Trigger Point Injections

What is it and how it works.

A trigger point injection is an injection into a painful area of the muscle. Normal muscles tighten and relax as you use them. A trigger point is a tight knot or band of muscle that forms when the muscle will not relax. They can be very painful. An injection into the muscle can help it relax and relieve the pain. Patients most often find the best results when they do a series of injections, usually 4-10 days apart.

Trigger points can cause spasms or pain in a muscle, or cause “referred pain” in another part of the body. The pain can affect posture, spinal and joint alignment, range of motion and muscle strength. Trigger points can be caused by a number of conditions, including:

●  Problems with posture (computer work, driving, exercise, prolonged positioning, etc.)

●  Imbalances in muscle strength and flexibility

●  Muscle and/or joint injuries or repetitive use injuries

●  Muscle-related conditions such as myofascial pain syndrome or fibromyalgia

Why do I need it?

Trigger points can cause spasms or pain in a muscle, or cause “referred pain” in another part of the body. The pain can affect posture, spinal and joint alignment, range of motion and muscle strength. Trigger points can be caused by a number of conditions, including:

●  Problems with posture (computer work, driving, exercise, prolonged positioning, etc.)

●  Imbalances in muscle strength and flexibility

●  Muscle and/or joint injuries or repetitive use injuries

●  Muscle-related conditions such as myofascial pain syndrome or fibromyalgia

Trigger point injections can be done in nearly any muscle group of the body, with exception of the face and front torso. Most common areas include neck and shoulders, mid-back, low back, and gluteal muscles.

What is in the injection?

Typically, there are two medications used in the injections – Toradol (ketorolac) and Lidocaine. Toradol is a non-steroidal anti-inflammatory (NSAID) similar to ibuprofen. It is not a steroid. This helps with pain as well as inflammation. Lidocaine is a topical anesthetic and provides short-term relief of pain. If you have a condition in which you may not use NSAIDs such as medical allergies, use of blood thinners, kidney disease, heart disease, high blood pressure, etc., injections can be done safely with lidocaine only and still provide pain relief. Please discuss with your medical provider if you are concerned about the use of NSAIDs in your injection.

How do I prepare?

There are a few things you can do to make sure your procedure goes better:

① Medicine changes. It is advised to limit use of OTC or prescription NSAIDs (ibuprofen, Motrin, Advil, Diclofenac, etc.) within 24hrs of the procedure. Tylenol or non-NSAID pain relievers are preferred, if needed.

② Medication list. On the day of your procedure, bring a list of all your current medications, including over-the-counter medications and supplements.

③ X-rays or other images. Bring these on the day of the procedure as well.

④ Medical history. Be sure to tell your medical provider about any recent or impending medical procedures, allergies to medications or chronic medical conditions.

⑤ Clothing. Wear loose clothing that allows access to the muscles affected by your pain.

What happens during the injection?

Trigger point injections can be done in a doctor’s office. The actual injection procedure may only take a few minutes, but plan on 30 minutes for the whole visit. You will remain awake and able to communicate the entire time. These steps will be part of your procedure:

① Positioning.  Depending on where you will be having the injection, you will be sitting or lying down.

② Numbing the skin. A topical numbing spray will be applied to the skin in each area that will be injected.

③ Injection. A small needle will be inserted into the muscle at the trigger point. A small amount of the medication will be injected into the area. A dry-needling technique is then used to elicit blood flow to the area of muscle.

④ Brief pain. The injection may cause some pain that can last from a few seconds to a few minutes. This is typically due to the use of and action of lidocaine.

⑤ Pain relief. The trigger point injection will cause the trigger point to relax. The lidocaine will help numb the area of muscle as well.

⑥ Additional injections. Multiple injections will be repeated in the various trigger points found within the muscle area.

What happens after the injection?

You may be monitored in the office after your first set of injections to make sure you don’t have a reaction to the medication. You will be able to drive after the procedure and resume normal activities. The injection may provide relief immediately for a few hours and cause local numbness. You may feel sore around the area for a few days. Your medical provider may recommend you apply ice on it.

How do I care for myself?

Here are some tips on how to ensure you recover properly from your injection:

Stretching – It is very important to stretch the treated area for a few days after the injection. This helps elongate the muscle and prevent the trigger point from reforming. Stretching DAILY is also important to limit the formation of trigger points in the future. 

Activity Modification - It is advised to limit physical activity for 24hrs after the injections, even if your pain is relieved. Using the muscles too soon or too strenuously may cause the trigger points to reform. Your medical provider may provide additional activity restrictions based on your individual pain.

Chiropractic care – you may continue chiropractic care alongside trigger point injections based on the recommendations of your chiropractor. Many patients benefit from receiving an adjustment on the same day as their injections.

Massage – massage therapy is an excellent modality to use in conjunction with trigger point injections. Not only does it help the muscles relax, but it helps elicit blood flow to the painful areas of muscle and helps flush out cellular waste.

What can I expect for pain relief?

Trigger point injections have been found to be effective in relieving pain, especially when combined with the care tips described above. In many patients the pain will decrease, and in some patients, the pain may go away. Keep in mind that muscles have “muscle memory” and it is not uncommon for the trigger point to begin to reform in the days following your injection. If there is reduction but not an elimination of your pain, your doctor may recommend additional injections.

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