January 2026
Once again I have to apologize for not keeping up to date with the newsletter on my website as promised. I have no excuses but my lethargy and lack of motivation to write. I am still working on my narratives for Myomemory Advantage Transformation (M.A.T.) the fascial, neuromyofascial, and skeletal process I use in treating acute and chronic musculoskeletal pain and other symptomatology at my clinic and as I mentioned previously I am preparing for a total knee procedure in March.
As of right now, my surgery is scheduled for March 4. Clients continue to ask, “When will you return?” Since I don’t believe in the “magic 8 ball” to predict the future, I honestly do not know. However, I do know this: it takes at least eight weeks for soft tissue healing and whatever time after that to restore strength and flexibility of the soft tissue traumatized by the surgical procedure. I will know more after those first eight weeks.
For those who want to know, my surgeon is Christopher Hanosh, M.D., at Lovelace. I have the utmost confidence in his ability to get me on the right track regarding the degeneration of my left knee that goes back to my original surgery in 1971. For the first three months after that surgical procedure to repair a torn meniscus and medial collateral ligament, I was placed in a straight leg cast unable to flex my left knee. In retrospect, I feel a lot of the degeneration of my left knee joint I experience today can be attributed to being in a straight leg cast for three months after surgery. Believe me, that will not be the case this time and I will give you updates after my surgery on my website about my return to the office. For those of you that have sent me messages upon learning of my upcoming surgery, I thank you.
Now that I have that out of the way, I want to write about probably the most forgotten isolated muscle of your neuromyofascial system, the internal and external intercostals.
Obviously, they are active in breathing, pulling the ribs closer together in inhalation and forced exhalation. Today based on electromyography, the intercostals are now thought of as tertiary muscles of breathing, trailing behind the primary muscle, the diaphragm, and the secondary muscles, the scalenes.
The famed Czech researcher Dr. Karel Lewit states: “Respiration is our primary and most important movement pattern and also the most dysfunctional.” Most healthcare clinicians are aware of how breathing affects your posture, alignment, and bodily functions, but there is much confusion when it comes to treating underlying joint and myofascial disorders.
Anyone who tells you that some part of the body has just one function simply hasn’t looked hard enough or doesn’t understand the integration of the body through its nervous and fascial systems. Every isolated and identifiable piece in the body seems to serve multiple functions and your intercostals are no exception.
Their name “the intercostals” lives up to their name by covering the short vertical distance between any two ribs from the thoracic spine segment T1 to T12. When you place your order at a barbecue restaurant for “baby back ribs” you are eating intercostals bathed in barbecue sauce.
The intercostals and their associated fascia span the ribs and their associated cartilages on either side of the body from the sternum in front all the way around the trunk nearly to the transverse processes in the back.
Actually, there are three layers of intercostals consisting of the external, the internal, and the innermost. These three layers not surprisingly correspond facially to the abdominal layers including the internal and external obliques and transverse abdominis respectively. The innermost intercostals are irregular, and often follow the same line as the internal intercostals, so we will drop them from our discussion to concentrate on the stronger and more consistent internal and external layers.
The external intercostals angle down and in much like the external oblique and similar to the direction of your hands and fingers when you put your hands in your jacket pocket. They extend from where your ribs meet the transverse processes of your spine in the back all the way around the ribs to the front, but they end where the rib bones end and the rib cartilages begin an inch or three from the sternum.
Conversely, the internal intercostals angle down and back, and fill an area between or the cartilages all the way up from the sternum in front around toward the back. They end around the angle of the ribs, where the ribs can no longer be palpated, a few inches from the spine.
In other words, simply the external intercostals are more in back and the intercostals are more in the front, but they overlap along the whole lateral aspect of the ribs that involve M.A.T.’s deep side lineal fascial and neuromyofascial pattern.
During your inhalation or breathing in efforts, the ribcage has the unique ability to increase its anterior and posterior and lateral dimensions concurrently. The structure most responsible for the generation of negative intra-thoracic pressure is the diaphragm.
Inhalation causes the diaphragm to contract and move inferiorly. This action flattens the dome-shaped muscle causing decrease of pressure in your thorax and an increase in air taken into your lungs. As you exhale, the diaphragm relaxes, the dome shape is restored, and air space in the lungs decreases causing you to push air out. Any increase in abdominal pressure via inhalation flattens spinal curves causing an increase in thoracic spine and rib cage stiffness and stability.
This involuntary action works in close coordination with other structures you know as the “core.” Because of the intimate releationship between breathing and bony structures, anything that weakens the diaphragm also adversely affects your thoracic spine and rib cage function. And when the body’s joints stiffen, normal breathing patterns suffer. It matters very little if you are engaged in competitive sporting activity, or simply lifting an infant from a car seat, the core muscles must be properly engaged. Dysfunction in any respiratory-related structure makes you more susceptible to musculoskeletal pain and other symptomatology.
