Intercostal Neuralgia (Rib Pain)

Intercostal Neuralgia (neuropathic pain in the intercostal nerves). The body’s nervous system is so finely tuned in to any amount of proprioceptive feedback. Persistent pain puts so much stress on the mind and body. In a medical or biological context stress is a physical, mental, or emotional factor that causes bodily or mental tension.”


There are so many ways. However here we will simply focus on breathing. BREATH is the first principal of Pilates practice. And Intercostal Neuralgia effects the nerves of the ribcage and therefore the intercostals muscles and function of breathing. Because the body on high alert it is generally in a constant sympathetic nervous system pattern which can bring fatigue, poor concentration, elevated heart rate, all over muscle tension, loss of restful sleep, poor digestion and the list continues.

As a Pilates teacher, when working with clients that have persistent pain my focus is to guide them into the Parasympathetic Nervous System (rest and digest).

The most effective way to get here is with breathing techniques and visualization cuing.

The reduction in deeper whole ribcage breath and ribcage mobilaztion also leads to neck and head tension, headaches, poor posture, rounded shoulders, tight pectoral muscles, forward leading gait which can effect hips knees , ankles and feet, perhaps poor pelvic floor tone, lack of strength in the hip extensors (big balance muscle groups here), balance and can perhaps be more prone to falls and lower back pain. Imagine being in pain and the shape you body naturally conforms to is a foetal position.

So with teaching breath we can influence the whole body and the mind. It is not ‘airy fairy’. Clients are always surprised at how much influence the breath has, including into our lymphatic system.

The intercostal muscles are part of our respiratory system and we are increasing their movement through deeper breathing. Clients with Intercostal Neuralgia (intercostal nerve pain) generally have a fear of deeper breath and movement of the ribcage through the breath because of the pain. Pain can hit at any point in time and from the smallest amount of ‘pressure’ (even the lightest touch of fabric on the skin). *So a side note here, when working with these clients be mindful of your hands on cuing, communicate with how the person is feeling today in regards to this.

I find the most effective way to teach the beginnings of breath practice and connection, so as it can be taken home by the client, is to empower them to use their own hands as tactile guides to beginning to mobilize the ribcage. Seated in a comfortable position allows for freedom of the ribs front back and sides. Even laying propped up on some pillows, anything so as the ribs at the back of the body have freedom move while learning this.

Moving forward, taking this breath into movement can be as little as laying with the arms out from the body palms up to allow the chest to open using the breath out to soften through the chest. You are already doing so much into assisting posture and influencing where the shoulder blades rest over the back of the ribcage along with strengthening the postural muscles surrounding the shoulder blades (who’d have thought).

So how can this help neck and head tension? and posture? and calmness?

Read above regarding the reduction of whole ribcage breath. In this posture it can be really difficult to access a full deep breath (your lungs are pretty long organs, right is a little larger than the left). Head and neck tension whilst in this rounded posture comes from many causes, but for the sake of me staying on track, we will keep is focused on the breath. (I am a tangent queen).

When we; shallow breathe, chest breath, pant etc we use our ancillary breathing muscles, (scalene, SCM) muscles that run down the back sides and front of the neck and connect at various upper ribs. These muscles do play a part in our breathing as they assist to life the ribs. It is when we access them as our dominant breathing muscles that they can get cranky and cause neck and head pain, we are asking them to do a job that they are not designed to do on their own.


  • So begin somewhere simple. Taking a few minutes to lay in a comfortable position (propped to allow freedom for the back of the ribcage to move) knees gently bent, support your lower back by either propping your feet up onto some books or placing a pillow under the back of your pelvis (your butt) if you really find laying difficult then by all means sit or stand comfortably. I just find laying helps to reduce that ‘sinking of the ribs into the pelvic cavity’ posture.

  • Gently placing the tongue into the roof of the mouth can allow nice access to a breath IN through the nose. When you breathe OUT, allow the jaw and neck to relax, try not to squeeze your abdominals, we are not squashing toothpaste from a tube.

  • Bring the palm of your hand on to your chest, this is your tactile cue. Send the breath forward in to the hand (whole breath) notice how you are influencing a subtle mobilization to extension of your upper thoracic spine.

  • Then changing the breath direction focus and draw the breath into the back of the body (without curling the spine) imagine your hand sinking into the chest as you breath IN through the nose. Begin to notice the subtle expansion and widening of the back body towards your mat in. You’ve just mobilized your thoracic spine into subtle flexion.

  • How about taking your hands to the sides of your body, just above waist height, thumb towards the back and fingers over the front, now breath sideways into your hands (this one takes practice) I like to cue clients here ‘Imagine you’re ribs as a frill necked lizard, puffing up his beard”

  • Now……I wonder what it could feel like if you took more breath into the right trying to shift that right hand out of the way as the breath moves into the right ribs and follows into the right hand……how about the left side? Notice which side may feel a little more restricted and take a couple of extra breaths there. There’s your mobilization to side flexion of the spine.

  • This one needs to be done sitting or standing. What about breathing into the right again but this time picture the right hand shifting back as the left hand shifts forward (it’s a visual cue remember). You’ve just mobilized your spine and ribs into rotation.

How many times a day? How many breaths a time? Use your own judgment. You are the one living in your body. It can be very normal to feel ‘light headed’ or ‘fuzzy’ when you begin learning to breathe with your whole system, you’re getting more oxygen into the blood.

Oh and you’re also teaching your PELVIC FLOOR to relax and to tone at the same time. Along with accessing your deeper lower and upper transverse abdominal support muscle you’re your deep back muscle. BONUS. You’re also teaching your body pelvic stability which all leads to assisting balance. Breathing is a foundational building block to movement.

Disclaimer: Please consult with your GP before beginning any form of exercise. Please use your own judgment with regards to your body's needs as to the suitability of any movement. advice

#holistichealth #holistic #pilates #complimentary #intercostalneuralgia

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