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Trigger Point Injections

Sometimes massages, cupping, acupuncture and other therapies to decrease muscle pain are not as effective as we’d hope. For those who experience pain in their arms, legs, lower back, or neck, there may be a treatment to offer you some relief. Trigger point injections are an in-office procedure used to treat pain located in different muscles of the body. The injection contains a local anesthetic which is inserted directly into the “knots” of muscle.

What are trigger points?

Trigger points are areas of hypertonic (excessive tension) muscle that can be very tight and painful. Many people call these areas “knots”, and they can be found all over the body. Trigger points can also cause pain or numbness to radiate. This can cause the pain to travel down limbs or other parts of the body. From your neck to your forearms and even down to your calves, trigger points may occur in any of your muscles.
Trigger points develop when an area of muscle receives low blood flow which causes a buildup of lactic acid or other pain modulators (modulators are the process by which the body alters a pain signal as it is transmitted along the pain pathway). Without blood flow, these modulators can come in but not out, meaning you can end up using and contracting the muscle without allowing the muscle to relax. Repetitive use of these muscles can then cause “knots” that are actually trigger points.

How do trigger point injections work?

A trigger point injection is an injection of a numbing medicine like lidocaine into the trigger point. Your physician will gently dry needle the area, which allows your muscle to regain blood flow. The lidocaine or other numbing medicine will counteract the soreness of the area once the treatment is complete. By returning blood flow, your body will be able to flush out all the pain modulators in the muscle, which will cause your muscle to relax and your pain to decrease.

Returning blood flow to the area is key for reduction in trigger point pain. Sometimes people will use other things to treat trigger points. Massaging can return a superficial kind of blood flow to your muscles. Cupping can also help return blood flow; however, trigger point injections can reach deeper, more difficult areas like the jaw and neck that cupping cannot.

Should I try trigger point injections?

People can experience a number of symptoms from trigger points. More common symptoms include tightness, soreness, or radiating numbness. Your pain can also depend on where on your body the trigger point is located. You can test to distinguish a trigger point from other sources of pain in the body. If can reproduce the pain by pressing on the painful muscle, it is a good indicator that you might have a trigger point.

Patients can try a number of things before resorting to trigger point injections. For some heat and stretching can be really effective at decreasing your pain. However, if these options aren’t effective, patients can move on to the next step.

Preventing future trigger points

Unlike other forms of treatment, trigger point injections aren’t meant to be routine. After your procedure, your doctor will probably discuss some ways to prevent future trigger points from occurring. Trigger points are often caused by repetitive motion from work life. For example, looking down at the computer at work is a very common source of neck and trap pain.

“Imagine you’ve got a 10-pound bowling ball on a smaller stick. If you’re constantly looking down at your cell phone or the computer, how do you hold the 10-pound bowling ball? You have to use those muscles to pull it back and you’ll get trigger points,” said Sports Medicine Specialist, Saunora Prom, DO, FAOASM of Tidewater Sports and Osteopathic Medicine, Greenbrier in Chesapeake. Certain stretches and exercises can prevent this pain from reoccurring, as well as lifestyle changes. If you notice your neck is constantly bending to look at your computer, consider putting your monitor on a raised platform to prevent the repetitive motion.

Athletes like runners are also prone to trigger points. Your doctor will work with you to discover the cause of your trigger points and prevent them in the future, whether that means at-home fixes like exercises and orthotics or long-term physical therapy.

Are there any risks?

This is a relatively low-risk procedure. Patients will often experience soreness for a few days at the sight of the trigger point injection and bruising caused by superficial blood vessels. These are both normal reactions and no cause for concern. Oftentimes drinking water and stretching will reduce your soreness. In fact, patients can sometimes experience more pain and soreness with physical therapies like dry needling.

Depending on the location of the trigger point injection there is some risk associated. For areas like the neck where you can find deeper structures like bigger blood vessels, doctors will use instruments like ultrasound machines to guide the needle and minimize the risk to patients. Trigger point injections don’t involve steroids or spine injections, instead, this procedure works directly with muscle to relieve pain.

There is no recovery period for those undergoing trigger point injections. In fact, the best time to start stretching is right after the injection because you can get more range out of the muscle and decrease your soreness later on.

Trigger point injections are an excellent option for relieving trigger point pain and relax tight muscles. If you are experiencing pain that you think might be caused by trigger points, talk to your doctor today to see whether or not trigger point injections might be right for you.

Saunora Prom, DO, CAQSM

About Dr. Saunora Prom, DO, FAOASM

Saunora Prom, DO, FAOASM started Tidewater Sports & Osteopathic Medicine, Greenbrier in 2011 to provide the Hampton Roads area with a variety of interventions for orthopedic issues and with a vision to bring non-surgical options to the forefront of orthopedic medicine. As many musculoskeletal issues do not require surgery, Dr. Prom first strives to find a true root cause of pain and the right personal treatment for his patients. As a sports medicine specialist, he is an ideal physician for the “weekend warrior” and “industrial athlete”, as well as the non-athlete; including those who wish to become active or begin an exercise program. He also provides the latest in concussion treatment, including ImPact testing and OMT.

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