Trigger Point Therapy
Trigger points are sore, tense spots within muscles.
Trigger points are usually found near areas where muscles attach to bones. Trigger points are common in people with fibromyalgia but can occur in any individual. In some cases of people who suffer from myofascial pain, releasing the trigger points may result in drastic improvement or complete resolution of their painful symptoms.
The procedure for performing trigger point injections is fairly simple.
Steps of trigger point injections:
- The patient can sit or lay down in a comfortable position.
- The healthcare practitioner locates the trigger point. This is done by pressing on the area of pain until the point of maximal tenderness is palpated. This extremely tender point is often associated with what feels like a muscle spasm or nodule.
- The healthcare practitioner then marks the site with a pen and cleans it with alcohol, clorhexidine or iodine.
- The marked muscle spot is then injected with a local anesthetic such as lidocaine or bupivacaine. The area will be injected with the anesthetic two or three times.
- The practitioner then massages the entire area to diffuse the anesthetic into the tissue. The massaging should be significantly less painful than when the trigger point was initially being palpated. If the trigger point is not less painful, the practitioner should be informed as he or she may need to inject more lidocaine or bupivicaine.
After the very first trigger point injection, the physician should observe for any signs of an adverse reaction to the injection. This may manifest as lightheadedness, slurring of speech, drowsiness, numbness of one or more extremities and even seizure activity.
If an adverse reaction occurs, or the patient is aware of an allergy to local anesthetic prior to injection of trigger points, there are alternative injections. Sterile saline appears to work as well as lidocaine in several studies. Some individuals seem to respond particularly well to the injection of a steroid into the trigger point.
Ideally, passive stretching of the injected muscle by the health care practitioner or patient’s partner should be done immediately after the injection. For best results, individuals who have received trigger point injections should do light stretching daily.
Some people may experience a temporary increase in pain for a day or two following trigger point injections. Additionally, follow up trigger point injections may be required if the pain relief from the initial injection wears off.
*Fowler, G., Pfenninger, J. Procedures for Primary Care. 2nd Ed. Mosby Inc. 2003.