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Trigger Point Injections

Myofascial trigger points are knots or tight bands of skeletal muscle which are palpable and produce a characteristic referred pain upon palpation, along with pain locally and occasionally a local twitch response. Trigger points may also cause stiffness and decreased range of motion, and can sometimes be associated with chronic disorders of the musculoskeletal system. Trigger points may be formed after acute trauma or from repeated micro-traumas, leading to stress on muscle fibers.

One trigger point may be present, or many, but the key is identifying a palpable tender area that produces a referred pain pattern. Clients may also have chronic or episodic headaches, temporomandibular joint pain, back pain, decreased range of motion secondary to trigger points, or groin pain.

There are several approaches to treatment including ultrasound, physical manipulation, spray and stretch, and #trigger injections. The most common muscle groups treated using trigger point injections include the masseter, levator scapulae, gluteus medius, quadratus lumborum, trapezius, sternocleidomastoid, and temporalis muscles. Interestingly, trigger points affecting the trapezius muscle may clinically manifest as tension #headaches, pain in the neck, shoulders, and proximal arms. The iliopsoas muscle is the primary muscle responsible for trigger points causing groin pain.

Trigger Point Injections

This treatment modality offers a temporary relaxation of the taut muscle cord, which in turn allows for improved perfusion, ATP replenishment to release the actin-myosin chains causing lengthening of the muscle fiber, along with removal of metabolite waste. The ultimately result is a break in the pain-tension cycle.

There are blatant reasons not to perform a trigger point injection such as open wounds over the area, but a clinician might also consider those who have history of keloid formation as not being appropriate candidates, someone who is needle-phobic or has a poorly controlled psychiatric disorder might also not be the best candidate, severe fibromyalgia and those who are on anticoagulants are also individuals who may need additional consideration.

When performing the procedure, the clinician will first identify the area of greatest tenderness, isolate the tightened muscle, prepare the site, and then inject a combination of medication into the muscle itself, after sort of teasing it into relaxing. Complications are exceedingly rare. Clients generally return to normal activity fairly immediately.

Word of Caution

While the risks here are minimal, be aware that a thorough history and physical exam with a clinician is necessary prior to initiating #trigger point injections. I want to make clear that these sort of procedures are quick and easy within the clinic setting, so are easy sort of add-ons that bring in money without a great deal of risk. The concern though is that without a more thorough evaluation from a clinician, you may have another underlying issue entirely that isn't going to resolve with trigger point injections, but this was the go-to recommendation because of its ease and quick money return.

This procedure also does require a bit of training and skill. Physicians, nurse practitioners, and physician assistants are typically those who are administering these injections but because they can be easily interpreted as a simple intramuscular injection, #chiropractors, nurses, and even medical assistants may be delegated this task, or even a nurse practitioner without proper training, informed that it is a simple injection, and unfortunately, you won't see the best results. Trigger point injections really can be effective primary or adjunctive therapy for decreasing musculoskeletal pain, but assure you are getting a complete evaluate and a trained practitioner for this procedure.

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