Trigger Point Injections
Trigger point injections (TPI), sometimes called myofascial injections, are a therapeutic modality commonly used in pain management settings. So, what is a trigger point? A trigger point is typically described as an area of sensitivity attributed to tight muscle fibers which can form due to injury or overuse. Often referred to as a muscle “knot,” these strains result in pain throughout the muscle. Frequently this sensitivity and pain persists and worsens with time and may be diagnosed as myofascial pain syndrome.
Trigger points are palpable and often produce a characteristic pattern of referred pain. For example, pressing or squeezing the muscles in the neck or shoulders hurts where you touch but also causes pain to radiate into your head (like a headache), or down your back, or out to your shoulder or upper arm. Palpating irritated muscles sometimes causes a localized twitch response of that muscle due to its hyperexcitability. If left untreated, these muscles often result in increased stiffness, increased pain, and decreased range of motion.
The Science
Taking a more technical look at what causes trigger points to form, it is believed to result from either acute trauma or repeated micro-trauma. These types of trauma stress the tissue beyond what the body is able to effectively repair. With time, this results in the formation of abnormal motor end-plates within the muscle fibers where nociceptive nerves co-exist. In histological studies, biopsies show hyper-contracture of the muscle fibers related to continuous release of calcium from the sarcoplasmic reticulum. Moreover, examination with electromyography (EMG) has documented abnormal action potentials, what the nervous system uses to induce muscle contraction. What then does this indicate? A chronic state of hypertonicity and hyperexcitability of muscle fibers in individuals with myofascial pain syndrome.
If interested, click below to watch a brief video on how muscle contraction works in the body
Treatment
Research has shown that injections are an effective treatment for trigger points because it works directly on the pathological tissue and pain generators. This type of injection induces a temporary numbness and relaxation of taut muscle cords. Relaxation of the muscles facilitates tissue perfusion (blood flow) which allows the bodies reparative systems to get to work removing metabolite waste and repairing muscle fibers. Increased blood flow to the muscles also allows for faster replenishment of ATP, a vital component for releasing the actin-myosin chains and allowing muscle to lengthen (relax). Research suggests that trigger point injections are at least as effective as Dry Needling but patients report less pain after injections compared to needling alone. Patients report an increase in range of motion and functionality with a decrease in muscle tension and pain.
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