Painful, Knotted Muscles? Trigger Point Injections Might Help

Tight, contracted muscles, often referred to as “knots,” can occur anywhere in the body but are most common in the muscles near the shoulder, hip and spinal joints. Medically known as trigger points, muscle knots can be very painful and lead to referred pain such as headaches, neck, jaw and lower back pain. Sometimes, they can even cause numbness and tingling in the extremities if the tightened muscles are squeezing the nerves within them.

Trigger point injections are used to relax and release the connective tissue that is holding the muscle in a taut, contracted state. “The goal of treatment is to provide relief from pain in the muscle and the tender areas that surround it, resolve any referred pain and allow the patient to get back to their normal activities,” says Anna Serels, MD, Physical Medicine and Rehabilitation physician at University Hospitals.

How Are Trigger Point Injections Done?

The area to be treated is first cleaned and sprayed with a local anesthetic. Small needles containing lidocaine with or without added cortisone are injected into the affected muscle. “I almost exclusively use lidocaine alone,” says Dr. Serels. “But other physicians will sometimes add cortisone. The data has not shown any benefit from the addition of cortisone, so I never add it.”

The length of the procedure will depend on how many injections are needed. “Sometimes I do as few as one or two injections,” says Dr. Serels. “For other patients, I may do as many as 18-20 injections in one session to achieve optimal results. Each injection takes about five seconds so regardless of the number of needle placements, the procedure only takes a few minutes from start to finish.”

Sometimes, just inserting the needle is enough to mechanically release the tight muscles but data show that injections with lidocaine yield better results. Trigger point injections done without any medication is called dry needling, a procedure that is typically performed by a physical therapist or a chiropractor.

What to Expect During the Procedure

“Patients may feel some mild discomfort while the needle is inserted, but most describe it as more of a pinching sensation. Many patients report feeling immediate relief as soon as the needle enters the muscle and releases the tight fibers,” says Dr. Serels.

For several hours after the procedure, the area treated will remain numb due to the lidocaine. When this wears off, most patients will feel some soreness which is normal. “I always warn patients that this is to be expected and to use ice on and off if needed. Most soreness will resolve within 24-48 hours, although there may be some residual bruising at and around the injection sites,” says Dr. Serels.

“For the first 24 hours after the procedure, I also advise patients to avoid strenuous exercise or heavy lifting. Instead, I recommend gentle stretching and range of motion exercises for a few minutes every hour until they go to bed. Bathing and swimming should also be avoided, but showering is fine.”

Are Trigger Point Injections Safe?

When performed by a trained, experienced physician, trigger point injections are generally safe and effective. However, as with any procedure there are some risks and possible side effects, including:

• Infection and/or bleeding at the injection site
• Excessive bruising
• Allergic reaction to the lidocaine (very rare)
• Collapsed lung if injections are made in the upper torso area (very rare)

“To minimize the risks, I do not perform this procedure on anyone with an active infection, those currently taking a course of antibiotics or individuals with potentially inflamed tissues, such as someone who recently had a deep tissue massage. In addition, to avoid the unlikely chance of going too deep and causing unintentional organ puncture, I use ultrasound guidance for all abdominal wall injections and when treating patients with very little body fat,” says Dr. Serels.

Is One Treatment Enough for Long-Term Relief?

“For some patients, yes. If I perform one or two rounds of trigger point injections and the patient’s pain is completely resolved, I may never see them again,” says Dr. Serels. “Others may achieve 50-60 percent improvement with the first round that lasts for several weeks before the pain starts creeping back, so I’ll do a second round. Some patients come in every 3-4 months for maintenance injections. I’ll keep doing them as long as they are helping the patient to function in their day-to-day life.”

“However, my goal is always to see progressive, lasting improvement each time I do the injections. If a patient comes back after the first round saying it didn’t help at all, I don’t repeat the procedure – instead, I will discuss other options to treat the patient’s pain.”

“Trigger point injections are always more successful when paired with an exercise program designed to strengthen the affected muscles. Strong, limber muscles are less likely to revert into a state of tension and may make future injections unnecessary.”

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The Physical Medicine & Rehabilitation physicians at University Hospitals have the training and experience to treat a wide variety of conditions including painful knotted muscles, also known as trigger points.