Trigger Point Injection

What is it?

Trigger points are tender spots within a tight band of skeletal muscle that can cause pain both where they are and in a distant area when pressed. For example, a trigger point in the shoulder girdle can cause pain that spreads to the side of the head. Regional muscle pain caused by these points is called myofascial pain syndrome.

A trigger point injection involves inserting a fine needle into these points and usually injecting a small amount of local anaesthetic. It can often be done in a clinic setting. For deep muscles, or areas close to the lungs and major blood vessels, it may be done under ultrasound guidance.

When is it considered?

Trigger point injections are considered for muscle-related pain that persists despite stretching, exercise, posture correction and medication. They are commonly used for myofascial pain with neck pain, shoulder girdle pain and upper back and chest wall pain.

Fibromyalgia is a different condition, with widespread pain, fatigue and sleep problems. Its treatment is built on exercise, sleep routines, education and, where needed, medication. Trigger point injections can only play a supporting role for stubborn muscle pain in specific areas.

Trigger points sometimes accompany pain from a disc herniation or the spinal joints. In that case, the underlying cause also needs to be assessed; for example, for pain spreading from the neck into the arm, the options described under non-surgical cervical disc treatment may be relevant.

How does it work?

Inserting the needle into a trigger point can mechanically release the tight band in the muscle, and you may feel a brief twitch. The local anaesthetic helps break the cycle between pain and muscle spasm. As pain eases, the muscle can be stretched more comfortably and an exercise programme becomes easier to keep up.

The injection is not a treatment on its own. To stop trigger points from coming back, triggers such as poor posture, repetitive strain, stress and sleep problems also need to be addressed.

In some cases, dry needling, in which the needle is used without injecting any medicine, may be preferred. The choice depends on how widespread the pain is and how you have responded to earlier treatment.

Before the procedure

The painful area is examined to make sure the pain is not due to a cause other than the muscle. Imaging or blood tests may be requested if needed. Let the team know if you take blood thinners, have a bleeding disorder or are allergic to local anaesthetics. Your doctor will decide whether any change to blood-thinning medicine is needed beforehand; please do not stop it on your own.

Eating a light meal beforehand may lower the chance of feeling dizzy during the injection. Wear comfortable clothing that gives easy access to the painful area.

What happens during the procedure?

Depending on the area, you will be seated or lying face down. The doctor finds the trigger point with the fingers and holds the tight band of muscle between two fingers. As the fine needle enters the trigger point, you may feel a brief twitch and a sensation similar to your usual pain; this shows the needle is in the right place.

Near the lungs, such as around the chest wall and shoulder girdle, the depth of the needle is set with particular care, and ultrasound may be used. Several trigger points can be injected in one session. The procedure usually takes ten to twenty minutes.

After the procedure

After a short period of observation, you can return to your daily routine the same day. The injection site may be tender or sore for a day or two; warmth and gentle stretches can help. Avoid strenuous exercise on the first day, then start the recommended stretching and strengthening programme.

To stop trigger points from returning in the longer term, regular stretching and strengthening, frequent breaks at work, adjusting your screen and desk height and a steady sleep routine are recommended. Because stress can increase muscle tension, relaxation exercises may also be added to your programme.

Contact your doctor if you notice redness, swelling or a fever after the injection. Seek help at once if you develop breathlessness or chest pain after an injection around the chest wall.

When might you notice results?

Because of the local anaesthetic, pain often eases straight after the procedure. The area may be tender for the first day or two, so the effect is assessed over the following days.

How long the relief lasts varies from person to person. For some people one session is enough, while others need repeat injections a few weeks apart. Trigger point injections are most useful when combined with exercise and physiotherapy. To have your muscle pain assessed, you can request a consultation.