Physical pain can often be caused by a mechanical source, which is why pills don’t always work. Trigger points are painful sites inside our muscles or connective tissues. They behave like a burr caught in the moving parts of our body. Trigger points are defined as having the following characteristics:
- Pain related to a specific point inside a muscle (like a knot in a wooden plank) or in the tight fascial layer covering the muscle. These are not caused by an obvious local injury or infection.
- Palpable nature: these can feel firm, like a small walnut embedded in muscle, or they can be palpated as a thin sheet of tenderness in the overlying fascial layer.
- Reproduction of symptoms: Direct pressure over the correct trigger point will reproduce the symptoms, often not in the same place.
- Invisible on images such as x-ray, ultrasound or MRI. As such, they are often missed.
Commonly, pains present in one or more parts of the body, while the root cause comes from a distinct trigger point. For example, pains in the arm could be coming from a trigger point in the neck. Or a tender trigger point in the sacro–iliac joint (low back) can cause a person to “walk funny”. This can shift the burden of weight- bearing, thus setting up myriad muscle pains in the back or limbs. We usually do not need to treat each of these extra sore spots, just the one or two that are the root cause.
For decades, doctors have used cortisone shots into trigger points, with some good effects. However, the cortisone itself carried considerable risk of side effects in the local tissues, such that it could be only used three times a year in the same site. Happily, it turns out that the shape of the needle was more important than its contents. Researchers found the same results injecting plain saline, or using a dry needle, as long as it passed through the trigger point.
The trigger point needle is hollow and has a beveled edge, which makes it possible to mechanically break down these painful spots. We only treat one or two spots at a time, to maximize benefits. The needle tip is used to gently explore around the area of pain through a single point of entry, using a drop of local freezing if needed. Through touch, the needle will detect areas of inflammation, scar tissue, or calcification. Once discovered, these targets are then microdissected with the tip of the needle. This allows restoration of normal blood supply and function.
The procedure takes only a few minutes and, with a few drops of local anesthetic, is basically painless. Results are usually quick, although a few patients may experience a temporary soreness for several hours before improving. It is helpful to drink lots of water following the treatment, and to be moving rather than resting or sitting for the next while. One can go straight to the gym or yoga class or back to regular activities.
Examples of acute and chronic cases we treat: back pains, from upper to lower, rotator cuff and frozen shoulders, tennis elbows, and tendon pains in wrist and hand. In the lower limbs we treat hip pains and stiffness, sciatica, sacro-iliac strain, knee, calf and iliotibial (lateral thigh) pains, ankle and foot issues including plantar fasciitis.
This depends on the root cause. If the injury is recent and unique, a few visits may be all we need. If the root cause is a recurring one, such as bad posture or poor ergonomics, then the complaint is likely going to come back.
The technique is done with the usual sterile protocols. Because there is no cortisone, there are no drug interactions, nor any problems interfering with current medications. If you are on blood thinners – please consult your doctor first. We do use a few drops of local anesthetic, Xylocaine 1% (Lidocaine). This is only injected if the patient feels discomfort. In case of allergy to local anesthetics, treatment can be done with nothing in the needle.
Other treatments: Trigger Point Injections work well in conjunction with other disciplines such as physio, acupuncture, IMS, therapeutic massage, yoga and chiropractic treatments. Indeed, by restoring blood supply to trigger points, simple medications like Advil will work better, and stretching and exercises will be easier to do.