Trigger Point Injections

What is a trigger point?

A trigger point, also known as a myofascial trigger point, is a painful nodule within a taut band of fascia, a connective tissue that covers your muscles. To the touch, it feels like a hardened lump or knot in the soft tissue. It is often painful when pressed and/or during certain body movements and may also cause referred pain to other areas of the body.

Trigger points and similar types of muscle pain can be caused by overworking or overusing a muscle, or by not using a muscle enough. There is also often an underlying issue in bones or joints below the muscle (such as in the spine or shoulder) that irritate the myofascial tissue to create a trigger point.

What are trigger point injections?

A trigger point injection is a superficial (shallow) pain-relief injection into muscles under tension in any part of the body that have an electrical connection to other parts of that muscle or muscle group. These injections commonly treat what is called a “referred pain pattern,” which is pain in one area of the body stemming from an injury elsewhere in the body.

While trigger point injections are not the same as acupressure or acupuncture, they work through a similar philosophy. These injections target trigger points that can cause a wide area to experience pain. By injecting pain-relief medicine near a trigger point, pain-relief can be dispersed to a wide area.

What medication is used for trigger point injections?

Typically trigger point injections contain lidocaine, and sometimes also a small dose of cortisone, which may help prolong the pain relief from a trigger point injection.

But it is up to the doctor to decide whether steroids are appropriate. For example, if the patient has already recently taken other steroids or has a history of steroid intolerance, the doctor may want to avoid introducing cortisone to the body.

Is a trigger point injection the same as a cortisone shot?

No, the term cortisone shot refers to any of various injection treatments that use cortisone, a type of steroid, as the primary medication. Cortisone is frequently used inside a joint, such as the knee, to reduce inflammation caused by osteoarthritis or injury. It can also be used to treat pain and inflammation in soft tissues, or even inflamed nerves (such as in the ulnar nerve for a person with cubital tunnel syndrome).

In the case of a trigger point injection, cortisone’s anti-inflammatory qualities aid in relaxing tight muscle tissue that creates trigger points. While the lidocaine provides immediate pain relief, cortisone can extend the benefit by treating the underlying inflammation.

What conditions can a trigger point injection treat?

Trigger point injections are used to treat myofascial pain – muscle pain associated with the fascia that covers the muscle. It is typically used to alleviate pain in irritated, palpable knots (“trigger points”) within the muscle tissue. Several common areas of the body that are candidates for trigger point injections because they all contribute significantly to movement.

These include the:

• neck (sternocleidomastoid or levator scapulae muscles)
• back of the shoulder (trapezius)
• lower back (quadratus lumborum)
• the gluteal muscles in the buttocks (especially the gluteus medius)

Who is a good candidate? Should anyone not get a trigger point injection?

Trigger point injections are not very deep compared to many others used to treat pain, such as knee joint injections or epidural spine injections. For this reason, anyone can be a candidate for trigger point injections if they are experiencing a pattern of pain that is present in several different muscle groups. Trigger point pain from overuse, muscle strain, muscle stiffness, or due to an underlying condition can all be good candidates.

Another common situation in which trigger point injections are used is when someone is going through physical therapy, but they are getting stuck at a certain range of motion or stretching exercise. Maybe the patient fell behind on exercises or overworked the muscle, or the physical therapist is having difficulty working out a specific point of muscle tension. A trigger point injection can break up that tension so the patient can progress and get the full benefit of physical therapy.

How much do trigger point injections cost?

Trigger point injections are almost always covered by insurance, unless they are done too frequently, which is inadvisable because it means there’s an underlying issue that is still not being addressed. Trigger point injections are generally done on an as-needed basis.

Sometimes insurance companies will not cover the use of ultrasound guidance for trigger point injections, but guidance is rarely needed. Always check with your healthcare provider and insurance company beforehand, but a ballpark estimate of the cost of a trigger point injection without insurance is around a few hundred dollars.

What type of doctor performs trigger point injections?

Many different doctors perform trigger point injections. The most common doctors that perform trigger point injections are pain management physicians, physiatrists, and some sports medicine physicians. Sometimes, rheumatologists or neurologists may also perform trigger point injections.

Will I be sedated? How should I prepare for a trigger point injection?

Patients remain awake and are not sedated with anesthesia for a trigger point injection, and there is special preparation required. It is simple procedure done in a physician office setting rather than a hospital, ambulatory care center or special procedures unit. Patients can just come into the office like a regular doctor’s appointment.

How are trigger point injections performed?

