What are Trigger Point Injections?
A trigger point is an area of irritation or tightness in your muscles. Many people identify these areas as “knots.” When pressed, these areas can be painful not only in the immediate area of the “knot,” but also in a distant area. This is called referred pain. Trigger points can develop due to injury, compensatory/dysfunctional movement patterns, trauma, or inflammation.
Sometimes trigger points will resolve on their own. Sometimes they disappear after a chiropractic adjustment, self-massage, stretching, or a massage by a licensed professional. However, there are times when they cause significant pain or discomfort and refuse to go away no matter what you do.
In these cases, trigger point injections (TPI) can provide immediate and long-term pain relief from these knots.
**It’s also important to note that not all trigger points or knots are painful or cause discomfort.
Why Do Trigger Points Form?
Trigger points tend to form in predictable patterns across your body. However, it is not always clear why they form. It is suggested in medical literature that they are the result of acute trauma or repetitive minor traumas, which places increased stress on your muscle causing it to spasm. This line of thinking is due to the fact that trigger points are very common in people who have chronic musculoskeletal disorders such as carpal tunnel syndrome, epicondylitis, muscle sprains, etc.
Trigger points are also extremely common in people who do not have a regular exercise routine, who perform manual labor with poor body mechanics, and who spend long periods sitting or standing.
How Do I Know If My Pain is From a Trigger Point?
If the area where you are having pain is easily reachable and it feels both tender and harder than the surrounding areas, it’s likely to be a trigger point. Trigger points also “twitch” when pressure is applied to them.
Trigger points can occur at a single point or in multiple points and can appear in any skeletal muscle in your body. They also tend to produce a specific and predictable pattern of pain.
Some trigger points do not cause pain unless pressure is applied, but may restrict movement or cause muscle weakness.
If you have pain, movement restrictions, or muscle weakness, it’s possible that these are being caused by trigger points. Call us to schedule your evaluation today.
What Are Trigger Point Injections?
Trigger point injections (TPIs) are injections of local anesthetic directly into the knots in your muscle. These knots are called trigger points and they occur when your muscle involuntarily contracts or spasms, this can cause the area to become tender and painful and the pain can radiate elsewhere in your body.
A small needle is used to inject medication directly into the trigger point. Typically local anesthetic such as lidocaine is used, but other medications can be used as well (steroid, saline, or injectable NSAIDs).
This works to relieve the trigger point and associated pain in several ways. First, the needle helps to disrupt the signals that are telling your muscle to spasm (similar to dry needling that is often performed by physical therapists). When the needle is inserted, the nerve fibers are stimulated which causes them to release substances that interrupt pain signals and stimulates a “twitch” response. This causes the muscle tissue to depolarize and relax.
Second, injecting something into the middle of the trigger point helps to break up the tight band of tissue from the inside out. Massage works to break up trigger points from the outside, but sometimes that isn’t enough to get things to relax and stay that way. Going from the inside out can help to continue to disrupt the nerve signals that were telling your muscles to spasm in the first place.
Lastly, using lidocaine, a numbing medication, can help to provide some immediate pain relief while your nerves and muscle fibers are working on calming themselves down. The numbing effects of lidocaine are not the main way that this procedure provides relief, but in cases where the pain is significant, it can be a welcomed break from the discomfort. The numbing effects of lidocaine kick in within a few minutes and last for about 4-6 hours.
Who Are Trigger Point Injections Good For?
Trigger point injections can help people who are suffering from back, neck, arm, or leg pain. However, people who are having pain in other areas may find relief from TPIs.
If you are having pain or discomfort that makes it difficult for you to sleep or go about your activities of daily living, you may find TPIs beneficial. In order to determine if you are a good candidate for TPIs call 907.345.3223 and schedule an appointment today.
What to Expect During Your Appointment
The procedure for TPIs is short and can be done in-office.
First, your provider palpates the trigger point with their fingers to identify the exact places where the painful knots exist.
Then your provider uses a small needle to deliver the injection into those specific areas. You may either be sitting up or lying down depending on where these trigger points occur. You may also have more than one injection depending on the number of trigger points you have for a specific issue.
How Many Appointments Will I Need?
Everyone is different and the response to this treatment varies greatly.
In some cases such as an acute injury, it’s possible to resolve the pain and underlying trigger points in just a couple of appointments.
If the issue has been chronic and your trigger points continue to reoccur in the same spot over and over again, then you may require a longer course of treatment.
A typical treatment course involves weekly appointments for several weeks (anywhere from 2-6 weeks). Once your pain has decreased and does not reoccur quickly, we increase the amount of time between appointments. Ultimately our goal is to get you into “maintenance mode” where we see you as little as possible for this issue (and only if/when it reoccurs)!
What Else Can I Try?
- There are many ways to treat trigger points and relieve pain that don’t involve needles:
- Topical pain relief such as Biofreeze
- Manual therapy (rolfing, massage, chiropractic, physical therapy)
- Home exercise programs
These are all effective treatments early on the development of trigger points. They can help the knot from becoming a chronic issue. However, trigger point injections are one of the most effective treatments for providing immediate relief and preventing recurrence of painful trigger points.
Who Should Avoid TPIs
TPIs are safe and effective for the treatment of trigger points and myofascial pain. However, you are not a good candidate for TPI if you:
- Have a local infection in the area to be injected
- Have a systemic infection
- Have an allergy to local anesthetic
- Have a bleeding or coagulation disorder
If you have a significant fear of needles, TPIs might not be for you, however our staff can help you to feel more comfortable during the procedure if it’s something that you feel would be otherwise beneficial for you.
What Are the Possible Complications?
In most cases you will feel relief from your pain almost immediately. There are a few short-term, mild complications that can occur as a result of using a needle as part of the treatment.
You may experience temporary numbness or pain at the injection site. This pain is not your trigger point pain getting worse, but is similar to when you feel sore after you get a massage or workout hard. Bruising, redness, and irritation can also occur around the injection site.
Severe complications are very rare, but they can occur. These are most often due to poor technique. They include:
- Skin infections
- Severe allergic reaction
If you experience one of these complications, please seek immediate medical attention.
Trigger point injections, especially when combined with massage and chiropractic care, are a safe and effective way to resolve the pain associated with muscle knots or trigger points. They can provide immediate and long-term pain relief.
Call 907.345.3223 and schedule your appointment today.