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Trigger Point Injection

What is it?

A trigger point injection is an injection (shot) into a painful are of muscle. Normal muscles tighten and relax as you use them. A trigger point is a tight knot or band of muscle that forms when a muscle does not relax. They can be very painful. An injection into the trigger point can help it relax and relieve the pain.

Trigger point injections are usually accompanied by muscle strengthening and flexibility exercises.

Many patients recieve a series of trigger point injections, usually at 7-14 days apart.

Why Do I Need it?

Trigger points are discrete, focal, hyperirritable spots that are painful on compression and can produce referred pain or tenderness as well as problems with muscle function. The pain can affect posture, cause weakness, and reduce your range of motion. Trigger points can be caused by or associated with a number of conditions, including:

  • Muscle tension conditions, such as myofascial pain syndrome (a common chronic pain that surrounds muscle tissue), or fibromyalgia, (chronic pain in the muscles of soft tissues surrounding joints)
  • Tension headaches or TMJ pain
  • Muscle injuries or repetitive use injuries
  • Spine conditions such as herniated discs, pinched nerves and fractures.

How Do I Prepare?

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

Medication Changes. You may be asked to stop taking certain medications, such as blood thinners (Coumadin, plavix), before the procedure. Be sure to check with you regular doctor before stopping any medications.

Medication List. On the day of the procedure, bring a list of all your current medications to the appointment. This includes over-the-counter medications, herbals and vitamins.

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

Medical History. Be sure to tell your doctor about any blood thinners, or if you are ill on the day of your injection.


Potential Benefits

  • May relieve pain often unrelieved by conservative measures
  • Allows fast recovery
  • Does not require hospital stay


Risk & Potential Complications

Complications are rare, but could include:

  • Bleeding or infection. These are risks of any injection
  • Nerve Injury. The needle may hit a nerve that could cause pain.
  • Vasovagal response- passing out.
  • Lung Puncture (pneumothorax). When a muscle near the ribcage receives a trigger point injection, there is a small risk of puncturing a lung or the membrane that surrounds the lungs. Vary rare.


Alternatives

Trigger point injections are usually recommended after first trying:

  • Stretching
  • Posture Correction
  • Heat or cold
  • Medications
  • Message

What Happens During?

Trigger point injections can be done in a doctor’s office. The actual injection takes on a few minutes, but plan on 30 to 60 minutes for the whole procedure. You will remain awake and able to communicate the entire time.


These steps will be part of your procedure:

Position. Depending on where on your body you will have the injection, you will be sitting or lying down.

Numbing the skin. You may be given a local anesthetic or spray near the injection site so you don’t feel it.

Injection. a small needle will be inserted into the trigger point, breaking the cycle of muscle spasm. The injection will contain a local anesthetic (increases blood flow and helps get rid of accumulated inflammatory substances) that sometimes includes a corticosteroid to reduce inflammation. If you are allergic to the medication, a dry-needle technique (involving no medications) can be used.

Brief pain. The injection may cause some pain that can last from a few seconds to a few minutes.

Pain relief. The injection will allow the trigger point to relax, and the pain should go away.

Additional injections. Several sites may be injected in one visit.

What happens after

You will be monitored in the Doctors office for up to 20 minutes after the procedure. This will allow the doctor to make sure you don’t have reactions to the medication.

You may feel numb in your arms or legs for about an hour after the procedure. You may also get a bruise at the site of the injection.

You may feel sore around the area for a day or two. Your doctor may recommend that you put ice on it for short periods throughout the next few days.

If the injection is into an arm or leg, you will not be allowed to drive. Someone else will need to drive you home.

In the first day after the procedure, it’s important to stretch the treated area. Ask your doctor for stretching exercises that will help you heal.

Aside from the stretching exercise, you should relax for the first few days after the procedure. Your doctor may recommend physical therapy.

Be SURE to follow up with your doctor to see how you’re responding to the injection and to make aany changes to your rehabilitation program.

What can I expect for pain relief?

Trigger point injections have been found to be very effective in relieving pain, especially when combined with exercise and medication. For many patients, the pain will go away and not return.

For some, the pain will decrease but not go away entirely. Frequently, your doctor may recommend another injection, or a series of injections.

The major benefit of Trigger Point Injections is to allow the patient to move effectively so they can participate in a rehabilitative program.


When to call a doctor

Call your doctor if you have:

  • Redness, pus or swelling at the injection.
  • Ongoing numbness or weakness
  • Difficulty breathing; if severe, go to the nearest emergency room.