Author: Dr. Alyssa Boyer, DC, DNCert
Trigger point injections, or TPI’s, have become much more common in the musculoskeletal space in recent years. Maybe you’ve heard about them, maybe you haven’t, but let’s cover their purpose, when they’re necessary, and how they can become a part of your treatment plan. Trigger points can be very painful and also cause referred pain to another area of the body. There is typically more than one in one muscle and there can be many that exist throughout other muscles at the same time, For example, you may feel a knot in your upper trap, but also have a trigger point in your QL, which is in your lower back. TPI’s are generally very safe and have limited side effects that include soreness and potential for some hematomas (bruising) in the skin. Be sure to let your doctor know if you have any allergies to local anesthetics as well.
What is a trigger point injection and how does it work? Trigger points may be formed after acute trauma or by repeated micro-trauma, leading to stress on muscle fibers. Trigger point injections are a therapeutic modality to treat myofascial trigger points, especially in symptomatic patients, and have been demonstrated effectiveness to inactivate trigger points. Active trigger points are painful, but you can also experience inactive trigger points that are still palpable that can cause issues later on or referred pain to another area. Everyone has trigger points in the muscles at some point in their life. Depending on your lifestyle and your activity level, may determine the severity and frequency of trigger points.TPI’s can help soothe myofascial pain by injecting a local anesthetic along with saline directly into the “knot” that is felt in the muscle fibers. I think it’s important to understand that injecting the substance itself doesn’t eliminate the trigger point. The physician who is injecting the TPI’s uses a technique, typically a star-pattern of taking the needle through that movement as they are injecting the substance. This manipulates the tissue that is injured, increasing oxygen to the area and working to eliminate the trigger point. These are very effective for muscle knots that contribute to low back pain, jaw pain and even headaches and migraines.
Trigger points are most effective with a multimodal approach and are a great adjunctive therapy along with other conservative care methods. The dry needling that we do in the office has a similar concept, but sometimes chronic, stubborn pain leads us to adding another element into the care plan. In my experience, if a patient hasn’t been progressing as quickly as I would like to see with the needling, I will suggest trigger point injections and then continue with the dry needling at the next visit. I feel like the injections can increase the effectiveness of the dry needling technique and patients may get a better result. Most people ask me if they’re painful, and of course anything involving a needle doesn’t feel the best, but that’s what the local anesthetic is for. If this is something you’re interested in or you feel like could benefit you in any way, reach out. We are always available to answer any questions or curiosities. This could be the last piece of the puzzle to get you back to feeling like your best self.
