Pilates and Breathing for Intercostal Neuralgia

Guest article by Simmone Cser Pratzky

First published 12.11.2022.
Link to original article: Pilates 44 Studio


How Pilates and breathing techniques may assist in managing rib pain.

Intercostal Neuralgia affects the nerves of the ribcage and therefore muscles and function of breathing can become less functional. Due to pain, the body can be on high alert and is generally in a constant sympathetic nervous system pattern which can bring weakened immunity, fatigue, poor concentration, elevated heart rate, all over muscle tension, loss of restful sleep, poor digestion.

When working with clients that have persistent pain part of my focus is to guide them into the Parasympathetic Nervous System. The most effective way to get here is with breathing techniques and visualisation cueing.

There are many on-flowing effects from reduced deeper, whole diaphragmatic breath that may include; headaches, poor posture, forward leading gait which can effect hips knees , ankles and feet, perhaps poor pelvic floor tone, lack of strength in the hip extensors (big balance muscle groups here), balance and can perhaps be more prone to falls and lower back. There are also mental effects such as depression. Imagine being in pain and the shape you body naturally conforms to is a foetal position. Teaching breath we can influence the whole body and the mind.

How can breathing help?

The intercostal muscles are part of our respiratory system when we inhale. Through deeper breath we can increase their movement and ribcage mobility. Clients with Intercostal Neuralgia may have a fear of deeper breath and movement of the ribcage because of possible pain. Pain can flare at any point in time and from the smallest amount of ‘pressure’ (even the lightest touch of fabric on the skin). *A side note when working with these clients communicate with how the person is feeling today in regards to this, as it will direct you to know if tactile cuing is appropriate. One of the most effective ways to teach breath practice is to empower clients to use their own hands as tactile guides while beginning to mobilise the ribcage.

Let’s Get Started

Seated in a comfortable position also allows for freedom of the ribs front back and sides. Even laying propped up on some pillows, anything so as the ribs at the back of the body have freedom move while learning this.

  • Begin somewhere simple. Seated or laying supported.

  • A little breath for extension Bring the palm of your hand on to your chest, this is your tactile cue. Send the breath forward in to the hand, notice how you are influencing a subtle mobilization to extension of your upper thoracic spine

  • Gently placing the tongue into the roof of the mouth can allow nice access to a breath IN through the nose. When you breathe OUT, allow the jaw and neck to relax, try not to squeeze your abdominals.

  • Changing the breath direction focus and draw the breath into the back of the body (without curling the spine) imagine your hand sinking into the chest as you breath IN through the nose. Begin to notice the subtle expansion and widening of the back body.

  • Lateral breath. Taking your hands to the sides of your body, just above waist height, thumb towards the back and fingers over the front, now breath sideways into your hands (this one takes practice). Imagine you’re ribs as a frill necked lizard, puffing up his beard.

  • Playing with lateral breath to mobilize the ribs. What does it feel like to focus the breath more into the right side trying to shift that right hand out of the way as the breath moves into the right ribs and follows into the right hand……how about the left side? Notice which side may feel a little more restricted and take a couple of extra breaths there.

  • Playing with rotation using breath. This one needs to be done sitting or standing. What about breathing into the right again but this time picture the right hand shifting back as the left hand shifts forward (it’s a visual cue remember). You’ve just mobilized your spine and ribs into rotation.

How often?

How many times a day? How many breaths a time? Use your own judgment. You are the one living in your body. It can be very normal to feel ‘light headed’ or ‘fuzzy’ when you begin learning to breathe with your whole system, you’re getting more oxygen into the blood.

Oh and you’re also teaching your PELVIC FLOOR to relax and to tone at the same time.



[1] World Health Organization, 2021.

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