Rehabilitation Protocol for Intercostal Strain

 Phase I: Acute Management (Days 1-7)

1. Pain Management:

   • Prescribe NSAIDs for pain relief and to reduce inflammation.
   • Apply ice therapy for 15-20 minutes every 2-3 hours during the initial 48 hours.

2. Restoration of Function:

   • Advise relative rest to avoid exacerbating the injury.
   • Encourage shallow breathing to minimize pain during respiration.

3. Modalities:

   • Utilize modalities such as ultrasound therapy or TENS for pain relief and to promote tissue healing.

Phase II: Early Rehabilitation (Days 8-21)

1. Gentle Mobilization:

   • Initiate gentle mobility exercises to maintain flexibility without causing pain.
   • Encourage slow, controlled movements of the trunk, avoiding sudden or forceful actions.
   • Gentle mobilization techniques can help promote blood flow, reduce muscle tension, and improve flexibility without exacerbating intercostal strain. Here are some gentle mobilization exercise

2. Manual Therapy:

   • Introduce soft tissue mobilization and myofascial release techniques to alleviate muscle tension and improve tissue elasticity.

3. Core Stabilization:

   • Begin with isometric core stabilization exercises to engage the deep abdominal muscles without stressing the intercostal muscles.
   • Emphasize proper breathing techniques during exercises to minimize strain on the injured area.

   • Core stabilization exercises are essential for promoting recovery and preventing re-injury in cases of intercostal strain. Here are some gentle yet effective core stabilization exercises:

     1. Diaphragmatic Breathing:

        • Lie on your back with your knees bent and feet flat on the floor.
        • Place one hand on your abdomen and the other on your chest.
        • Inhale deeply through your nose, allowing your abdomen to rise while keeping your chest relatively still.
        • Exhale slowly through your mouth, allowing your abdomen to fall.
        • Focus on breathing deeply into your diaphragm, rather than shallow chest breathing.
        • Perform 10-15 repetitions, gradually increasing as tolerated.

     2. Supine Pelvic Tilts:

        • Lie on your back with your knees bent and feet flat on the floor.
        • Gently flatten your lower back against the floor by tilting your pelvis backward.
        • Hold for 5-10 seconds, then release.
        • Repeat for 10-15 repetitions, focusing on controlled movement and maintaining a neutral spine position.

     3. Bridging:

        • Lie on your back with your knees bent and feet flat on the floor, hip-width apart.
        • Engage your core muscles and lift your hips off the floor, forming a straight line from your shoulders to your knees.
        • Hold for 5-10 seconds, then lower your hips back down to the floor.
        • Perform 10-15 repetitions, focusing on maintaining stability through your core and avoiding excessive arching of the lower back.

     4. Dead Bug Exercise:

        • Lie on your back with your arms extended toward the ceiling and your knees bent at a 90-degree angle.
        • Engage your core muscles and slowly lower one arm overhead while simultaneously straightening the opposite leg, keeping both hovering just above the floor.
        • Return to the starting position and repeat on the opposite side.
        • Perform 10-12 repetitions on each side, focusing on maintaining stability through your core and avoiding any movement in your lower back.

     5. Quadruped Arm and Leg Lifts:

        • Start on your hands and knees, with your wrists directly under your shoulders and your knees under your hips.
        • Engage your core muscles and extend one arm forward and the opposite leg back, maintaining a neutral spine position.
        • Hold for 3-5 seconds, then return to the starting position and repeat on the opposite side.
        • Perform 8-10 repetitions on each side, focusing on stability and control throughout the movement.

     These exercises help to strengthen the core muscles while minimizing strain on the intercostal muscles. It's essential to start with gentle movements and gradually increase intensity as tolerated, always paying attention to proper form and technique. If any exercise causes pain or discomfort, it should be discontinued, and medical advice sought.

Phase III: Intermediate Rehabilitation (Days 22-42)

1. Progressive Strengthening:

   • Gradually introduce strengthening exercises for the intercostal muscles.
   • Start with low-resistance exercises such as resisted breathing exercises using a spirometer or resistance bands.

2. Functional Movement Patterns:

   • Incorporate functional movement patterns that mimic daily activities, focusing on proper body mechanics and posture.
   • Progress to activities that involve controlled rotation and lateral movements of the trunk.

3. Cardiovascular Conditioning:

   • Initiate low-impact cardiovascular exercises such as stationary cycling or swimming to improve cardiovascular fitness without aggravating the injury.

Phase IV: Advanced Rehabilitation (Days 43-60)

1. Sport-Specific Training:

   • Tailor rehabilitation exercises to mimic the demands of the patient's specific activities or sports.
   • Gradually reintroduce sport-specific movements, starting with low-intensity drills and progressing to full activity.

2. Dynamic Core Stability:

   • Implement dynamic core stabilization exercises that challenge the intercostal muscles in various planes of movement.
   • Incorporate exercises on unstable surfaces to enhance proprioception and neuromuscular control.

Phase V: Return to Function (Days 61+)

1. Gradual Return to Activity:

   • Allow the patient to gradually resume normal activities and sports participation as tolerated.
   • Encourage the use of proper warm-up and cool-down routines to prevent re-injury.

2. Maintenance Program:

   • Prescribe a maintenance program consisting of regular stretching, strengthening, and cardiovascular exercises to sustain gains achieved during rehabilitation.
   • Emphasize the importance of ongoing self-management strategies, including proper posture and body mechanics.

Note: Progression through each phase should be individualized based on the patient's pain levels, functional capacity, and response to treatment. Continuous reassessment and modification of the rehabilitation program may be necessary to optimize outcomes and minimize the risk of re-injury.

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This protocol provides a structured framework for the gradual rehabilitation of intercostal strain, focusing on pain management, restoration of function, progressive strengthening, and eventual return to full activity. Adjustments can be made based on the patient's specific needs and clinical progress.

Thanks and Regards

Dr.Jaishree Tiwari

P.H.D Physiotherapy