Trigger Point Injections
Trigger point injections (TPIs) are treatments that help relieve myofascial pain caused by tight knots in muscles. These are usually caused by trauma or repetitive micro-trauma, which causes stress on muscle fibers. Stress causes muscle fibers to contract, and you may feel the knots when rubbing the muscle. Trigger point injections are used to treat myofascial pain and alleviate pain caused by muscle knots. Trigger point injections can include local anesthetics, corticosteroids, and botulinum toxin.
What are Trigger Points?
Trigger points, also known as myofascial trigger points, are small, sensitive areas within muscle tissue where muscle fibers have become tight and contracted. These knots often develop as a result of acute trauma, repetitive micro-trauma, or ongoing stress on the muscle. When you press on a trigger point, it can feel like a firm bump or nodule under the skin, and it is usually tender or even painful to the touch.
One of the unique features of trigger points is their ability to cause referred pain, or pain felt in a different area of the body than where the trigger point is located. For example, trigger points in the trapezius muscle (the large muscle across your upper back and shoulders) can lead to tension headaches or pain radiating into the neck, shoulders, or arms.
Trigger points can develop in any muscle, but are especially common in people with myofascial pain syndrome or those who have experienced muscle overuse, injury, or chronic conditions. Recognizing and treating these trigger points is essential for managing persistent muscle pain and improving overall muscle function.
Myofascial Pain Syndrome
Myofascial pain syndrome is a chronic pain condition that occurs when trigger points form within muscle tissue, leading to ongoing discomfort and limited movement. People with myofascial pain syndrome often experience both localized pain at the site of the trigger point and referred pain in other areas of the body. This condition can also cause muscle stiffness, decreased range of motion, and persistent muscle strain.
The causes of myofascial pain syndrome are varied and may include muscle overuse, injury, poor posture, or underlying chronic conditions. Treatment typically involves a combination of approaches to address both the pain and the underlying muscle dysfunction. Physical therapy is often recommended to stretch and strengthen affected muscles, while pain medication can help manage symptoms.
Trigger point injections, which deliver a local anesthetic directly into the trigger point, are a valuable tool for providing pain relief and restoring range of motion when other treatments are not effective. By targeting the source of pain within the muscle, these injections can help patients regain function and improve their quality of life.
Uses in Myofascial Pain Syndrome
As mentioned, trigger point injections are used for treating myofascial pain and other types of musculoskeletal pain. Fascia refers to the thin connective tissue wrapped around muscles. A patient with myofascial pain may have one or more trigger points, which often feel like tiny bumps or knots. Usually, trigger point injections are used for the most common muscle groups, such as:
- Masseter (in the jaw)
- Levator scapulae (on the sides of the neck)
- Quadratus lumborum (in the lower back)
- Gluteus medius (in the hip)
- Sternocleidomastoid (in the front of the neck)
- Trapezius (upper back and neck)
- Temporalis (side of the head)
Trigger points can also cause additional symptoms, depending on the affected muscle group. Healthcare providers recommend trigger-point injections for patients who haven’t responded to other treatments, such as medications, massage, or heat therapy. Typically, trigger point injections are combined with physical therapy and exercises. The injection can help with pain relief when a patient is unable to do physical therapy.
Doctors usually do a complete physical exam to rule out conditions that may cause similar pain, such as muscle strain, degenerative arthritis, herniated disk, spinal stenosis, and radiculopathy.
Preparation
Myofascial pain is common, and almost 80% of the population has it at some point. There is no preparation required for trigger point injections, but your doctor will discuss your health history, current medication, and other details before considering TPI injections. Taking a detailed history is important to ensure appropriate treatment and prevent adverse outcomes. You can go home immediately after the injection is administered (no downtime).
Procedure for Trigger Points
During the TPI procedure, the healthcare professional inserts a needle into the trigger point. The injection usually contains a local anesthetic and may or may not include a corticosteroid. The injection makes the trigger point inactive, thus offering relief from the pain. Patients may need a course of injections before they get ongoing relief. The procedure is performed in a clinic and takes no more than a few minutes. Multiple trigger points can be treated in a single visit. If the patient is allergic to a drug, the dry-needling technique, which contains no medications, can be considered.
