Trigger Point Injection

Trigger Point Injections

A trigger point injection can help soothe myofascial pain, especially in your neck, shoulder, arms, legs, and lower back.

This information sheet will explain what it is, Dr. Singer can determine if it is for you.

What is a trigger point? A trigger point is a discrete, hyperirritable nodule (like a "knot") that is palpable in a taut band of muscle. It can produce pain in a particular spot or in another part of the body.

How do you diagnose trigger points? There are no diagnostic tests or way to image trigger points. Sometimes trigger points occur because of an injury, trauma, or repetitive strain. In other instances, they can result from poor posture (like sitting hunched over a computer) or excessive exercise. In each instance, a muscle nodule (or "knot") develops. Trigger points are generally caused when a muscle gets overloaded and it gets stuck contracted, and the fibers stay closely banded together. Trigger points are thought to be associated with chronic stretch or overload of the muscle. The chronic stress leads to chemical changes within the muscle that likely cause an over-sensitization in pain receptors. Trigger point pain is often out of proportion to the underlying injury, due to the pain sensitization process. In some instances, the pain can be associated with muscle dysfunction, muscle tightness or weakness, decreased flexibility, and a limited range of motion. Because trigger points are not a medical condition unto themselves, there isn't a diagnostic blood test, imaging technique or tool that can be used to definitively identify them. The most commonly used technique is palpation of a suspected trigger point.

What is a trigger point injection? In a trigger point injection, a local anesthetic and corticosteroid are injected into the irritated knot. The local anesthetic, a numbing medicine, lessens your pain temporarily. The corticosteroid reduces inflammation that may be causing pain. In addition to trigger point injections, massage, physical therapy, and stretching can all help to relieve trigger point pain. The goal with each of these treatments is to release the trigger point so the taut band of muscles relaxes, and the pain dissipates.

Where can I get a trigger point injections? Trigger points can develop in any muscle, but the most common muscle groups that are treated with trigger point injections include:

• Masseter (a muscle in your jaw).
• Levator scapulae (a muscle on the sides of your neck).
• Gluteus medius (a muscle in your hip).
• Quadratus lumborum (a deep muscle in your low back).
• Trapezius (the muscle extending over the back of your neck and shoulders).
• Sternocleidomastoid (a muscle in the front of your neck).
• Temporalis (a muscle on the sides of your head).

Trigger points can cause certain types of pain or issues. For example, trigger points affecting your trapezius muscle may cause tension headaches. A trigger point affecting your piriformis muscle (a muscle in your buttocks) can cause piriformis syndrome — when the piriformis muscle presses on your sciatic nerve. It causes pain or numbness in your buttock and down the back of your leg.

What happens during an injection?

• Depending on the trigger point location, you may be sitting or lying down on an exam table.
• Dr. Singer will cleanse your skin on the affected area with an alcohol pad.
• Once Dr. Singer has identified the trigger point by feeling it, he will pinch the point between his fingers and stabilize the tissue. This may feel uncomfortable.
• Dr. Singer will insert a thin needle attached to a syringe into the trigger point and rhythmically continue needling the area by repeatedly inserting and retracting the needle without completely withdrawing the needle from the muscle or your skin.
• You'll likely feel your muscle spasm or twitch. Dr. Singer will continue the motion in multiple directions until the muscle twitching has stopped or until the muscle feels adequately relaxed.
• Dr. Singer will then inject the area with a local anesthetic with or without corticosteroid or botulinum toxin.

What happens after an injection? You will be free to get re-dressed and check out at the front desk. It may help to move in ways that hurt before the injection, to see if the pain is still there, but do not overdo it. You may feel immediate pain relief and some numbness for a limited time after the injection. This may indicate the medication has reached the right spot. You can return to work the day after the injection. Your pain may return after this short pain-free period or may even be a little worse for a day or two. It may be caused by needle irritation or by the steroid itself. Steroids usually take two or three days to start working, but can take as long as a week. Massage and ice for the first 24-48 hours can help ease tenderness at the site of injection.

How long can I expect pain relief? Pain relief typically lasts for about a month. If you're still experiencing pain after this time, your healthcare provider may recommend additional injections to achieve long-term pain relief.

This information is for general education only. Specific questions or concerns should always be directed to your doctor. Your doctor can explain possible risks or side effects.