Trigger Point Injections
Targeting painful muscle knots
What Are Trigger Point Injections?
Trigger point injections (TPIs) involve inserting a needle into painful muscle knots (trigger points) to relax them and relieve pain. They can be done with local anesthetic, saline, or even dry needling (no medication).1
What Are Trigger Points?
- Tight bands of muscle that won't relax
- Tender to touch
- Can cause referred pain (pain in distant areas)
- Often described as "knots"
- May twitch when palpated
Common Areas Treated2
- Upper trapezius (neck/shoulders)
- Rhomboids (between shoulder blades)
- Levator scapulae (side of neck)
- Quadratus lumborum (lower back)
- Piriformis (buttock)
- Temporalis (jaw/head)
The Procedure
- Quick office procedure (minutes)
- Trigger point identified by palpation
- Needle inserted, may be moved around
- Muscle twitch response often occurs
- Multiple points can be treated
What's Injected
- Local anesthetic - Lidocaine or bupivacaine
- Saline - For those sensitive to anesthetics
- Nothing (dry needling) - Needle alone
- Corticosteroid - Sometimes added
- Botox - For chronic cases
After the Injection3
- Muscle may be sore for a day or two
- Apply heat or ice as needed
- Gentle stretching recommended
- Effects may last days to weeks
- Can be repeated as needed
References
- Scott NA, Guo B, Barton PM, Gerwin RD. Trigger point injections for chronic non-malignant musculoskeletal pain: a systematic review. Pain Med. 2009;10(1):54-69.
- Travell JG, Simons DG. Myofascial Pain and Dysfunction: The Trigger Point Manual. Williams & Wilkins; 1983.
- Lavelle ED, Lavelle W, Smith HS. Myofascial trigger points. Anesthesiol Clin. 2007;25(4):841-851.