In daily life, maintain good posture, avoid strenuous exercise and sudden movements, and stretch regularly.

One more look

Intercostal neuralgia is easily mistaken for muscle pain, but it is pain caused by a nerve. If your rib pain gets worse when you breathe or move, consider intercostal neuralgia, but it's safest to first have heart and lung conditions ruled out. At Ssukssuk Rehabilitation Medicine Clinic in Bangbae, after an exam we work with you to choose the right approach from among injection therapy, manual therapy, shockwave therapy, rehabilitative exercise therapy, and physical therapy.

Last reviewed: October 7, 2026 This article provides general medical information. Individual diagnosis and treatment plans are determined through an in-person consultation.