How to Sleep With Intercostal Muscle Strain

December 6, 2023 | Casper Editorial Team

Fact checked by Casper Labs Review In Progress

To sleep with intercostal muscle strain, side sleepers should avoid sleeping on the affected side and use a pillow between their knees, while back sleepers should cushion their upper back by hugging a body pillow to their chest.

Many people have a rough time falling asleep and staying asleep. In fact, insomnia affects between 10-30% of adults in the U.S., disrupting their work performance and overall well-being.1 Adding pain from intercostal muscle strain to the mix, on top of other sleep issues you may be experiencing, makes getting a good night’s sleep feel impossible. 

With how vital sleep is to health and wellness, it’s important to find avenues to sleep through the night for better, more restful sleep. Adjusting your sleep position, practicing deep breathing, and investing in a supportive mattress are all changes you can make today to start feeling relief.

Read on for how to sleep with intercostal muscle strain and start feeling and sleeping better. 

Understanding Intercostal Muscle Strain

To understand the sleep disruptions caused by intercostal muscle strain, it’s important to learn more about what it is, what intercostal muscle pain feels like, and get to the root of its cause. In this way, you can move toward recovery, all while prioritizing your 7-9 hours of sleep.

What is Intercostal Muscle Strain?

Between each of your ribs is a set of intercostal muscles that stretches from your upper back towards the front of your chest, with 22 sets surrounding the rib cage in all.2 

When we breathe in, our back muscles, rib muscles, and chest muscles expand as our lungs do. That stretching that’s happening is made possible because of the intercostal muscles. The intercostals play a key role in stabilizing your back and facilitating movement, allowing you to twist, bend, and fill your lungs fully.3 

Sometimes, these muscles can be overextended or even torn, causing slight or severe pain and discomfort in the upper back. 

Fortunately, intercostal muscle strains usually heal on their own—typically within a few days for minor cases or up to two months in major ones.2 But dealing with the severe pain of torn or overstretched muscles can be difficult depending on the severity of the injury, especially when you’re trying to sleep. 

Causes of Intercostal Muscle Strain

Intercostal muscle strain is most commonly the result of blunt force trauma that pushes the ribs apart, straining or tearing the rib cage muscles in between.2 Car accidents, falls, and blows during high-contact sports can all put strain on the ribs and chest wall, and cause problems for the intercostal muscles.2

Other lower-impact causes of intercostal muscle strain include2:

  • Excessive twisting past the ribs’ normal range, most common for dancers, or those who play sports like golf or tennis
  • Lifting or reaching for objects over your head repeatedly, stretching the ribs past their normal range
  • Repetitive, thrusting movements performed during sports like rowing, tennis, or baseball

Athletes and heavy laborers are the most at risk for developing intercostal muscle strain, but anyone who performs these types of motions that overstretch the ribs are vulnerable to strain.2 Additionally, those with weakened or atrophied muscles are also more susceptible.2 

Recognizing the Symptoms

The pain scale for intercostal muscle strain can range widely, from slight discomfort to intense pain.3 Symptoms can include3:

  • Stiffness and tension in the upper back, exasperated by bending or twisting motions
  • Rib muscle and chest muscle spasms, tenderness, and swelling
  • Trouble taking full breaths

Pain can also depend on how the strain was caused. Intercostal pain from a car accident, for example, may come on more suddenly and severely than from repetitive twisting from swinging a golf club, which would be more gradual.3

The Impact of Intercostal Muscle Strain on Sleep

Pain from intercostal muscle strain can affect your daily life, but it’s most upsetting when it causes you to lose sleep, due to: 

  • Pain and discomfort – The pain and discomfort associated with intercostal muscle strain is probably the biggest disrupter of sleep. During the day, you can distract yourself from intercostal pain by doing other activities, but at night, pain becomes its own distraction. 
  • Limited mobility – You don’t realize how much you move in your sleep until you’re unable to due to intercostal muscle strain. Lying down, getting up, and rolling over in bed all become significantly more challenging when you’re not able to bend or twist. 
  • Breathing difficulties – Your breathing naturally slows and deepens as you fall asleep. So when you’re only able to take shallow breaths, it becomes much harder to drift off peacefully. 

Intercostal muscle strain hits you from all angles. To minimize its negative impact on your sleep, it’s best to combine different types of treatment. 

Expert Tips for a Restful Sleep With Intercostal Muscle Strain

Here are some effective tools you can equip yourself with to combat intercostal muscle strain and make bedtime bearable again. 

