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Myofascial Trigger Point Injection

By

Sarah Lewis, PharmD

What is a myofascial trigger point injection?

A myofascial trigger point injection is a minor procedure to treat a painful area in a muscle, called a trigger point. Trigger points are tight knots or bands of muscle or connective tissue that are painful to touch. They can also send pain to other body parts and cause muscle spasms and weakness

A myofascial trigger point injection involves injecting a long-acting anesthetic, and sometimes an anti-inflammatory medicine, into the trigger point. Myofascial trigger point injections can relieve your pain and improve mobility for several days or weeks, or even longer. You can also repeat these injections as needed to maintain results.

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Trigger points commonly occur in the buttocks, back and neck, but can affect almost any body part. Trigger points can be active or latent. Latent trigger points cause muscle weakness and stiffness, but generally cause pain only with pressure. Active trigger points cause pain even at rest. Trigger points can also cause other symptoms, such as headaches and eye pain.

A myofascial trigger point injection is a minor procedure, but it still involves some risk. It is only one method used to treat painful muscles. Discuss all of your treatment options with your doctor to understand which options are right for you.   

Why is a myofascial trigger point injection performed? 

Your doctor may recommend a myofascial trigger point injection to control pain from active trigger points. Your doctor may only consider a myofascial trigger point injection when other treatments have failed to relieve your symptoms. Ask your doctor about all of your treatment options before deciding on myofascial trigger point injection.

A myofascial trigger point injection can also help control pain enough to start a physical therapy, exercise therapy, or rehabilitation program. These programs are usually necessary to resolve the trigger point and keep it from coming back.

Causes of trigger points include: 

  • Acute injuries, including direct hits, strains, twisting or tearing of muscles

  • Chronic muscle clenching, including tension from mental or emotional stress

  • Inactivity, including being bedridden, sedentary or deconditioned

  • Overuse injuries, including repetitive motions from daily activities and activities such as typing, using a mouse, playing a sport, or cradling a telephone

  • Poor body mechanics, including having poor posture and using furniture with poor design

  • Sustained muscle overloading, including heavy lifting, carrying loads with unequal weight distribution, and wearing body armor

Who performs a myofascial trigger point injection?

Many types of healthcare providers perform myofascial trigger point injections, including doctors, nurses, and allied health professionals. Doctors who commonly perform myofascial trigger point injections include:

  • Family medicine doctors provide comprehensive healthcare to adults and children. They focus on caring for the health of the entire family through all stages of life.

  • Obstetrician-gynecologists (Ob/Gyns) provide medical and surgical care for the female reproductive system. Ob/Gyns may perform trigger point injections for chronic pain in the muscles and soft tissue area of the pelvic area.

  • Orthopedic surgeons specialize in the medical and surgical treatment of conditions of the bones, joints and connective tissue including muscle. 

  • Pain medicine doctors specialize in diagnosing, treating and managing pain and a range of painful disorders. Many pain specialists are also anesthesiologists.

  • Physical medicine and rehabilitation doctors specialize in muscle, bone, and nervous system conditions that affect physical and mental ability.

  • Rheumatologists diagnose and treat conditions of the joints, tendons, ligaments, bones and muscles.

How is a myofascial trigger point injection performed?

Your myofascial trigger point injection will be performed in an outpatient setting. A myofascial trigger point injection involves the following steps:

  1. You will lie down on a procedure table.

  2. Your provider will locate the trigger point and clean the overlying skin. 

  3. Your provider will pinch the trigger point between two fingers to keep it in place. This will prevent it from sliding away from the needle.

  4. Your provider will insert the needle into your skin and guide it into the trigger point.

  5. Your provider will inject medicine into the trigger point once the needle is in place.

  6. Your provider will stretch the muscle to its full length and may massage the area.

  7. You will likely return in a few days so your doctor can evaluate your pain.

  8. Your doctor may prescribe a series of injections, spaced many weeks apart if needed.

Will I feel pain with a myofascial trigger point injection?

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Your comfort and relaxation is important to both you and your care team. You may feel discomfort, sharp pinching, or unpleasant twitching when your doctor inserts the needle and it contacts the trigger point. You may also feel a mild burning or stinging when the doctor injects the medicine. Take a few long, deep breaths to help yourself relax. Tell your doctor if any discomfort does not pass quickly. 

What are the risks and potential complications of a myofascial trigger point injection?  

Complications after a myofascial trigger point injection are not common, but any medical procedure involves risks and complications. Complications may become serious in some cases. Complications can develop during the procedure or recovery. Risks and potential complications of a myofascial trigger point injection include: 

  • Allergic reaction

  • Bleeding

  • Bruising

  • Infection

  • Nerve or blood vessel injury

  • Organ puncture with a trigger point on the trunk

Reducing your risk of complications

You can reduce the risk of certain complications by: 

  • Following activity, exercise and lifestyle restrictions and recommendations

  • Following instructions after the procedure exactly

  • Informing your doctor if you are nursing or if there is any possibility of pregnancy

  • Keeping all scheduled appointments

  • Notifying your doctor immediately of any concerns, such as bleeding, fever, or increase in pain

  • Taking your medications exactly as directed

  • Telling all members of your care team if you have any allergies

How do I prepare for my myofascial trigger point injection?

You are an important member of your own healthcare team. The steps you take before your myofascial trigger point injection can improve your comfort and outcome. You can prepare yourself by:

  • Answering all questions about your medical history, allergies, and medications. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times.

  • Taking or stopping medications exactly as directed. This may include not taking aspirin, ibuprofen (Advil, Motrin), and blood thinners.

Questions to ask your doctor

Having a myofascial trigger point injection can be stressful. It is common for patients to forget some of their questions during a doctor’s office visit. You may also think of other questions after your appointment. Contact your doctor with concerns and questions before your procedure and between appointments.

It is also a good idea to bring a list of questions to your appointments. Questions can include:

  • Why do I need a myofascial trigger point injection? Are there any other options for treating my condition?

  • How long will the procedure take? When can I go home?

  • What restrictions will I have after the procedure? When can I return to work and other activities?

  • How will you treat my pain?

  • What kind of assistance will I need at home? Will I need a ride home?

  • How should I take my regular medications?

  • When should I follow up with you?

  • How should I contact you? Ask for numbers to call during and after regular hours.

What can I expect after