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Trigger Point Injections

What is Trigger Point Pain?

If you spend long hours at a computer or holding your ear to the phone for business or personal calls, you may be setting the stage for trigger point pain. This is what happens, in a nutshell. If you are holding your muscle in an awkward position for long periods of time, this may force the development of a trigger point. Poor posture, a chair that does not support your back, sitting at a desk, grasping a mouse, and placing consistent stress on muscles, these are situations that create trigger points. Additional reasons for trigger point pain include emotional stress, sports injuries, and poor posture.

Straight to the point

Patients often present a doctor with pain indications that may be quite a distance from the origin, a term called referred pain. Most trigger point pain is local, specific to a muscle group.

One theory about trigger point pain is that when irritation with repetitive activity or damage (trauma) happens it might directly affect the nerve systems that are responsible for telling the muscle to contract. Normally, the brain tells the muscle to work when you want it to, but when that system goes off course, the nerve starts constantly releasing chemicals that activate the muscle. The result: an area of muscle to go into a tight, spastic knot that impedes blood flow. The reduced blood flow prevents the area from getting the right amount of oxygen, creating a spot for lactic acid and toxins to create a “nutshell” or what some patients refer to as a “nut” or “green pea” nodule. This knot, or nut-like area, irritates the nerves, and the patient experiences chronic pain.

When a patient experiences trigger point pain when trying to move, the pain creates a chain reaction. The patient may lose range of motion, and be reluctant, from this trigger point pain, to move the area (a shoulder, arm, forearm) and when that location is resistant to move, other muscles compensate for the weakness. The chain reaction continues. As other muscles are overworked, these muscles are subject to the development of trigger points. Trigger point pain, experienced by patients, has been said to be throbbing, sharp, deep, and although rarely mild, it is sometimes an agonizing pain.

Trigger points cause local pain and often send pain to other parts of the body — called referred pain — sometimes quite a ways from the location of the trigger point. CMP may also come on as a result of fatigue, repetitive motion, a medical condition, or lack of activity.

What do trigger points have to do with back pain and how are they treated?

Trigger points are tight-tender areas of muscle that can be very painful to touch and can cause referred, radiating pain.  Activation of trigger points in the paraspinal muscles can be caused by sudden overload during lifting objects, twisting and flexing the back, stooping or poor posture.  You may also have tightness in your back that prevents you from some movements.  Trigger points can be very painful and disabling and may even cause weakness.  Proper diagnosis and treatment is essential.  Treatment consists of finding ways to “de-activate” the active trigger point.  This includes Myotherapy (deep pressure, counterstrain technique), Mechanical vibration, Pulsed ultrasound, Electrostimulation, Ischemic compression, Injection, Dry-needling, Spray-and-stretch, etc.

Trigger Point therapy is part of the multidisciplinary treatments we recommend and prescribe.  A thorough history and physical exam focusing on the symptoms of neck and back pain can help reveal the underlying cause of the pain.  Many patients will have trigger points that can contribute to all or most of their pain.  Trigger point injection therapy is usually helpful with these patients and helps them get back on the road to recovery.  The injection is usually performed with a mixture of lidocaine and bupivicaine to ease some of the stress from injecting the muscle, followed by some dry needling which is thought to de-activate the point.  A technique called Myofascial release can be performed after the injection for further relaxation of the affected muscles.  A technique called Spray-and-stretch can also be used instead of injections.

Trigger point therapy may need to be repeated for multiple sessions 1-2 weeks apart until the points are de-activated and the patient is more mobile with a decreased level of pain and tenderness.  It is one step in the road to recovery from neck and back injury and works well combined with physical/massage therapy and/or manipulative treatments.