What Are Trigger Point Injections and How Do They Work?
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Trigger Point Injection Overview
Have you ever said to someone ‘stop being such a pain in the neck’? It could be that your neck was “triggered,” not just out of annoyance, but because a knot was forming in the muscles of your neck. Neck pain is often the result of irritability and sustained tension in the muscles that support your neck, shoulders, and shoulder blades.
A common treatment for this knot-like pain is called a trigger point injection. Also called myofascial pain, trigger point pain can be eased with trigger point injections, especially when the pain is experienced in the neck, shoulder blades, mid back, and lower back. The prefix “Myo” means muscle and the suffix “fascial” means fascia. The fascia is the thin, white connective tissue that is wrapped around every muscle.
When a person experiences a knot in his muscle that isn’t responding to treatment, such as physical therapy or medications, trigger point injections may provide pain relief. Trigger point injections may be used initially to reduce pain in people who are experiencing intense pain that prohibits them from completing physical therapy. The injection can make it possible for the physical therapy to be more beneficial.
Patients Ask: What Causes Trigger Points?
Texas Back Institute Responds: When muscle fibers, fascia, ligaments, or tendons are weakened, overstretched, or inflamed, they develop tiny tears in the soft tissue. As the soft tissue heals, it can contract, becoming “knotted”. If that happens, the knotted fibers restrict the blood supply needed by the muscle’s cells. Additionally, there is a tendency for the muscle fiber to shorten to avoid pain and protect itself from further injury.
Other contributing causes might include structural imbalances, improper body mechanics, poor nutrition and stress. Affected muscles react to avoid pain and guard against it by limiting muscle movement, which can then result in loss of range of motion to the joint. At that point, muscle and associated structures could develop trigger points.
Table of Contents
Treats
Diagnosing
Physical examination:
Recovery
Patients Ask:
What Causes Trigger Points?
Texas Back Institute Responds: When muscle fibers, fascia, ligaments, or tendons are weakened, overstretched, or inflamed, they develop tiny tears in the soft tissue. As the soft tissue heals, it can contract, becoming “knotted”. If that happens, the knotted fibers restrict the blood supply needed by the muscle’s cells. Additionally, there is a tendency for the muscle fiber to shorten to avoid pain and protect itself from further injury.
Other contributing causes might include structural imbalances, improper body mechanics, poor nutrition and stress. Affected muscles react to avoid pain and guard against it by limiting muscle movement, which can then result in loss of range of motion to the joint. At that point, muscle and associated structures could develop trigger points.
History of Trigger Point Injections
The term “trigger point” was first used by Dr. Janet Travell. Travell eventually became the White House physician for President John F Kennedy. Kennedy was known to have suffered chronic, debilitating back pain since his childhood and this pain was made worse by his combat duty in World War II.
What Travell described as trigger points are a clinical finding with specific characteristics related to pain from irritable, painful trigger points in the skeletal muscles – not due to acute local trauma, inflammation, degeneration, or infection. Trigger points are nodules that can be felt. Trigger point nodules often radiate pain signals along a referred pain pathway and outward to broader areas away from the trigger point.
Travell coined the term trigger point in 1942. She also used a pain management method she called “dry needling,” which is a treatment for this condition that is still used today. Trigger point treatment to disrupt pain signals by dry needling has long been recognized as a method of treating this condition.
Contemporary American physicians believe Trigger point injections work along a different philosophy than acupuncture. Centuries-old Chinese medical texts refer to energy pathways, or meridians. Acupuncture practitioners were instructed on where and how to place a needle to release the pain and unblock the energy. This ancient treatment of acupuncture for pain relief is still used by many people today.
What Are Trigger Point Injections?
Trigger Point Injections, also called TPIs, are a common medical treatment for relieving pain caused by myofascial trigger point pains and are typically part of an overall treatment plan, combined with other treatments like physical therapy and gentle stretching. Chiropractic care and manipulation may also be beneficial in the treatment of trigger points.
Patients Ask:
How Do Trigger Point Injections Help?
