Trigger point injections (TPI) are used to treat extremely painful areas of muscle. Normal muscle contracts and relaxes when it is active. A trigger point is a knot or a tight, ropy band of muscle that forms when muscle fails to relax. The knot often can be felt under the skin and may twitch involuntarily when touched (called a jump sign). The trigger point can trap or irritate surrounding nerves and cause referred pain — pain felt in another part of the body. Scar tissue, loss of range of motion, and weakness may develop over time. TPI is used to alleviate myofascial pain syndrome (chronic pain involving tissue that surrounds muscle) that does not respond to other treatment, although there is some debate over its effectiveness. Many muscle groups, especially those in the arms, legs, lower back, and neck, are treated by this method. Trigger point injection (TPI) is a procedure used to treat painful areas of muscle that contain trigger points, or knots of muscle that form when muscles do not relax. Many times, such knots can be felt under the skin. Trigger points may irritate the nerves around them and cause referred pain, or pain that is felt in another part of the body.
Trigger points can become problematic for a number of reasons. Patients may develop trigger points because of injury to muscle tissue. Examples of muscular injury include whiplash, overuse of a muscle group, or a post viral syndrome. Trigger points may also occur because of an underlying structural problem. Spinal abnormalities such as herniated and degenerative discs, scoliosis, postural problems, osteoarthritis are examples of conditions commonly associated with trigger points.
Trigger points are diagnosed by physical examination. The examiner palpates muscles for tender areas over taut bands and knots. X-rays, biopsies, and laboratory tests are of no use in detecting trigger points, but may be helpful in revealing an underlying condition.
In the TPI procedure, our provider inserts a small needle into the patients trigger point. The injection contains a local anesthetic that sometimes includes a corticosteroid. With the injection, the trigger point is made inactive and the pain is alleviated. Usually, a brief course of treatment will result in sustained relief. Injections usually take just a few minutes. Several sites may be injected in one visit. If a patient has an allergy to a certain medication, a dry-needle technique (involving no medications) can be used.
TPI is used to treat many muscle groups, especially those in the arms, legs, lower back, and neck. In addition, TPI can be used to treat fibromyalgia and tension headaches. TPI also is used to alleviate myofascial pain syndrome (chronic pain involving tissue that surrounds muscle) that does not respond to other treatments.
You may experience soreness, bruising, or even an increase in pain for a few days until your body has time to recuperate from the injections. Heat and stretching exercises may help to lessen the discomfort.
Trigger point injections are very safe. Patients may feel some injection site tenderness following the injection as the local anesthetic wears off. It may take a few days for the anti- inflammatory action of the steroid to take effect. Patients will sometimes feel a little dizzy for up to an hour if multiple trigger points are injected with a large dose of local anesthetic. DO TRIGGER POINTS HURT? Most patients would compare the pain of trigger point injections to that of placement of an IV or blood draw.
A definitive answer is not possible because it depends on the nature of the patient’s condition. The local anesthetic will numb the area for 1 to 3 hours. The corticosteroids remain in the tissue in active form for about one month. The major benefit of trigger point injections is to allow the patient to more effectively participate in a rehabilitative program. Trigger point injections loosen muscle groups thereby improving patient progress in physical therapy and joint mobilization.
If trigger point injections are not effective in reducing your pain, other modalities are available (such as medical management, nerve blocks, electrical stimulation techniques, intradiscal techniques, radiofrequency, prolotherapy) to control pain depending and your condition.