Trigger Point Injections
A trigger point is a sensitive area in the muscle or connective tissue (fascia) that becomes painful when compressed. Trigger points can also be a point from which pain radiates throughout the muscle and fascia, causing myofascial pain syndromes. Trigger points are painful “knots” in your muscles that can be very sensitive to touch/pressure. They may form after acute trauma or by repetitive micro-trauma, leading to stress on muscle fibers. It causes the muscle fibers to be stuck in a contracted state. Sometimes you can feel these knots when you rub your muscle.
A trigger point injection can help soothe muscle pain, especially in your arms, legs, lower back, and neck. It also can treat fibromyalgia, tension headaches, and myofascial pain. Injecting small amounts of anesthetic and steroids into the trigger point can help ease the pain.
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Healthcare providers use trigger point injections to help treat myofascial pain. Your fascia is the thin, white connective tissue that’s wrapped around every muscle. Trigger points can develop in any muscle. 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.​​
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Candidates for Trigger Point Injections
A trigger point injection may be right for you if your trigger point pain has not improved with other treatments, including over-the-counter pain medication, heat therapy, massage therapy, myofascial release ad physical therapy. Providers typically use trigger point injections alongside physical therapy and stretching exercises to alleviate the pain.
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This strategy can be particularly beneficial when a trigger point injection is initially used to reduce pain in people who are unable to do physical therapy or stretching due to intense pain. The trigger point injection can allow physical therapy to be more effective.
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Benefits of Trigger Point Injections
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Trigger point injections are generally safe and can provide pain relief to people who have been experiencing pain associated with trigger points and have not found relief using more conservative treatments, like over-the-counter pain medication or physical therapy. Trigger point injections can also provide significant improvement in range of motion and overall muscle functionality, depending on which muscle is affected.
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Most people experience pain relief starting between 24 and 72 hours after the trigger point injection procedure. 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.
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Procedure Process
Depending on the trigger point location, you may be sitting or laying down on an exam table. Your healthcare provider will cleanse your skin on the affected area with an alcohol pad.​ Once your provider has identified the trigger point by feeling it, they’ll pinch the point between their fingers and stabilize the tissue. This may feel uncomfortable. They’ll 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. Your provider will continue the motion in multiple directions until the muscle twitching has stopped or until the muscle feels adequately relaxed. Your provider will then inject the area with a local anesthetic with or without corticosteroid.
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Procedural Expectations
Trigger points are typically painful to the touch, so you’ll likely experience some pain when your healthcare provider is manually locating the trigger point before the injection.
You may feel a stinging and burning sensation when your provider inserts the needle and medication. When the tip of the needle touches the trigger point, you may feel a brief increase in your pain. Although this may be uncomfortable, this pain is a good sign that the needle is in the correct spot.
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Post-Procedure
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After a trigger point injection, you can go home and can actively use the affected muscle. However, you should avoid strenuous activity for the first few days.
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Risks and Side Effects
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Trigger point injections are generally safe and carry a low risk of complications. The most common side effect is temporary discomfort or numbness around the injection site. Your healthcare provider may recommend treating this with acetaminophen (Tylenol®) or ibuprofen (Advil®). You can also apply ice packs to injection sites to reduce the risk of bruising. Complications of trigger point injections, which are rare, can include the following: bleeding, infection, bruising, allergic reaction to the anesthetic agent, or vascular (vein) injury.
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