How Trigger Point Injections Relieve Pain

It's quite a common experience to have a "knot" in a muscle. Many people experience myofascial pain at some point in their lives, and are familiar with the tender soreness that entails. These knots are known as trigger points, and may cause pain at the site of the knot or cause referred pain in a different part of the body. 

What is a trigger point?

Trigger points are knots in a muscle that form when a muscle involuntarily contracts or spasms.  They may be sensitive to touch or pressure, and may be felt as bumps or nodules under the skin. These knots may be formed as a result of an injury or as a result of repeated micro-tears from repetitive use or stress. They are common to the muscles of the neck, shoulders, arms, legs, and lower back. They can cause tension headaches or sciatic flareups as well as general myofascial pain.

If heat and cold treatments, over-the-counter pain medications, rest, and massage or physical therapy don’t work to loosen those knots, the next option may be trigger point injections. 

What is a trigger point injection?

Trigger point injections involve injecting medications to reduce pain and inflammation directly into the knot in the muscle. For pain relief, providers often use a local anesthetic such as lidocaine. This allows the muscle to relax, which improves blood flow and can speed healing. To further reduce inflammation, a corticosteroid is sometimes combined with the pain reliever. The pain relief this provides sometimes allows for stretching and physical therapy exercises that may further relax and release the muscles, but were impossible to perform before because of the pain. 

For people who are sensitive to medications, there is a technique called “dry-needling” that involves using the needle only with no injection to stimulate the muscle to twitch and relax, to allow increased blood flow and healing. 

Trigger point injections may be used in muscles in any part of the body. Side effects are generally minimal. There may be pain, numbness or bruising at the injection point. 

Pregnancy, active infections, acute injury, bleeding disorders, and medication allergies are contraindications for trigger point injections. Discuss any concerns with a health provider.

Most patients report relief immediately or within 24 hours of an injections, and this relief typically last for a month. If recurring knots are an issue, stretching, massage, and physical therapy may help address the underlying causes. 

What to expect at an appointment

Depending on the location of the trigger point, a person may lie down or sit up for a trigger point injection. The provider will locate the trigger point to be treated and may mark it with a skin marker. Trigger points are sensitive, so this may be uncomfortable. The provider will clean the area to be injected with an alcohol pad and will stabilize the tissue with their hand. They will then insert the needle into the trigger point. This may involve moving the needle without completely withdrawing it from the skin and muscle in order to cause the muscle to twitch and then to relax. After the muscle has relaxed the medication may be injected and the needle removed. 

Trigger point injections are a brief, outpatient procedure. Multiple trigger points may be treated at the same appointment. Patients can drive themselves home and resume normal activity after the procedure. 

At Natural State Health Center, our integrated health care team can help you assess the cause of your pain. Our physical therapist, massage therapist, nurse practitioner, and chiropractors will work together to create a plan that addresses your needs.