Texas Back Institute Responds: Trigger point injections are used to reduce or eliminate back spasms by loosening the knots built up in the muscle tissue causing the pain. Muscles in the neck and back will often present themselves as “knots” and can be so uncomfortable that they restrict the range of motion. During palpation, a local twitch response, which is a transient muscle contraction, can occur and helps differentiate between active and latent trigger points. Trigger points irritate the nerves around them and can cause referred pain that’s felt in another part of the body. Trigger point injections help reduce the inflammation and irritation caused by these back muscle spasms. When used in conjunction with muscle manipulation and physical therapy, trigger point injections may improve the blood flow to areas that have chronic spasms.
How Do Trigger Point Injections Differ from Epidural Injections?
Since trigger point and epidurals are used for pain relief and both are delivered by injections, many patients confuse the two. They are not the same type of treatment.
Both trigger point injections (TPI) and transforaminal epidural injections are treatments used to manage chronic pain. Both types of treatments inject a combination of local anesthetics (numbing medication), normal saline, and corticosteroids (anti-inflammatory hormone also made by the human body).
TPIs are given to painful areas of muscle that contain trigger points or knots of muscle that form when muscles fail to relax. An epidural is an injection that is given in the space (known as the epidural space) just outside the membrane that protects the spinal cord. A transforaminal epidural injection numbs the spinal nerves and can also be used to diagnose the type of pain the individual is experiencing. When used in conjunction with muscle manipulation and physical therapy, trigger point injections can improve the blood flow to areas that have chronic spasms. Very often patients report an immediate reduction of pain. Improvement is usually seen with each subsequent visit and over several sessions, you can see long-term relief.
Conditions that can benefit from trigger point injections include:
- Lower back pain
- Sciatica
- Knee pain
- Ankle pain
- Tennis elbow
Unlike trigger point therapy, epidural injections are used for spinal treatment. This treatment is used to treat conditions such as herniated discs (link to this condition on the website) or spinal stenosis (link to this condition). While this treatment does involve the use of injections, it is still a minimally invasive alternative to surgery. Minimally invasive procedures such as epidural injections reduce the tissue damage from traditional surgery, lower the risk of infection complications from this surgery and can lead to faster recovery time for patients.
The epidural injection is usually a combination of a steroid mixed with an anesthetic. Steroids diminish the proteins that cause inflammation. The spine experts at Texas Back Institute recommend these injections should be limited to just a few a year, because there’s a risk that too many injections can weaken spinal bones or nearby muscles.
Patients Ask:
Is there a limit to the number of trigger point injections that are safe for patients?
Texas Back Institute Responds: In the diagnostic phase, if results are not satisfactory after the first injection (or first set of injections), a second injection or second set of injections is reasonable, at an interval of no sooner than one week and preferably two weeks. The number of injections should be limited to no more than four per year.
What Are Spasms?
Spasms are involuntary but they are not uncommon. According to the NIH, “Spasms, called myoclonus, refer to sudden, brief involuntary twitching or jerking of a muscle or group of muscles. The twitching cannot be stopped or controlled by the person experiencing it. Myoclonus is not a disease itself, rather it describes a clinical sign.”
Described as jerks, shakes or spasms, myoclonus is:
- Transitory
- Sudden
- Involuntary
- Shock-like
- Varied in intensity and frequency
- Occurring in one part of the body
- Occurring all over the body
Patients say a back spasm produces a tight knot or nodule, or a cramp that comes and goes. Sometimes, back spasms can make bending or moving challenging. Some people say they feel weak. When patients experience myoclonus symptoms in the back, it’s called spinal myoclonus, meaning related to nerve activity in the spinal cord. In its simplest terms, you might think of a back spasm like a bad case of hiccups in the back.
Everyone has had hiccups, a common form of myoclonus. So are the sudden jerks or “sleep starts” sometimes felt just before falling asleep. These forms of myoclonus occur in healthy people and usually aren’t serious, but other forms of myoclonus can be symptoms of a more serious condition like epilepsy, or a possible reaction to medication.
It’s common for people to mistake other forms of lower back pain for back spasms. When low back spasms last longer than a few days, or if they go away and come back, it may be indicative of a chronic medical condition like:
- problems with the disks that cushion the spinal column
- osteoarthritis or rheumatoid arthritis
- narrowing of the spinal column
- fibromyalgia
- scoliosis
- spondylolisthesis
- a bone fracture
- sciatica
Patients Ask:
How Can I Tell If I Am Experiencing Back Spasms?
