What causes rib pain from coughing? Related conditions and treatments

Rib pain is a common problem that can occur for various reasons. Ribs are fixed in place by muscles and tendons. When those muscles are used too much or too harshly, it can cause pain. Most of the time, the pain is caused by a pulled muscle, which can occur from one violent cough, a few coughing episodes, or persistent coughing.

Overview: What does rib pain from coughing feel like?

Usually, it feels like a dull ache, but even a pulled rib muscle can cause severe, sharp pain. The pain often worsens when taking a deep breath, coughing, or sneezing. If it’s an injury, there may be pinpoint tenderness that is painful when pressed on with a finger. Rarely, there is overlying skin bruising or discoloration. However, chest wall pain can sometimes be caused by the lungs or the sac surrounding the lungs, not the ribs themselves. In those cases, there will probably be other symptoms indicating something’s wrong with the lungs or other tissues.

RELATED: What causes coughing? Related conditions and treatments

Why do my ribs hurt when I cough?

Coughing too much can cause musculoskeletal injuries, much like doing too many sit-ups may make the muscles between your ribs sore. Specifically, these musculoskeletal injuries may be intercostal muscle strain, cartilage inflammation (costochondritis), bruising, or rib fracture.

Intercostal muscle injury

The most common injury caused by coughing is intercostal muscle strain. The intercostal muscles are the muscles between the ribs. They connect the ribs to one another and help control the expansion and contraction of the chest wall. Persistent or violent coughing works these muscles a bit too hard. It’s like running a marathon without training or exercising too hard and pulling a muscle somewhere. Like any other pulled muscle, rib muscle strain heals on its own with time and rest.

Costochondritis

Costochondritis is injury or inflammation of the cartilage that joins the ribs to the breastbone (sternum). Because of the location in the middle of the chest, most people describe the pain as “chest pain” rather than rib pain. As with intercostal muscle strain, the pain worsens when breathing deeply or coughing. Costochondritis is a temporary condition that heals on its own with time and rest.

Rib bruise

Bruised ribs are usually caused by trauma, like from falls, accidents, or getting hit in the ribs. They can be caused by chronic or forceful coughing. The pain is usually mild but worsens with taking deep breaths, coughing, or sneezing. Bruising takes a week or two to heal on its own.

Rib fracture

Coughing rarely causes broken ribs. There are only a few reported incidents, usually involving older people with thin bones and osteoporosis. Most rib fractures heal on their own over a few weeks and over the counter analgesics (acetaminophen or ibuprofen) may be needed. Some rib fractures can damage other intrathoracic or intra-abdominal organs and require more medical intervention, such as when a fractured rib causes a hole in the lung (pneumothorax) or punctures other organs like the liver. 

Other conditions

Sometimes, what feels like rib cage pain is instead a problem in the tissues under the ribs, like the lungs or the pleura (membranes that form a sack around the lungs). The problem may be the same one causing the cough and may include any of the following:

• Pneumonia

• Pleurisy (inflammation of the sac surrounding the lungs)

• Lung cancer, which can cause a chronic cough

• A blood clot in the lungs

These conditions typically will have other symptoms, many of which are more concerning than rib pain. One distinguishing feature of the rib pain caused by these conditions is that it’s not always tender or painful to the touch, like a rib cage muscular injury is. 

Should I go to the hospital if my ribs hurt when I cough?

Not if the pain is minor and breathing is normal. But you should call a healthcare provider for medical advice if the cough lasts more than two weeks to make sure there isn’t a more serious problem. 

If the pain is relentless, taking deep breaths is difficult, or you have other symptoms like shortness of breath or chest pressure, see a healthcare provider. People with osteoporosis should also see a healthcare provider if they experience rib cage pain due to coughing. 

You should go to the hospital or urgent care if your pain feels like chest pain and is accompanied by symptoms like shoulder pain, back pain between the shoulder blades, arm pain, lightheadedness, or shortness of breath. These are signs of a possible heart attack and require emergency treatment.

The most concerning symptom is not the rib pain, but the chronic or severe cough that causes it. If a cough persists for longer than two weeks or you experience violent coughing fits, see a healthcare professional. If you’re already seeing a healthcare professional about the cough, tell them about the rib pain, too.

