Sharp Rib Pain When You Breathe In: Costochondritis vs Pleurisy vs Muscle Strain—Red Flags Included

A sudden, sharp pain along your ribs when you breathe in can be scary—especially if it feels like a knife jab or a “catch” that makes you stop mid-breath. This kind of pain is often called pleuritic pain (pain that worsens with breathing), but that label only describes the pattern, not the cause. Some causes are common and benign (like a strained rib muscle). Others need prompt medical evaluation (like a collapsed lung or a pulmonary embolism). A well-structured way to tell them apart starts with one simple question:

Does the pain come from the chest wall (ribs, cartilage, muscles), or from inside the chest (lung lining, lung, heart lining)?

This article focuses on three frequent explanations:

• Costochondritis (inflamed rib cartilage near the breastbone)
• Pleurisy (inflamed lining around the lungs)
• Intercostal muscle strain (strained muscles between ribs)

…and it includes red flags that should override everything and push you toward urgent care.

Breathing isn’t just “lungs inflating.” Each deep breath moves multiple structures:

• The rib cage lifts and expands.
• The intercostal muscles between the ribs contract.
• The cartilage where ribs meet the breastbone shifts slightly.
• The lung lining (pleura) glides as the lungs expand.

If any of these are inflamed or injured, a deep breath can stretch or rub the area and trigger a sharp pain. Pleuritic chest pain is commonly described as sudden, sharp, stabbing, or burning pain that is worsened by deep breathing, coughing, sneezing, or laughing (American Academy of Family Physicians: ^[1]).

These quick clues don’t diagnose you, but they help separate “likely chest wall pain” from “possible lung lining pain.”

• Pain is reproducible when you press on a specific spot on the ribs or near the breastbone (costochondritis is often tender)
• Pain increases with twisting, reaching, lifting, or certain positions
• You can point to the pain with one finger and it feels “on the surface”. Costochondritis pain often worsens with deep breath, coughing, sneezing, or chest wall movement (Mayo Clinic: ^[2]; Cleveland Clinic: ^[3]).

Intercostal muscle strain commonly causes pain when you breathe, cough, sneeze, or move the affected muscles (Cleveland Clinic:^[4]).

• Pain is sharp and worse with breathing or coughing, but pressing on ribs doesn’t reproduce it
• You also have shortness of breath, cough, fever, or feel unwell
• Pleurisy is inflammation of the lung lining (pleura) that causes sharp chest pain, typically worse when you breathe or cough (Cleveland Clinic: ^[5] ; Mayo Clinic: ^[6]).

Costochondritis is inflammation at the junction where ribs attach to the breastbone (the costochondral joints). It is a common cause of chest wall pain and can feel alarming because the pain can be sharp and located near the center or left side of the chest.

According to Mayo Clinic, pain associated with costochondritis can be sharp or aching and worsens with a deep breath, coughing or sneezing, or movement of the chest wall. ^[2] Cleveland Clinic similarly notes it can become suddenly sharp with torso movement and can worsen with deep breathing and coughing.^[3]

Location clues

• Often near the breastbone (front of chest), where ribs meet cartilage
• May involve more than one rib level
• Often one side is more painful than the other

The most helpful self-check for costochondritis

Press test: If pressing on the sore costochondral area reliably reproduces your pain, costochondritis rises on the list. (Tenderness on palpation is a classic clinical clue discussed in many clinical resources, and the “movement/breathing makes it worse” pattern is documented by Mayo Clinic and Cleveland Clinic.)

Common triggers

• Recent heavy lifting or repetitive upper-body movement
• A coughing illness (repetitive chest wall strain)
• Poor posture with prolonged hunching (can increase chest wall stress)

Because chest pain can signal serious causes, Mayo Clinic advises seeking emergency care for chest pain to rule out life-threatening problems. ^[2] If your pain is new, severe, or paired with shortness of breath, sweating, fainting, or radiating pain, treat it as urgent (see Red Flags below).

Pleurisy (also called pleuritis) means inflammation of the pleura, the thin lining that surrounds the lungs and lines the inside of the chest wall. When inflamed, the pleural surfaces can rub during breathing, producing a sharp, breath-dependent pain.