Texas Back Institute Responds: Pain symptoms from muscle spasms in the back can be felt as anything from minor discomfort and stiffness to a sharp, severe pain that causes muscles to tighten and prevent normal back movement. This pain may be a signal to the back to avoid certain movements, like twisting or bending, or it could be a warning of a more serious underlying issue in the spine. Symptoms of back spasms are a red flag that should prompt a visit to a healthcare provider. If back spasms are accompanied by the loss of control of the bladder or bowel, muscle weakness in the arms or legs, loss of balance, or the loss of sensation on one side of the body, patients should seek immediate medical attention.
How Do Trigger Point Injections Relieve Pain?
Myofascial trigger point injections are a common treatment for myofascial pain syndrome and generally safe. They can relieve myofascial trigger points and improve mobility for several days or weeks, or longer. These trigger point injections reduce localized pain by relaxing the affected muscles.
Physicians can map referral pain patterns and pinpoint which muscles are triggering the pain. Each muscle has a specific referral pattern associated with its trigger points. For example, trigger points in the trapezius muscle -located in the upper back and neck- can refer pain to the head, temples, or down the arm. Trigger points located in the gluteus minimus, or buttocks muscle, can cause pain down the leg, mimicking sciatica. By releasing tension in the affected muscles, trigger point injections interrupt the nerve signal that is causing the referred pain.
Patients Ask:
What Is the Procedure for Trigger Point Release?
Texas Back Institute Responds:
The procedure usually takes about 30 minutes, and the injection is typically performed in the physician’s clinic. First, the skin in the injection area is cleaned and may be numbed with a local anesthetic. A small needle is inserted into the muscle causing the spasm-related pain and a corticosteroid medication is sometimes added. It’s possible that the muscle may spasm or twitch. The administration of the trigger point injection may require several minutes before the muscle is sufficiently relaxed.
More About Trigger Point Injections
A local anesthetic is injected directly into the trigger point and may be all that’s required to relax the affected muscle. One such anesthetic is lidocaine. The anesthetic breaks up the cycle of pain – allowing blood flow to return to the muscle. At other times, it may become necessary to combine a steroid with the anesthetic to provide even more anti-inflammatory relief, and both short-term and long-term results. When a corticosteroid is added to the injection, the anesthetic provides immediate relief while the cortisone may take longer to show effect, typically within a week, but may have a more lasting effect.
Cortisone provides relief by reducing inflammation. Reducing inflammation usually reduces pain, however, conservative usage guidelines recommend that cortisone injections be limited to four times a year. Trigger point injections are known to have few side effects, however, some studies suggest overuse of cortisone injections could potentially lead to damage in the muscle and joint, so conservative use is suggested.
When the pain is severe, some people require multiple trigger point injections to fully release the irritated trigger point. TPIs that are limited to anesthetics alone can be administered on a more frequent basis.
Trigger point management is essential in relieving pain and dysfunction associated with musculoskeletal disorders. This includes various treatment techniques such as injection therapies and dry needling, which have shown effectiveness in addressing myofascial pain syndromes.
Patients Ask:
How Long Does Pain Relief from Trigger Point Injections Last?
Texas Back Institute Responds:
Many patients report pain relief that comes within 24-72 hours after the injection. Relief typically last for 30 days, if not longer. If muscle pain relief does not last, another trigger point injection may be required.
What Muscle Groups Respond to Trigger Point Injections?
Trigger points can develop in any muscle. Trigger points in the trapezius muscle may cause tension headaches. When trigger points are in the piriformis muscle, they can result in piriformis syndrome. When the piriformis muscle in the buttocks presses on the sciatic nerve, it causes pain or numbness in the buttock and down the back of the leg.
