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How to Manage Rib Cramps with COPD

COPD Basics

July 27, 2023

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Photography by David Prado/Stocksy United

Photography by David Prado/Stocksy United

by Stephanie Orford


Medically Reviewed by:

Nick Villalobos, MD


by Stephanie Orford


Medically Reviewed by:

Nick Villalobos, MD


COPD can cause changes in your lungs and chest tissues that make it harder to breathe. Using accessory muscles to compensate, like your rib muscles, may lead to cramping and pain.

About 22–54% of people with COPD experience pain in their thoracic area — the region around the ribs.

Living with COPD often leads to a loss of elasticity in your lung tissues, which makes it harder for you to inhale enough air with each breath. As a result, you may compensate by taking deeper breaths and using other muscles to expand your ribcage.

The rib muscles, also called intercostals, sometimes become longer or shorter than usual in people with COPD, preventing the muscles from contracting in a typical way.

On top of that, research in 2018 suggests that chronic pain in the intercostal muscles may sensitize you to feel pain when nearby muscles work — even if they aren’t affected by COPD.

The fascia or connective tissue in the ribcage may also be a source of pain, as it stiffens over time from the chronic strain and inflammation of COPD.

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What is a rib cramp?

A rib cramp happens when a muscle in your ribcage contracts involuntarily and won’t relax, but it usually goes away within a few seconds or minutes.

You might experience rib pain or cramping after doing an activity that requires you to breathe heavily for a long period of time, like cardio exercise. You may also get a rib cramp after repeated coughing or expanding your chest in an effort to breathe deeply if you’re experiencing shortness of breath.

“Pressing pain” is how people with COPD described their chest pain in a 2016 study. Many also reported having lower back, shoulder blade, and neck pain at the same time.

When living with COPD, you tend to use your neck, back, and rib muscles, as well as surrounding muscles, to breathe.

Rib cramping or pain may also happen if you have hyperinflated lungs, which can occur when the airways collapse and trap air due to a loss of elasticity that can come with COPD.

However, some of the research has not shown a connection between thoracic pain and lung hyperinflation, so more research is needed.

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What are the treatment options for rib pain?

There are a few things you can do at home or with help from your doctor to reduce rib pain and cramping in COPD.

Stay well hydrated

Muscle cramps can happen more often in athletes who are dehydrated, and the same principle applies to you. Make sure you’re drinking water frequently throughout the day.

Stretch and walk

If you have a cramp, stretching it out may help. Walking around the room and gently moving your shoulders may help you breathe easier and clear out mucus.

Change your posture

A straight, upright posture can help open up your lungs so you can breathe with less effort.

Try straightening your back and putting your hands on your thighs as you breathe in slowly.

Get a rib massage

A 2019 study on people living with COPD found that massage therapy could reduce tension in the chest muscles and even help with mucus clearance.

Getting a manual massage or using a vibrating massager can help. If you’re experiencing a rib cramp, massaging the cramp can also help.

Try diaphragmatic breathing

This is a deep breathing technique in which you push down your diaphragm rather than expand your chest to take deeper breaths.

A 2016 study found that diaphragmatic breathing could help reduce the use of other muscles for breathing and reduce abnormal movement of the chest wall. This may reduce the stress on your ribs that cause pain.

When you do diaphragmatic breathing correctly, your belly will rise and fall.

Apply a heat or cold pack

Heat packs are best for cramps where you have a muscle that suddenly feels tense and painful.

On the other hand, applying a cold pack may help with rib pain caused by an injury or inflammation in your rib muscles.


Several over-the-counter and prescription medications may help reduce rib pain if you live with COPD. You can talk with your doctor for a personalized recommendation.

This may include medication to reduce COPD symptoms that cause rib pain, like coughing. Or it may be a medication that helps address the pain directly, like ibuprofen.

Pulmonary rehabilitation

No matter how serious your COPD, improving your condition and quality of life may be possible with a combination of therapies, including exercise, education, and behavioral changes. And if you smoke, quitting is key.

Pulmonary rehabilitation can improve how you feel physically and mentally and may reduce symptoms of COPD, such as rib cramps and pain.

What are other possible causes for rib cramps?

Other causes for rib cramps or rib pain include:

  • not stretching enough before exercise
  • dehydration
  • electrolyte imbalance
  • an injury, like a fall or sports injury
  • short-term inflammation of the cartilage that connects the ribcage to the sternum (costochondritis)
  • other inflammatory conditions such as:
    • bronchitis (chronic or acute)
    • fibromyalgia
    • pleurisy
  • urgent medical conditions such as:

It’s a good idea to see your doctor if your rib cramping or pain hasn’t gotten better after a day or two. But if it’s severe, you may need to visit an emergency room right away.

If you’re also experiencing what feels like fluid buildup in your lungs, or breathing feels heavy or difficult, it may be pneumonia. See your doctor as soon as possible to avoid complications.

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The takeaway

Many people with COPD report experiencing pain around their ribcage.

The changes that happen in your airway and other chest tissues when you have COPD can cause you to rely more on surrounding muscles to breathe, including muscles in your ribcage, neck, and back.

That can cause muscle pain and cramping in your ribs.

However, there are ways you can treat rib cramps and pain when you have COPD. And pulmonary rehabilitation can help improve your condition as a whole, no matter your stage.

Medically reviewed on July 27, 2023

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