The needles used are very small and there is usually no need for image-guidance. Doctors typically perform these injections using their knowledge of anatomy and an understanding of where the pain is. Ultrasound guidance may be used in cases where it is important for the physician to inject into a very specific muscle, rather than into a few different muscle groups, but there can sometimes be problems with insurers covering the image guidance.

How painful are trigger point injections?

It can depend on how painful the problem area is already, as well as the sensitivity of the patient, but most patients tolerate this procedure very well. It is typically a small pinch similar to that of a vaccination shot.

Can I drive myself home after a trigger point injection?

Yes, since there is no anesthesia, and no major disruption to the body, patients can drive themselves home. Similar to getting a vaccine, there might some minor bleeding afterward treated with a simple bandage.

How quickly can I return to normal activity after a trigger point injection?

For the most part, patients can return to all normal activities immediately after receiving a trigger point injection. In fact, sometimes doctors may try to coordinate with physical therapy. If the patient is doing a stretching regimen with a trainer or a physical therapist, trigger point injections can work well with physical therapy, perhaps even the same day, to work through the pain or tightness of that muscle group.

What should I not do after an injection?

Patients may want to avoid heavy lifting for the first 24 hours. If there is any numbness from the lidocaine, patients may not realize that they are over-straining a muscle. This is similar to when you get numbed at the dentist: if your mouth is numb, you may not realize you’re biting yourself if you try to eat solid foods. Patients can return to heavy lifting after the complete sensation in their muscles comes back.

What to expect for recovery after a trigger point injection?

Recovery for trigger point injections is minimal. Patients can drive themselves home, go back to work, and can go back to exercise or physical therapy right after the injection. However, patients should avoid lifting heavy weights until the numbness from the injection wears off to avoid injury from straining their muscles too far.

How long does the pain relief from a trigger point injection last?

The pain relief from a trigger point injection can depend on the situation. If the injection is used to treat the right health condition, and the patient is able to use the trigger point injection combined with physical therapy to work through the painful muscle group, the pain relief could theoretically last an infinite amount of time. The medicine in the injection might only last for a few days, but that may be all that is needed for the patient to get back on the correct path with their healing.

For patients with a chronic underlying condition, trigger point injections may be used to enhance other pain management treatments if the underlying health condition is causing muscle tension. In these cases, trigger point injections, combined with physical therapy or a home exercise regimen, along with treatment for the underlying health condition, can give many patients two to three months of improved pain relief.

Are there side effects for trigger point injections?

If a patient is receiving several injections at once, sometimes lidocaine can cause a short period of lightheadedness while the patient is still at the doctor’s office.

If the trigger point injection contains a steroid, it is possible to experience some side effects including insomnia for a night or two, a little bit of redness or flushing in the face or feeling jittery for a day or two. People with diabetes may also experience a rise in their blood sugars. These side effects are not specific to trigger point injections and are possible with any type of steroid.

What are the risks of trigger point injections?

The risks of trigger point injections are very low. As with any treatments involving needles, there is a small risk of minimal bleeding or bruising. There is a small risk of infection, but the risk is very low because the needles and skin are sterile, the needles are very small, and they are not entering the spine, joints, or any other cavity of the body.

If the trigger point injection is going into the thoracic region, which is somewhere between the mid shoulder blades and somewhat lower down, there is a very, very small risk of puncturing a lung. However, this is an extremely rare occurrence.

What is the success rate for trigger point injections?

If done for the right reasons, trigger point injections have a very high success rate, estimated at over 95%. Most of the time, trigger point injections are performed to get patients over a small hump of pain so they can get back on track with exercise or rehab.

The pain relief from trigger point injections doesn’t necessarily last long. However, these injections can break the cycle of muscle tension so patients can progress with rehab and get the muscle to strengthen and loosen correctly. The success rate for treating chronic conditions is low, but trigger point injections are not really meant to be used in this way.

How often can you get trigger point injections?

There is not an exact number of how often a patient can get trigger point injections. This must be clinically determined depending on the underlying diagnosis. If there is another underlying condition besides the muscle pain (also called myofascial pain or myalgia), a patient might get trigger point injections every three to four weeks for a short period of time. However, if there is no improvement, it is probably not helpful to continue these injections into the same area, and doctors will examine whether there is another underlying condition.

What is the next step after a trigger point injection?

The next step after a trigger point injection would be physical therapy – if the patient hasn’t already started PT for that particular muscle group. If physical therapy isn’t working, the doctor may consider repeating a trigger point injection, and they may also look deeper into the cause of the muscle pain, including something occurring in the spine, a joint, or some other type of muscle.

Posted: 2/18/2025

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