Focal, hyperirritable, palpable, taut bands of skeletal muscle are one of the most common causes of musculoskeletal pain. These bands, known as "trigger points," may result from direct muscle injury, irritation from an underlying disc herniation, poor posture, or repetitive overuse. Common activities which provoke trigger points include holding a telephone receiver between the ear and shoulder; prolonged bending; sitting in a chair with poor back support, wrong arm rest height or no arm rests at all; and heavy lifting using improper body mechanics. Over time, trigger points form scar tissue and result in reduced range of motion and weakness.
Trigger points may also mimic pain from a pinched nerve when they surround the adjacent nerves. This type of pain is called "referred pain," and it follows a consistent pattern which rarely coincides with the expected dermatologic or neurologic pattern. Often, the referred pain is not located in the immediate vicinity of the trigger point. Although there are several proposed mechanisms theorized to explain the development of trigger points, scientific evidence is lacking and there is no laboratory, pathologic or radiologic test to identify trigger points. After physical therapy, trigger point injections are the trigger point treatment with the most scientific support.
Trigger point injections relax the areas of intense muscle spasm. When Dr. Stein performs these injections, she identifies the active trigger points and then extinguishes them with a small needle using a technique known as "dry needling." She uses a small dose of lidocaine when dry needling to reduce the post-injection soreness. She does not inject corticosteroids. Sustained relief usually is achieved with a brief course of treatment. Each injection session is approximately 5-10 minutes and may cause a twitch or a pain lasting a few seconds to a few minutes. After the injections, Dr. Stein reviews a basic stretching program for the patient to do at home to prolong the injection's efficacy. Trigger point injections are a minor procedure and therefore have minimal risk. You should discuss these risks with Dr. Stein prior to the procedure.
The most effective early treatment for trigger point injections is physical therapy and/or a regular home exercise program. Exercises improve the body's strength and flexibility. Modalities such as TENS, heat, ultrasounds and massage complement the exercises by reducing muscle tension. Trigger point injections complement physical therapy. In some cases, trigger point injections improve pain after a patient has not improved with physical therapy alone.
