Trigger point injections can take your pain relief to a whole new level

The term Trigger Point Injection is synonymous with "wet needling". This treatment was the original therapeutic founded by Dr. Janet Travell, MD whose treatments and research eventually paved the way for the treatment of "dry needling". Dry needling involves an acupuncture needle (solid, non-hypodermic) inserted into a taught muscle band or knot (called a trigger point). Wet needling or "trigger point injections" on the other hand is also the treatment of needling into a tight muscle knot, however, a hypodermic needle is used and various therapeutic solutions are injected into the knot/trigger point.

Janet Travell cites in her second edition book "Myofascial Pain and Dysfunction: The Trigger Point Manual" that the following clinical signs must be present to diagnose a trigger point, and for needling to be appropriate: Spot tenderness, jump sign, pain recognition, palpable band, referred pain, and a twitch response. Think about when someone squeezes the top of your shoulders. Many of us will wince in pain (jump sign); that tight knot in your trapezius muscle is often felt by both the person squeezing and the person receiving (palpable band). The pain can shoot down the arm or back (referred pain). Some of the most common syndromes that arise from trigger points include cluster headaches or migraines, neck pain, repetitive strain injuries, low back pain, TMJ, and more.

While dry needling is a well-known and very effective treatment for relieving trigger point pain, injecting these trigger points with a therapeutic solution takes the efficacy to a whole new level. Trigger points are clinically different than normal muscle tissue. A hallmark of trigger points is sustained contracture (muscle tightness) which in turn causes an increase in resource need, increased metabolism locally, and a failed reuptake of calcium into the sarcoplasmic reticulum (a portion of the muscle). This perpetuating cycle that cuts off blood supply to the muscle can be difficult to break. Injecting solutions directly into the knot can often expedite beneficial results better than many other treatments.

The solution we use for trigger point injections can vary based on pathology presentation or patient tolerance. Janet Travell noted in her book that injecting Botox or Botulinum A toxin is one of the more effective solutions because it helps break that cycle of blocked calcium and actin and myosin dysfunction. After decades of research and use with Botox we know that indeed it does work quite well but it isn't without some potentially serious side effects.

A simple but often effective ingredient we use for our more natural cocktail for injections is an isotonic saline solution or bacteriostatic water. This solution hydrates the muscles and reduces spot tenderness. Mixing saline with a 1% lidocaine as a safe/mild anesthetic, plus a small amount of hydroxycobalamin (vitamin B12) which functions nicely to help reduce nerve pain, and an herbal anti-inflammatory solution called Traumeel is our favorite trigger point injection cocktail. Traumeel is a blend of 14 botanicals and is an emerging non-steroidal anti-inflammatory injectable option that has been used in many forms (topically, orally, etc) for decades. You can find a list of all 14 botanicals in Traumeel on our website. The botanicals used in Traumeel are very diluted; we often get many questions about if someone might have a reaction. Some patients cannot tolerate lidocaine, so we omit that, some patients cannot metabolize certain kinds of B12 which is why we use hydroycobalamin.

Reactions are possible for any substance, however, because these are intramuscular injections, not injections into the bloodstream, any reaction would be short-lived and mild. Our clinic has never had a reported reaction but we do screen patients if they have ever had problems with any of the ingredients.

These injections are not the same as cortisone steroid injections that are common from orthopedic doctors, nor are they a replacement for utilizing traditional physical therapy methods. One of the most common causes of trigger points is overuse. We see desk job workers, or manual laborers, or even competitive athletes being at the most risk for developing trigger points. Treating trigger points with specific strengthening exercises to counterbalance muscle imbalances, stretching or massage, and medical acupuncture with trigger point injections is your winning combination. We see patients with repetitive jobs or activities who develop trigger points do substantially better when these techniques are used with some regular frequency than those who only treat their trigger points when they are flared. Because we inject these solutions into the muscles, the solution will spread out affecting a larger portion of the muscle than the direct spot it was injected. We find that adding these simple and safe injections to our patients' routine treatments can expedite results and prolong efficacy.

If you're looking for a safe but effective solution to trigger points, look no further. We have clinic locations in both Evergreen and Conifer. We hope to help you soon.