Rehabilitation strategies for abdominal wall reinnervation after intercostal nerve injury: A narrative review.

The abdominal wall musculature, including the rectus abdominis, transversus abdominis, and internal and external obliques, is a complex, multifunctional unit essential for trunk stability, postural control, and respiratory function. Injury to the intercostal nerves innervating these muscles, which may occur following rib fractures, thoracic surgery, trauma, or iatrogenic interventions, can lead to significant motor and respiratory deficits, including abdominal wall bulging, reduced trunk stability, impaired cough, and diminished forced expiration. Surgical interventions such as intercostal nerve exploration and neurolysis with possible direct neurorrhaphy versus allograft nerve reconstruction offer the potential for reinnervation; however, successful functional recovery depends on structured, targeted rehabilitation. This narrative review synthesizes current knowledge on abdominal wall anatomy, intercostal nerve injury consequences, surgical repair strategies, and rehabilitation principles, focusing on abdominal wall-specific recovery. It proposes a phased rehabilitation framework that integrates motor retraining, respiratory optimization, cortical plasticity-guided techniques, and functional retraining. Objective outcome measures, including ultrasound, electrodiagnostic testing, and timed leg-lowering tests and respiratory metrics such as peak cough flow, can guide and track recovery. By combining neuroplasticity-driven interventions, respiratory integration, and progressive, task-specific retraining, clinicians may optimize functional outcomes for patients following intercostal nerve injury. Future research should prioritize the standardization of assessment methods and validation of structured rehabilitation protocols.