But the intercostal muscles are also muscles of your gait, the pinnacle of human neurodevelopment. They help to wind and unwind your rib cage as it provides the central spring in the unique movement pattern of your gait.
Keep in mind that during your gait, the whole body is in coordinated posture and movement. Walking is at least 4 million years old, and thus among the most healing and integrating activities you can engage in. When one part of your body is not working during your gait, other parts must overwork. Secondly, the closer to the center of your body, generally the smaller the movement, the more important it is.
In walking, the movements of your ribs, spine, and sacroiliac joints of your axial skeleton are essential. You miss one of them during your gait, and the other part has to compensate leading to overuse problems.
As an interesting sidelight, the most central movements of all are the various pulses and tides of the reciprocal tension membrane and fluids in your dorsal cavity referred to as the crania-sacral pulse. Inhibit or skew this subtle, tiny motion in the middle, and compensation with slowly, but inexorably creep to the outside.
Don’t let anybody tell you that anything in the body is “for” any particular thing. The body is more efficient, interesting, and integrated than any machine, and everything has multiple roles. Even those little intercostals between your ribs.
When tension, trauma and poor postural habits alter your biomechanics from the optimal and undermine smooth integrated core posture and movement, it is usually detectable during your gait. Because clumsy, uncoordinated posture and movement is less efficient, it alters your body’s loading and muscle activation patterns in response to gravity and ground reaction force. The two primary vertical forces of your environment. Many chronic pain clients develop overtime, “myomemory loss” and are unable to describe or feel alterations in their posture, movement, and breathing patterns. But, you’ll find the following conditions often go hand-in-hand with a weakened core and loss of proper diaphragmatic breathing.
• chronic low back pain
• frequent tension-type headaches
• emotional system overload, high stress, and anxiety
• chronic postural strain from desk-occupied postures, etc.
• repetitive and painful rib fixation
Another consideration is with the elderly in that a dysfunction of their intercostals can set them up for an infection such as pneumonia, the #1 infectious cause of death. It is the leading reason for hospitalization in seniors, significantly increasing mortality risk due to age-related vulnerabilities and existing health issues like heart disease and diabetes. Pneumonia is a major threat, particularly for those over 65 years of age, with its death rate climbing sharply with age.
Because of the body’s inherent integration, something our present medical model and system forget, a weakened diaphragm causes increased tone in the upper rib cage muscles such as the trapezius, levator scapulae, and pectorals. The latissimus dorsi and pectorals of M.A.T.’s superficial rectilineal pattern are not usually thought of as accessory muscles of breathing, but may be recruited in those paradoxical breathing patterns. This faulty breathing pattern occurs when your abdomen moves in on inspiration rather than out and out on expiration rather than in. This can result in your shoulder girdle protraction, forward head carriage, and decreased lumbar lordosis.
The subsequent head forward posture causes suboccipital spasm and cervicothoracic pain, as these areas of your body are now asked to bear excessive loads to compensate for a hyperkyphotic thoracic spine.
Remember, your rib cage and core work as a unit and their coordinated posture and movement is essential. Depending on how your brain will perceive the threat, pain and other symptomatology may manifest when a rib loses its ability to properly coordinate your posture and movement with the rest of the ribs and spine as part of a functional unit. This would be similar to a rowing team where one oarsman uses his oar out of sequence with the rest of the team. Altered rib function can cause difficulty breathing, restricted shoulder girdle movement, referred pain to other areas, and reactive muscle guarding. Additionally, misaligned ribs can pinch intercostal nerves, sending pain through the length of a rib and occasionally the chest wall reminiscent of the “ole heart attack scare.”
It is virtually impossible to overstate the influence of breathing on your thoracic spine and rib mobility and postural stability. Remember what Dr. Lewit stated, “respiration is our most foundational and dysfunctional movement pattern.” The diaphragm, abdominals, and accessory respiratory muscles produce upward of 21,000 breaths a day.
With a strong, freely moving diaphragm serving as the primary muscle of respiration, axillary muscles such as the internal oblique, external oblique, transverse abdominis, scalenes, and yes, the intercostals are able to remain soft and relaxed.
Again, referring back to Dr. Karl Lewit’s quote, everybody should be doing breathing exercises. A basic routine I find effective is place one of your hands over your lower abdomen and the other on your upper chest wall just below your throat. Push your abdomen out as you take a slow, relaxed full breath in through your nose, and forcefully pull your belly in as your exhale through your mouth.
As you age and your thoracic spine stiffens, breathing compensations begin. One thing is for sure, we tend to take our breathing for granted because it is so seemingly automatic and basic.
But breathing is one of the most essential innate movement patterns of not only spinal stability and acute and chronic musculoskeletal pain and other symptomatology, but chronic fatigue and anxiety as well. There is no better way to facilitate your “vagus nerve” and your parasympathetic nervous system than through your breathing. “Breathing is fundamental” to your survivability in this environment of gravity and ground reaction force. Just ask someone who has asthma or chronic obstructive pulmonary disease (COPD).
Terry