The most common muscle groups treated with trigger point injections are as follows:
- Masseter: a muscle in the jaw
- Levator scapulae: a muscle on the sides of the neck
- Gluteus medius: a muscle in the hip
- Quadratus lumborum: a muscle in the low back
- Trapezius: the muscle extending over the back of the neck and shoulders
- Sternocleidomastoid: a muscle in the front of the neck
- Temporalis: a muscle on the sides of the head
Spinal Trigger Point Injections
Spinal trigger point injections provide temporary, and sometimes long-lasting, relief from back pain and inflammation. They can reduce muscle tension in the affected areas, increasing blood flow to the muscles. Trigger point release can improve mobility and flexibility and TPIs are often helpful for improving range of motion in commonly affected areas like the neck, shoulders, and back.
What Are the Symptoms of Trigger Point Pain in the Spine?
Myofascial Pain Syndrome, or MPS, affects approximately 44 million people in the United States and is frequently reported as back or neck pain. Further classification includes the terms latent trigger points, referring to trigger points that limit range of motion but only cause pain when compressed or palpated and active trigger points, which are trigger points that can be painful at any time, even at rest.
Symptoms of MPS may include:
- Persistent Pain
- Tenderness
- A knot in the muscle
- Difficulty falling asleep
- Fatigue
- Muscle Spasm
Patients Ask:
How Is Trigger Point Pain Diagnosed?
Texas Back Institute Responds:
The spine specialists at Texas Back Institute are experts at detecting and diagnosing spinal trigger point pain. Physicians perform a physical examination to identify sensitive areas and palpitate for tense spots. Pressing on these nodules can trigger a pain response that travels in a referred pain pattern and may accompany other musculoskeletal disorders. Diagnostic imaging tests such as MRI scans or ultrasound may be ordered to rule out other possible conditions.
Are You Ready to be Pain Free?
Medical treatment, especially as it relates to alleviating chronic pain in the back and neck areas, has progressed at a remarkable rate. Patients no longer have “put up” with the constant, unrelenting pain that destroys any semblance of a quality of life. The world class experts at Texas Back Institute are waiting to help you be pain free. Click here (link to Appointments page) to set an appointment now.
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Frequently Asked Questions
Trigger Point Injections, also called TPIs, are a common medical treatment for relieving pain caused by myofascial trigger point pains and are typically part of an overall treatment plan, combined with other treatments like physical therapy and gentle stretching. Chiropractic care and manipulation may also be beneficial in the treatment of trigger points.
When muscle fibers, fascia, ligaments, or tendons are weakened, overstretched, or inflamed, they develop tiny tears in the soft tissue. As the soft tissue heals, it can contract, becoming “knotted”. If that happens, the knotted fibers restrict the blood supply needed by the muscle’s cells. Additionally, there is a tendency for the muscle fiber to shorten to avoid pain and protect itself from further injury.
Other contributing causes might include structural imbalances, improper body mechanics, poor nutrition and stress. Affected muscles react to avoid pain and guard against it by limiting muscle movement, which can then result in loss of range of motion to the joint. At that point, muscle and associated structures could develop trigger points
In the diagnostic phase, if results are not satisfactory after the first injection (or first set of injections), a second injection or second set of injections is reasonable, at an interval of no sooner than one week and preferably two weeks. The number of injections should be limited to no more than four per year.
Pain symptoms from muscle spasms in the back can be felt as anything from minor discomfort and stiffness to a sharp, severe pain that causes muscles to tighten and prevent normal back movement. This pain may be a signal to the back to avoid certain movements, like twisting or bending, or it could be a warning of a more serious underlying issue in the spine. Symptoms of back spasms are a red flag that should prompt a visit to a healthcare provider. If back spasms are accompanied by the loss of control of the bladder or bowel, muscle weakness in the arms or legs, loss of balance, or the loss of sensation on one side of the body, patients should seek immediate medical attention.
Many patients report pain relief that comes within 24-72 hours after the injection. Relief typically last for 30 days, if not longer. If muscle pain relief does not last, another trigger point injection may be required.
The spine specialists at Texas Back Institute are experts at detecting and diagnosing spinal trigger point pain. Physicians perform a physical examination to identify sensitive areas and palpitate for tense spots. Pressing on these nodules can trigger a pain response that travels in a referred pain pattern and may accompany other musculoskeletal disorders. Diagnostic imaging tests such as MRI scans or ultrasound may be ordered to rule out other possible conditions.
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