By Brian Pickering 

The Minnesota Twins placed Trevor Plouffe on the disabled list this week with an intercostal strain.  From a replay shown after the inning, it looked like Plouffe injured the muscle during a swing in his last at bat.  This overstretching during rotation of the trunk is the most common way to strain (pull, tear) the muscle.  For many, an intercostal muscle may be something that they have never heard of.  Unfortunately, for athletes it doesn’t matter what sport you play, the opportunity to sustain this injury is present.

The intercostal muscles are located on each side of the rib cage.  In total there are 22 intercostal muscles — 11 on each side.  The purpose of the intercostal muscles is to connect one rib to another and when working properly allow the ribs to spread apart and then come back together again.  Essentially, they are allowing expansion and contraction of the chest during breathing.  This core muscle group is fundamental to the mechanics of many baseball activities – especially throwing and batting.  Like explained prior, when rotating, the athlete may overstretch the muscle causing a tear or pulling of the muscle.  Diagnosis of the injury occurs through an exam.  Many times x-rays are taken to make sure there is not a fracture of the ribs.

Most people that sustain an intercostal strain complain of pain that is pretty constant.  Some may describe it as feeling as if someone is stabbing them with a knife.  A few days after the initial injury, the pain only occurs when there is excessive stress placed on the muscles.  This may be when there is excessive stretching, coughing, sneezing, or deep breathing.  For athletes, the rotation, bending, and energy transfer that takes place when moving from one activity — say hitting to running — can cause significant enough pain to require them to sit out a few weeks.  Some athletes have attempted to play through the injury, but later decided they just could not go on.

Treating an intercostal strain follows a common prescription for other muscular injuries.  Rest, ice and anti-inflammatories comprise the initial treatment.  After the pain of the first few days goes away, the athlete should begin some gentle stretching exercises to begin to rehabilitate the injury.  It is important that these exercises are controlled as any excessive movement of the trunk may cause further tearing or stretching of the muscle that could delay healing.  Other modalities such as ultrasound may be used to expedite healing as appropriate.

As common as this injury is in sport, there really is nothing that can completely prevent this injury.  There is some benefit from performing stretching exercises prior to activity to help stretch and warm up the muscle, but the force generated during competition is much greater than that used during the exercises.  The best stretches for the intercostal muscles are side-bending and side-bending with rotation (some people may call them windmill stretching as the fully outreached hand from one side touches the foot on the opposite side).

Most athletes fully recover from this injury.  I would anticipate Plouffe will be back between 3-4 weeks after the injury.  Most athletes feel they are fully recovered in about 6 weeks.  For Plouffe the biggest issue will be the chance of reinjuring the muscles at some point this season since it is so early.  He may have an extended period of moderate pain because of the swinging and throwing motions necessary to play baseball, but he should be able to play through that.

Do you have a question regarding sports medicine that you would like to see addressed in this space in the future?  Send your questions to SportsMed@lrhc.org and it may be featured in an upcoming article.

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