Rib and Side Pain? These Muscles Could be to Blame

Ella had always been active, but she wasn’t an experienced runner. When her friends invited her to go on a group run, she eagerly agreed, not wanting to appear weak or out of shape. As they picked up the pace, she pushed herself harder than usual, determined to keep up. By the end of the run, she was exhausted but proud—until she noticed a deep, aching tightness spreading through her ribs, chest, and sides. At first, she brushed it off as normal soreness, but over the next few days, the discomfort worsened, making it difficult to take deep breaths or twist her torso. The pain was sharp at times, almost like a stitch in her side that wouldn’t go away.

Concerned, Ella went to the doctor, who ran various tests to rule out any cardiac issues. The results came back negative, but as the weeks passed, the pain persisted. One evening, she started researching her symptoms online and came across an article explaining that rib pain could result from overexertion and rapid, shallow breathing. This strain could cause the small muscles between the ribs to become overused and develop knots known as trigger points. Intrigued, Ella scheduled an appointment with a massage therapist.

After a thorough assessment and a brief massage session, her pain had significantly diminished. The therapist explained how her breathing patterns and muscle fatigue had contributed to the issue and demonstrated proper breathing techniques to better support her rib muscles. Additionally, she was given exercises to strengthen her upper body and core. Determined to prevent future pain, Ella also started a regular running program to build her strength and endurance to be able to safely run with her friends again in the future.

Could overworked muscles be causing your rib and side pain too? Let’s explore how muscles become overused and which ones might be responsible for your symptoms.

How Overused Muscles can Cause Rib and Side Pain

Before exploring how muscles could be contributing to your pain, it's important to note that rib and side pain can stem from various causes that are not muscle-related, some of which may be serious. While massage and exercise can often provide relief, it's always a good idea to consult a professional who can assess your condition and determine if further medical attention is necessary.

When a muscle is overused—kept in a tight or constricted state for too long—it becomes fatigued and tense, much like you might feel after a stressful, overbooked week. Over time, or after a traumatic overload event, such as Ella's run, the muscle can lock into this tight position, forming painful knots known as trigger points. These knots don’t just cause localized pain; they can pull on surrounding muscles, restrict movement, and even contribute to joint dysfunction.

Rib and side pain can be caused by triggered muscles in the ribs and back. Various activities can contribute to this, such as chronic coughing, overexertion, repetitive pulling movements of the arm, or even hyperventilation. The symptoms of these trigger points can be very alarming, and it is a good idea to learn self-massage techniques to quickly determine whether a triggered muscle or muscles is the source of your discomfort so that you can know whether your symptoms come from a more serious source.

My exploration into how overused and triggered muscles impact daily life has been deeply influenced by Myofascial Pain and Dysfunction: The Trigger Point Therapy Manual by Dr. Janet G. Travell and Dr. David G. Simons. This comprehensive two-volume set transformed my approach to massage, allowing me to provide lasting relief to my clients. For a more accessible, hands-on resource, I highly recommend The Trigger Point Therapy Workbook by Clair Davies, NCTMB, which breaks down these concepts into a practical, easy-to-follow guide for self-treatment.

Muscles that can Create Rib and Side Pain

Now that we've explored how muscles can contribute to or even cause rib and side pain, let's take a closer look at the specific muscles that may be responsible. While there's much more to say about each one, I've highlighted the key points that you should know. If any of these symptoms sound familiar, be sure to check out the section below on what you can do to find relief.

1. Serratus Anterior

The serratus anterior is a fan-shaped muscle that lies along the side of the ribcage, underneath the arm. It plays a crucial role in the movement and stability of the shoulder blade (scapula), allowing for smooth and controlled arm movements. One of its primary functions is to rotate and protract the scapula, enabling the arm to lift overhead. This muscle is essential for actions such as reaching, pushing, and punching, earning it the nickname "the boxer’s muscle." A strong and well-functioning serratus anterior helps maintain proper shoulder mechanics, reducing the risk of impingement or instability.

Symptoms it can Cause:

• Pain in the side of the ribs

• Pain in the mid back

• Unable to take a deep breathe without pain

• Unusually sensitive breasts

How it can be Overused:

• Strenuous coughing

• Athletic exertion

2. Intercostals and Diaphragm

The intercostal muscles are a group of muscles located between the ribs, connecting them and assisting in the movement of the ribcage. They play a vital role in respiration by helping to expand and contract the chest during breathing. Working alongside them is the diaphragm, a large, flat muscle positioned at the base of the ribcage. The diaphragm is the primary muscle responsible for inhalation, as it contracts and flattens to create space for the lungs to expand. Both the intercostals and diaphragm are essential for efficient breathing, core stability, and overall respiratory health.

Symptoms it can Cause:

• Pain in the ribs and between the ribs, typically when exhaling

How it can be Overused:

• Chest breathing

• Overexertion

• Chronic cough

• Anxiety

3. Latissimus Dorsi

The latissimus dorsi is a large, powerful muscle that spans the lower and middle back. It plays a crucial role in upper body movement, primarily functioning to bring the arm down and toward the chest, as well as extending the arm backward. This muscle is heavily engaged in activities such as pulling, rowing, and climbing. It also assists in stabilizing the spine and shoulders during various movements, making it essential for both strength and posture.

Symptoms it can Cause:

• Pain low and on the side of the ribcage

• Pain in the mid back

• Pain in the shoulder

How it can be Overused:

• Any activity that requires a strong downwards pull of the arm

How do we Fix Triggered Muscles?

The good news is that triggered muscles can often be relatively quick and easy to "un-trigger." However, if you continue the activity that caused the issue in the first place, the muscle will likely become triggered again. Consider how you can modify or mediate these triggers—for example, don't push yourself to the point of overexertion during athletic activities. For activities that cannot be adjusted, consistently applying the following two steps can help keep your pain significantly reduced.

Step 1: Relax the Muscle

The first step in releasing a triggered muscle is to relax it. Whether through using self-massage of your side and back with a tennis ball or your hands, or seeking the help of a professional massage therapist, massage is the most effective way to ease muscle tension and restore movement. If you're interested in learning more about self-massage, I highly recommend The Trigger Point Therapy Workbook by Clair Davies, NCTMB.

Step 2: Strengthen and Stabilize

Relaxing the muscle alone is not enough. The reason it became overworked in the first place is often due to weakness—either in the muscle itself or in surrounding muscles that failed to provide adequate support. Strengthening the back muscles, such as the latissimus dorsi and serratus anterior, can provide better stability and prevent future strain. Additionally, learning proper breathing techniques to engage and strengthen the intercostals and diaphragm will help maintain stability and reduce the likelihood of the pain returning.

If you are currently dealing with rib and side pain, schedule a consultation with me today to see how we can work together to help you feel and move better!

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