Cleveland Clinic defines pleurisy as inflammation of the pleura causing sharp chest pain that is usually worse when you breathe or cough. ^[5] Mayo Clinic lists pleurisy symptoms as chest pain that worsens when you breathe, cough, or sneeze and may include shortness of breath, cough, or fever.^[6] 

StatPearls similarly describes pleurisy as sharp localized chest pain worsened with breathing, coughing, or sneezing. ^[18]

• Sharp, stabbing pain, often on one side
• Worse with deep breath, cough, sneeze
• Sometimes radiates to shoulder or back (Mayo Clinic notes spread to shoulders/back: ^[6]

These depend on the cause, but common companions include:

• Fever or chills
• Cough
• Shortness of breath (sometimes because you unconsciously take shallow breaths to avoid pain) (Mayo Clinic:^[6])

Pleurisy is a sign of another process, not the final diagnosis. Cleveland Clinic notes infections (viral or bacterial), autoimmune diseases, and lung conditions as common causes. ^[5] It can also occur with pneumonia and other inflammatory lung issues. Why pleurisy requires a careful “serious causes” screen: The American Academy of Family Physicians emphasizes that pulmonary embolism is the most common life-threatening cause of pleuritic chest pain and should be considered in all patients with pleuritic symptoms. ^[1]

Between each rib are intercostal muscles. They help stabilize the rib cage and assist with breathing. A strain can come from sudden twisting, heavy lifting, a blow to the ribs, vigorous exercise, or even prolonged coughing.

Cleveland Clinic lists key symptoms of intercostal muscle strain including pain when you breathe, cough or sneeze and pain when you move the affected muscles. ^[4] Medical News Today also describes sharp, direct pain and stiffness with intercostal muscle strain. ^[7]

• Localized pain along ribs or side of chest
• Worse with deep breath and movements that stretch the area (twisting, reaching, lifting)
• Sometimes muscle tightness, soreness, or spasm

• Stretch/contract test: If a gentle twist or side-bend toward/away from the painful side reproduces the pain more than breathing alone, a musculoskeletal source is more likely.
• If pressing on a specific rib muscle spot recreates the pain, that also supports muscle strain.

A common “gotcha”: cough-related muscle strain. A prolonged cough can strain the chest wall muscles. Many clinicians see this after viral respiratory illnesses.

Use these distinctions as a guide to what you tell your clinician and what you watch for.

If pressing on the area reproduces pain: think costochondritis or muscle strain

Costochondritis is classically a chest wall pain syndrome that worsens with chest wall movement and deep breath (Mayo Clinic: ^[2]). Muscle strains also hurt with movement and breathing (Cleveland Clinic: ^[4]).

If pain is strongly tied to breathing/coughing and you feel sick: think pleurisy or infection

Pleurisy often rides with cough, fever, or shortness of breath (Mayo Clinic: ^[6]).

Location matters

• Front near breastbone: costochondritis becomes more likely
• Side of ribs: muscle strain is common
• Deep inside chest with shortness of breath: pleurisy or other lung causes become more likely

Time course matters

• After an obvious strain (lifting/twist): muscle strain rises
• After a viral illness with cough/fever: pleurisy or muscle strain from coughing are both possible
• Sudden onset with breathlessness: treat as urgent until proven otherwise (see red flags)

If any of the following are present, do not “self-diagnose” costochondritis. Seek urgent or emergency care.

The National Health Service advises emergency action for chest pain that does not go away, spreads to arm/neck/jaw/back, or comes with sweating, nausea, lightheadedness, or shortness of breath.^[8]

Other red flags that raise concern for serious causes include abnormal vital signs and shortness of breath (MSD Manual red flags: ^[9]

You do not need to memorize these—just know why clinicians get cautious:

• Pulmonary embolism: commonly causes shortness of breath and pleuritic chest pain; may include cough, coughing blood, presyncope or syncope (StatPearls: ^[10]; Cleveland Clinic: ^[11]). Mayo Clinic notes chest pain that is sharp and felt when you breathe in deeply is a symptom. ^[12]
• Pneumothorax (collapsed lung): can cause sudden chest pain and shortness of breath (Mayo Clinic: ^[13]; Cleveland Clinic:^[14]).
• Pericarditis (inflammation of heart lining): sharp chest pain that can worsen with deep breathing or lying down and improve when sitting up and leaning forward (Mayo Clinic: ^[15]; American Heart Association:^[16]).
• Rib fracture: pain worsened by deep breath, pressure, twist (Mayo Clinic: ^[17]). Fractures can happen after trauma or severe coughing in vulnerable people.

