Trigger Point Injections for chronic neck, back, and leg pain

Trigger points (TrPs) are hyperirritable knots in taut bands of skeletal muscle, often causing localized or referred pain. These develop due to repetitive microtrauma, poor posture, or muscle overuse, leading to chronic myofascial pain syndromes affecting the neck, back, and legs. Palpation typically elicits tenderness, a "twitch response," and radiating pain patterns.

How Trigger Point Injections Work

Trigger point injections (TPIs) involve injecting a local anesthetic (e.g., lidocaine), corticosteroids, dextrose solution (prolotherapy) or botulinum toxin into the TrP to disrupt pain signals, reduce muscle spasms, and improve blood flow. Dry needling (without medication) is also effective, though post-injection soreness may be more pronounced. Ultrasound guidance enhances precision and minimizing risks like nerve and vessel injury.

Common Locations

• Neck and upper back

• Mid and lower back

• Gluteal region and legs

Symptoms

• Local tenderness and tightness - Knot

• Referred pain (e.g., pain from a neck trigger point radiating into the head or arms)

• Muscle weakness at times

• Limited range of motion due to pain and tightness - Knot

Causes:

• Muscle overuse

• Poor posture

• Repetitive strain

• Stress and anxiety

Clinical Effectiveness

1. Pain Relief: Studies report 72.8% pain reduction post-TPI, with effects lasting 1–3 months. Botulinum toxin may offer longer relief in chronic cases, though evidence remains mixed

2. Functional Improvement: TPIs improve range of motion and reduce disability, particularly when combined with physical therapy

3. Conditions Treated:

   • Neck/Upper Back: Tension headaches, trapezius muscle pain

   • Back: Quadratus lumborum or gluteal muscle pain mimicking sciatica

   • Legs: Piriformis syndrome (sciatic nerve compression)

Complementary Treatments

For best results, TPIs should be combined with:

• Stretching exercises

• Physiotherapy - Physical Therapy

• Postural correction

• Stress reduction techniques

Who Should Consider It?

• Individuals with chronic myofascial pain

• Patients with tension headaches or fibromyalgia

• Those not responding to physiotherapy alone

Procedure Steps

1. Area is cleaned and palpated to locate the trigger point.

2. A small needle is inserted into the trigger point.

3. Medication is delivered, or the muscle is needled repeatedly (dry needling).

4. The area may be massaged or stretched post-injection.

Benefits of Trigger Point Injections

• Quick and minimally invasive

• Provides fast relief (within hours to days)

• Improves mobility and function

• Reduces reliance on pain medications

Risks and Side Effects

• Mild soreness or bruising at the injection site

• Rare risk of infection or allergic reaction

• Temporary numbness

Conclusion:

Trigger point injections have emerged as a valuable intervention in the management of chronic musculoskeletal pain, particularly for conditions involving myofascial trigger points in the neck, back, and legs.

Supported by clinical evidence, these injections can effectively reduce localized muscle tension, interrupt pain cycles, and improve function when combined with a multidisciplinary rehabilitation approach.

While they are not a standalone cure, they offer meaningful short- to mid-term relief and can be an important adjunct to physiotherapy, manual therapy, and lifestyle changes.

Proper diagnosis, technique, and individualized treatment planning are key to maximizing the benefits of this intervention.

References:

1. Dessie, S. G., et al. (2019). Botulinum toxin type A injections for abdominal myofascial pain syndrome: A double-blind, randomized, controlled trial. Pain Physician, 22(4), 381–388.

2. Kwanchuay, P., et al. (2015). Efficacy of botulinum toxin type A in treatment of myofascial pain syndrome in the upper trapezius muscle: A double-blind, randomized, placebo-controlled study. Journal of the Medical Association of Thailand, 98(2), 123–130.

3. Qerama, E., et al. (2006). Botulinum toxin type A in the treatment of myofascial pain: A randomized, double-blind, placebo-controlled clinical trial. European Journal of Pain, 10(6), 553–560.

4. StatPearls Publishing. (2023). Trigger Point Injection. In StatPearls.

5. University Hospitals. (2023, October). Painful Knotted Muscles? Trigger Point Injections Might Help.