Trigger Point Injection

Overview

Trigger point injections provide relief for myofascial pain, especially in areas such as the neck, shoulders, arms, legs, and lower back.

These injections specifically target painful muscle knots known as trigger points, which are highly responsive to touch or pressure. These trigger points can develop as a result of acute trauma or repetitive micro-trauma, causing muscle fibers to become stuck in a contracted state. These knots are often detectable through palpation during massage.

Typically, trigger point injections involve administering a local anesthetic, sometimes combined with a corticosteroid, botulinum toxin, or no additional substance (known as dry needling).

Reasons for undergoing the procedure

Trigger point injections are a common treatment method employed by healthcare providers to address myofascial pain. This type of pain originates from trigger points, which are palpable knots or nodules within muscles. Fascia, the thin connective tissue enveloping muscles, can also contribute to this discomfort.

The muscles most frequently targeted for trigger point injections are:

• Sternocleidomastoid (neck muscle)
• Gluteus medius (hip muscle)
• Temporalis (head muscle)
• Masseter (jaw muscle)
• Levator scapulae (neck muscle)
• Quadratus lumborum (lower back muscle)
• Trapezius (neck and shoulder muscle)

Different trigger points can cause distinct types of pain or complications. For instance, trigger points in the trapezius muscle might lead to tension headaches, while those in the piriformis muscle (located in the buttocks) can result in piriformis syndrome, characterized by buttock and leg discomfort due to pressure on the sciatic nerve.

Trigger point injections become a viable option when other treatments, such as over-the-counter pain medication, heat therapy, massage therapy, myofascial release, and physical therapy, fail to provide relief. Typically, these injections are integrated into a broader treatment plan alongside physical therapy and stretching exercises. This combined approach proves especially beneficial for individuals initially unable to engage in physical therapy or stretching due to severe pain, as trigger point injections can alleviate discomfort, enabling effective participation in therapy.

Before recommending trigger point injections, healthcare providers conduct a comprehensive physical examination to exclude other potential causes of pain, including muscle strain, structural issues, spinal column abnormalities (e.g., degenerative arthritis, herniated disks, spinal stenosis), and radiculopathy (pain arising from a pinched nerve).

Risks

In general, trigger point injections are risk-free and rarely result in problems. Temporary pain or numbness near the injection site is the most frequent side effect. Acetaminophen or ibuprofen may be prescribed by a healthcare provider to treat this. To lessen the possibility of bruises, patients should also apply ice packs to the injection sites.

Trigger point injection complications are uncommon but can include the following:

• Bleeding.
• Bruising.
• Infection.
• Allergic reaction due to the anesthesia.
• Vascular (vein) injury.

Before the procedure

The patient does not need to make any preparations in order to get a trigger point injection. But before undergoing the operation, like with any kind of treatment, it’s important to talk to the healthcare provider about any symptoms, existing medications, and the general health.

During the procedure

Following a trigger point injection operation, the patient can anticipate the following:

• The patient may be lying down or seated on an examination table, depending on where the trigger point is located.
• Using an alcohol pad, the healthcare provider will clean the skin in the injection site.
• The healthcare provider may apply a skin marker to identify the trigger point.
• The healthcare provider will pinch the trigger point between their fingers to stabilize the tissue after they have located it by feeling.
• They will apply a small needle connected to a syringe to the trigger point and then, in a rhythmic manner, keep needling the area by putting and taking out the needle without entirely removing it from the skin or muscle.
• It’s possible that they’ll experience a twitch or spasm of muscles. Until the muscular twitches cease or the muscle feels sufficiently relaxed, the healthcare provider will keep moving the affected area in different directions.
• After that, the healthcare provider will inject a local anesthetic—with or without corticosteroids or botulinum toxin—into the affected area.
• The patient will be allowed to return home once their procedure is finished.

When the healthcare provider inserts the needle and medication, patient could experience a burning and stinging sensations. They can experience a temporary increase in pain when the needle tip comes into contact with the trigger spot. This discomfort, though it may be unpleasant, indicates that the needle is in the right place.

After the procedure

The patient may feel some discomfort as the healthcare provider manually locates the trigger point prior to the injection because trigger sites are usually painful to the touch.

Following a trigger point injection, the patient can resume using the affected muscle at home. But during the first few days, they should refrain from physically demanding activities.

Outcome

For individuals who haven’t found relief from trigger point-related pain through conservative treatments like over-the-counter pain medication or physical therapy, trigger point injections can provide a potentially effective solution that is generally considered safe.

Depending on the specific muscle affected, these injections can significantly improve overall muscle functionality and increase range of motion. Most patients experience reduced pain within 24 to 72 hours following the injection, with relief typically lasting about a month. If pain persists beyond this timeframe, healthcare providers may suggest additional injections for long-term pain management.

It’s crucial for patients to promptly contact their healthcare provider if they notice symptoms of infection, such as fever or warmth at the injection site, after undergoing trigger point injection treatment.