Intercostal neuralgia is a neural pain along the nerves that travel between the ribs.  A common example of intercostal neuralgia is caused by the herpes zoster virus, known as Shingles or Post Herpetic Neuralgia.

Causes of Intercostal Neuralgia
One of the more common causes of intercostal neuralgia is the herpes zoster virus. This is the same virus that causes Chicken Pox in children.  Any person, who has contracted the virus by contracting Chicken Pox or through receiving the vaccine, has the herpes zoster virus dormant in their system and is at risk of contracting Shingles.  Rheumatism, fibromyalgia or diabetes may also cause intercostal neuralgia.  Trauma, including vertebral or rib subluxation, and prolapsed thoracic discs are other potential causes.

Signs & Symptoms
Patients presenting with intercostal neuralgia will have a sharp, stabbing pain along the affected nerve. This is usually a unilateral pain.  They may or may not have nodules along the ribs near the affected nerve.  They may be hypersensitive to pressure, and they may be suffering a reflex spasm of muscles because of the pain.  Pain will inhibit active range of motion that may lead to consequential atrophy (wasting) of muscles.  Patients may also present with shallow, apical breathing as deep breaths may also increase pain.

Orthopedic Testing
Some of the typical orthopedic assessment techniques a massage therapist may use are:

• Active range of motion of the thorax within pain-free ranges.
• Rib expansion test – the therapist will measure multiple areas of the rib cage as the patient is asked to breath in and out.
• Breath count – the therapist will monitor the number of breaths per minute the patient takes.

Massage Treatment Goals
Massage therapy can be used to help reduce the sympathetic nervous system firing, increase circulation, reduce muscle spasm and hypertonicity of affected musculature, including the diaphragm, all of which will in turn help reduce pain.  Massage can be aimed at increasing thoracic mobility, avoiding further neural irritation, and maintaining pain-free passive ranges of motion as well as progressively restoring pain-free active ranges of motion and strength.

Typical Massage Treatment
During the acute stage local massage is contraindicated. General Swedish or relaxation massage may be performed to other areas of the body.

During the chronic stage General Swedish techniques may be used to stimulate circulation. Compressions, stroking and fine vibrations may be used to help relieve muscle spasm.  Diaphragmatic breathing, diaphragm release, and abdominal massage may be implemented to help decrease the hypertonicity of the diaphragm.  Myofascial release techniques, rib springing and/or rib raking and vertebral mobilization may be used to help maintain thoracic mobility if there is no muscle spasm present.  The massage therapist may use attachment release, or address trigger points when these modalities are within the patient’s pain tolerance.  Functional strength may be assisted with stimulating ROOD’s techniques, and muscle spasm may be reduced using sedating ROOD’s techniques.

Massage Contraindications & Precautions
Local massage during the acute stages is contraindicated.  The patient may be on strong pain medications and there is a potential for sensory impairment and/or easy bruising.  Pressure should be monitored and no extreme temperatures should be used.  The patient may also be intensely sensitive to cold.  The massage therapists should avoid stretching or dragging an inflamed nerve as this may aggravate the condition.  Trophic skin changes may be present.  Massage treatment should be discontinued if the pain increases instead of decreases.

Typical Suggested Homecare
It may be suggested that the patient apply mild heat to the ribcage to help increase circulation and reduce pain.  When the nerve is not inflamed, the massage therapist may suggest diaphragmatic breathing and or intercostal stretching.