RELATED: What causes coughing? Related conditions and treatments

How is the cause of rib pain from coughing diagnosed?

Healthcare professionals diagnose rib pain by trying to find the underlying cause of coughing and rib pain. If you see your primary care healthcare provider, they will perform a comprehensive history and exam (including lung function) and may order a chest X-ray. If needed, they may refer you to a specialist. 

If there’s suspicion that a lung problem is the cause, they may perform further tests such as:

• A chest X-ray

• A CT scan of the lung

• Bronchoscopy by a pulmonologist

If there’s chest pain, not just rib pain, the clinician may order a chest X-ray to assess the ribs and rule out lung pathology (like a mass or pneumonia). Other tests that may help evaluate the heart are an electrocardiogram (EKG) to assess the heart’s electrical rhythm and an echocardiogram (an ultrasound of the heart) to evaluate heart valves and overall heart function.

If the most likely problem is an injury, diagnosis is usually made based on the history, symptoms, and physical exam. The healthcare provider will palpate the rib cage and concentrate on the area that hurts. That’s usually enough for a diagnosis. If a rib is broken, the healthcare provider may obtain a chest X-ray or CT scan to make sure the lungs or other vital organs are not damaged.

How long does rib pain from coughing last?

If rib pain is due to muscle strain or bruised ribs, it could take weeks to get better. Rib fractures typically take about six to eight weeks to heal. If it’s a stress fracture, the pain may resolve in as little as three weeks.

Rib pain from coughing treatment

For any musculoskeletal injury, the primary treatment involves pain relief and rest. For muscle strain, costochondritis, bruising, and rib fractures, over-the-counter (OTC) painkillers and home remedies like ice packs should be sufficient to control pain. For bad rib fractures or severe pain that interferes with breathing, a healthcare provider may use nerve blocks or prescribe a short course of opioids. They may also advise not performing activities that cause pain, such as sports, exercise, or any other exertion, to give the injury a chance to heal. 

For a rib fracture or other painful rib cage injury, an incentive spirometer may be used at home to help maintain lung volume and decrease the chance of resulting pneumonia.  When it hurts to take a deep breath, the air sacs may close or get infected because they are not being expanded, and secretions settle. Using an incentive spirometer encourages patients to take several deep breaths every hour and helps keep the lungs healthy. 

Healthcare providers discourage the use of rib taping, rib binding, or rib braces. Although they help control the pain, they prevent people from breathing deeply and may even interfere with normal breathing. People using these devices are at an increased risk of developing pneumonia and other problems.

If coughing is still a problem, it will not only cause pain but could also worsen the injury. Instead of OTC cough suppressants, your healthcare provider may switch you to prescription cough suppressants to reduce the coughing. The cause of a chronic cough needs to be investigated, as this can result from uncontrolled asthma, COPD, or lung cancer.

RELATED: Antitussives: uses, common brands, and safety info

Living with rib pain from coughing 

Rib cage pain due to any musculoskeletal injury from coughing will take time to get better, but it will get better. Unless there’s severe pain, a few tips can help manage the pain:

• Take a break from strenuous activities.

• Use ice packs or heating pads over the affected area. Only use them for 15 minutes of every hour to allow the skin to return to normal temperature. 

• Use a small pillow or other cushion as a brace when breathing deeply, coughing, or sneezing to help reduce the discomfort.

• Move around—sitting around or lying about increases the risk of pneumonia and fluid build-up in the lungs.

• Take 10 deep breaths per hour. If you have an incentive spirometer, use it, as it measures the volume of your deep inspirations. 

• Control the cough with OTC cough suppressants, throat lozenges, steam, hot showers, humidifiers, an air purifier, and by drinking plenty of fluids.

RELATED: The best cough medicine for fast relief

Sources:

• How to cope with an intercostal muscle strain, Cleveland Clinic (2020)

• Costochondritis, StatPearls (2024)

• Bruised rib care, Mount Sinai 

• Clinical and radiological aspects of cough-induced rib fractures: A case report, Cureus (2020)

• Initial evaluation and management of rib fractures, UpToDate, (2025)

• Incentive spirometer, Cleveland Clinic (2022)