The healthcare provider will usually stretch the treated muscle after administering a TPI, which is critical for the treatment.
Is the Procedue Painful?
Because trigger points are painful, there can be some discomfort during the procedure. That also happens because the healthcare provider must find and mark the trigger point before administering the trigger point injection. You may feel a stinging sensation or burning when the needle is inserted. However, that is a good indirect sign, as it means the needle is at the right spot. You should avoid strenuous exercise for a few days, but you can use the treated muscle.
Benefits
A patient who has tried pain medications and physical therapy but has not experienced relief with trigger points will benefit from trigger point injections (TPIs). TPIs are specifically used to target and inactivate active trigger points, which are the primary sources of myofascial pain. The goal of TPIs is to treat pain and treat myofascial pain syndromes by breaking the cycle of muscle tension, thereby improving the overall range of motion and muscle functionality. While not the first line of treatment, TPIs are commonly used as part of a multimodal approach, which may include muscle relaxants and the stretch technique to further enhance outcomes.
Note: Not all trigger points need TPIs. Doctors usually recommend pain medications and physical therapy to check the response, especially in the early stages. However, for chronic trigger points, TPIs and needling can offer lasting relief. TPIs aren’t injected when there is a local infection. Patients who have bleeding disorders or other conditions will need a detailed evaluation before the treatment can be considered.
Risk & Side Effects
Complications of trigger point injections are limited or rare in most cases. However, one may experience discomfort and numbness at the injection site after the procedure. Medications like acetaminophen or ibuprofen are often prescribed for that. Using ice packs can also help reduce bruising. Rare complications include:
- Infection at the injection site
- Bleeding
- Allergic reaction to the drug
- Bruising
- Vascular injury
Trigger Point Injections Effects
Most patients see a difference in myofascial pain within 24 to 72 hours. The relief can last for a month or less, but if the pain returns, the healthcare provider may recommend additional trigger point injections. Call your doctor immediately if you notice signs of infection, such as fever.
Recover and Aftercare
After receiving a trigger point injection, most patients are able to resume their normal daily activities right away. However, it is generally advised to avoid heavy lifting or strenuous exercise for the first 24 hours to prevent additional muscle strain and allow the treated area to recover. Some mild soreness, bruising, or tenderness at the injection site is common, but these symptoms usually resolve quickly.
To support recovery and reduce the risk of trigger points returning, patients are encouraged to participate in gentle stretching and physical therapy exercises as recommended by their healthcare provider. Maintaining good posture and being mindful of activities that could aggravate trigger point pain are also important steps in aftercare.
Occasionally, patients may notice a temporary increase in pain or experience muscle twitching after the injection—this is often a sign that the trigger point is responding to treatment. If you have any concerns or experience unusual symptoms, be sure to contact your healthcare provider for guidance.
Success Rate and Frequency
Trigger point injections are widely recognized for their effectiveness in providing pain relief for patients suffering from trigger point pain and myofascial pain. The success rate can vary depending on the individual, the underlying cause of their pain, and how well they respond to treatment. Many patients experience significant improvement in their symptoms, including reduced pain and increased range of motion, after just one or two point injections.
In some cases, additional injections may be needed to achieve optimal results, especially for chronic pain conditions or when multiple trigger points are involved. On average, patients may require 2-3 trigger point injections per year to maintain pain relief, but the exact frequency will depend on each person’s unique situation and response to therapy.
It’s important to remember that trigger point injections are most effective when used as part of a comprehensive pain management plan, which may include physical therapy, pain medication, and lifestyle modifications. By combining these treatments, patients can achieve lasting relief and a better quality of life.
When to Reach Out
If you are suffering from myofascial pain, and pain medicines haven’t helped so far, you may need trigger point injections. Patients in Westchester or NYC can visit us at Chester Neurology, where we blend comprehensive care and treatment with advanced testing to deliver lasting relief. We will also explain every detail related to the treatment, ensuring you make an informed decision.
Call us today at (914) 816-1941 or email info@chesterneurology.com to schedule an appointment.
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