• Recent major surgery, prolonged immobility, or known clotting risk (pulmonary embolism risk)
• Recent chest trauma (rib fracture, pneumothorax)
• New severe shortness of breath or oxygen levels low if measured
• Fever with worsening breathing and chest pain (possible pneumonia/pleural involvement)

Clinicians start by ruling out dangerous causes, then narrow down to chest wall vs pleural causes.

• When did it start—suddenly or gradually?
• Where is it—front, side, back? One spot or broad area?
• Does pressing on it reproduce pain?
• Is there cough, fever, shortness of breath, leg swelling, recent travel/surgery?
• Any recent heavy lifting, twisting, workout changes, or injuries?

• Vital signs: fever, fast heart rate, low oxygen
• Lung exam: breath sounds (abnormal sounds can suggest pneumothorax or infection)
• Chest wall palpation: localized tenderness supports musculoskeletal causes
• Sometimes clinicians also look for signs consistent with pericarditis patterns (positional relief), and they will evaluate heart and lungs.

• Chest imaging: often used when pleurisy, pneumonia, pneumothorax, or pulmonary embolism is suspected
• Electrocardiogram: commonly used in emergency settings for chest pain evaluation
• Blood tests: sometimes to evaluate infection/inflammation or clot risk
• The American Academy of Family Physicians discusses using decision rules to guide testing when pulmonary embolism is a concern. ^[1]

If your symptoms are mild, you feel otherwise well, and you have no red flags, these are common supportive measures clinicians often recommend for musculoskeletal causes:

• Reduce aggravating movements temporarily
• Use heat or cold based on what feels better
• Consider anti-inflammatory pain relief if safe for you (ask your clinician if you have stomach, kidney, heart, or bleeding concerns)
• Cleveland Clinic notes costochondritis pain can worsen with movements like deep breathing, coughing, twisting, reaching overhead, and exercise, so temporary activity modification is logical. ^[3]

• Relative rest from painful activities
• Gentle breathing exercises (avoid extremely shallow breathing all day)
• Heat can help muscle tightness; ice can help early inflammation
• Cleveland Clinic outlines symptom patterns and typical care considerations. ^[4]

Because pleurisy often reflects an underlying infection or inflammatory condition, home care should not replace evaluation if symptoms persist or include fever/shortness of breath. Cleveland Clinic notes causes can be infections and other serious conditions and advises emergency evaluation for chest pains. ^[5]

Yes. Costochondritis can mimic concerning chest pain, which is why Mayo Clinic advises emergency evaluation for chest pain to rule out life-threatening causes.^[2] If you are unsure, treat new chest pain as urgent—especially with red flags.

Yes. Viral infections are commonly cited causes of pleurisy (Cleveland Clinic: ^[5]; StatPearls: ^[18]).

Coughing and sneezing increase chest wall movement and pressure changes in the chest. Mayo Clinic notes pleurisy pain can worsen with breathing, coughing, or sneezing ^[6], and costochondritis pain can worsen similarly.^[2]

A pneumothorax can sometimes occur without obvious reason, and symptoms often include sudden chest pain and shortness of breath (Mayo Clinic: ^[13]. Sudden breathlessness plus sharp one-sided pain should be treated as urgent.

• Costochondritis is chest wall pain near the breastbone that can worsen with deep breaths, coughing, sneezing, and movement (Mayo Clinic:^[2]; Cleveland Clinic ^[3] .
• Pleurisy is inflammation of the lung lining causing sharp pain worse with breathing or coughing and may come with shortness of breath, fever, or cough (Cleveland Clinic: ^[5]; Mayo Clinic:^[6]).
• Intercostal muscle strain commonly causes localized rib pain that worsens with breathing, coughing, sneezing, or movement (Cleveland Clinic: ^[4]).
• Red flags (shortness of breath, persistent severe pain, radiating pain, sweating, fainting, coughing blood, abnormal vital signs) should prompt urgent evaluation; the National Health Service lists emergency symptoms for chest pain,^[8] and pulmonary embolism is the most common life-threatening cause of pleuritic chest pain that clinicians consider (American Academy of Family Physicians:^[1]