Optimal Sleep Positions

When picking a sleeping position, spinal alignment is key. Whether you’re a side sleeper or a back sleeper, there are ways to ensure that your body is properly supported to reduce pain and facilitate healing4

  • Side sleepers – Avoid sleeping on your affected side. Place a pillow between your knees to maintain proper spine and back alignment. 
  • Back sleepers – Keep your upper back cushioned and protected by hugging a body pillow to your chest. 

Often, the most difficult part of sleeping with intercostal muscle strain is the act of getting into and out of bed. A fantastic tool that can make this action easier is an adjustable bed frame. Make the bed come to you by raising the head of the mattress and, once situated on the bed, then gently lower it down until you’re in a normal sleeping position. 

Casper offers adjustable bed frames with ease and comfort in mind. All bases come with wireless remote control, as well as head and feet adjusting capabilities. For additional control, try the Adjustable Base Pro or Adjustable Base Max, which also come with 2- and 4-zone massage functions, respectively. 

Supporting the Upper Body

Upper body support is especially important while sleeping, when you have less control over your body’s movements. Place pillows behind your back and head to raise you up slightly. This elevation will relieve additional strain on your muscles and help with breathing.4 

Soft, supportive pillows are your greatest tool for upper body support. Casper has a Foam Pillow that is designed with three layers of low- and high-density foam to keep you aligned all night. 

We also have a versatile Backrest pillow, which can be used both for sleeping and sitting up in bed, providing superior lumbar support. 

Heat and Cold Therapy

Heat and ice packs can both be used to soothe sore muscles and help with the healing process. 

Cold therapy should be used for the first two days after injury to reduce swelling and inflammation in the intercostal muscles.5 Heat therapy, including heat packs and warm baths, can be used at any time after this period.5 Not only does heat help relieve tension and soreness in the muscles, it also increases blood circulation to that area, which will help with healing.5

Breathing Techniques

The intercostal muscles play a significant role in breathing. So when they aren’t working as they should, it makes it hard to breathe. While you can avoid moving your body to prevent severe pain, you can’t avoid breathing. 

Shallow breathing, while it may feel better than taking full breaths, can negatively impact the healing process and lead to other complications.3 So what can you do to relieve the pain you experience when you inhale?

Breathing techniques for intercostal muscle strains act more like stretch exercises. Breathing exercises are meant to help gently stretch the intercostals so you can begin to breathe with more ease. The best breathing exercise is very simple5

  1. Remembering to keep your back straight, breathe in slowly, picturing your diaphragm and stomach expanding for a deeper, fuller breath.
  1. Breathe out slowly, focusing on using the same muscles as you did on the inhale.
  1. Repeat 5-10 times.

For more active stretching, you can try yoga poses like a gate pose or a forward stretch.

When performing any of these exercises, you’ll likely feel a strain on your intercostals, but don’t stretch them to the point of hurting, and don’t stretch for longer than 15 or 30 seconds.5

Importance of Mattress Selection

Proper sleeping positions and good sleep hygiene, while useful, can only do so much. A high quality mattress designed for total support will enhance the effects of all the advice above. 

When looking at bed mattresses, memory foam is the way to go. The foam will support the contours of your back, relieve pressure from the intercostal muscles, and hold you in place to limit movement or jostling in bed that may cause pain flare ups. 

Casper offers foam mattresses with varying degrees of zoned support to meet your individual needs. Our Original Mattress has three layers of foam and Airscape Technology that keeps you cool throughout the night. 

If you’re looking for a mattress with even more layers of support, check out our Nova Hybrid and Wave Hybrid mattresses.

The Casper Advantage for a Restful Recovery

If you’re dealing with intercostal muscle strain, you’re not alone. Casper is dedicated to creating products that offer maximum support and comfort to make sure you’re getting quality sleep, no matter where you are in your recovery. 

For bed frames, mattresses, and bed pillows that will support you through your recovery and beyond, choose Casper. We have a wide selection of products with different features to suit your specific needs, from softness and support to temperature control. 

Sleep more effectively and rest with less pain, with help from Casper.  


  1. National Sleep Foundation. Sleep by the Numbers. 
  2. Veritas Health. Upper Back Pain from Intercostal Muscle Strain. 
  3. Veritas Health. Causes of Intercostal Muscle Strain. 
  4. Veritas Health. Intercostal Muscle Strain Symptoms and Diagnosis. 
  5. Summit Health Management. Protecting Your Ribs: Understanding Intercostal Muscle Strain.   
  6. Veritas Health. Treating Intercostal Muscle Strain.