Daniel J. Ragone, Jr., M.D., PA
Trigger Point Injections
What is a Trigger Point?
Focal, hyperirritable, palpable, taut bands of skeletal muscle are one of the most common causes of musculoskeletal pain. These bands, known as "trigger points," may result from direct muscle injury, irritation from an underlying disc herniation, poor posture, or repetitive overuse. Common activities which provoke trigger points include holding a telephone receiver between the ear and shoulder; prolonged bending; sitting in a chair with poor back support, wrong arm rest height or no arm rests at all; and heavy lifting using improper body mechanics. Over time, trigger points form micro scar tissue and result in reduced range of motion and weakness in the muscle.
Trigger points may also mimic pain from a pinched nerve when they surround the adjacent nerves. This type of pain is called "referred pain," and it follows a consistent pattern which rarely coincides with the expected dermatologic or nerve pattern. Often, the referred pain is not located in the immediate vicinity of the trigger point. Although there are several proposed mechanisms theorized to explain the development of trigger points, scientific evidence is lacking and there is no laboratory, pathologic or radiologic test to identify trigger points. After physical therapy, trigger point injections are the trigger point treatment with the most scientific support.
Trigger point injections relax the areas of intense muscle spasm. When Dr. Ragone performs these injections, he identifies the active trigger points and then extinguishes using a small amount of anesthetic and small needle using a technique known as "dry needling." . He does not inject corticosteroids. Sustained relief usually is achieved with a brief course of treatment. Each injection session is approximately 10 minutes and may cause a muscle twitch or a pain lasting a few seconds to a few minutes. After the injections, Dr. Ragone reviews a basic home stretching program for the patient to prolong the injection's efficacy and reset the muscle memory. Trigger point injections are a minor procedure and therefore have minimal risk. You should discuss these risks with Dr. Ragone prior to the procedure. Soreness may last a 3-4 days post injection which can be managed with icing or moist heat and using Tylenol or anti-inflammatory medication.
The most effective early treatment for trigger points is physical therapy and/or a regular home exercise program. Exercises improve the body's strength and flexibility. Modalities such as TENS, heat, ultrasounds and massage complement the exercises by reducing muscle tension. Trigger point injections complement physical therapy. In some cases, trigger point injections improve pain after a patient has not improved with physical therapy alone.
Dr. Ragone has been specializing in myofascial pain for more than 34 years. He completed his residency training in PMR at the University of Pennsylvania Hospital.