Trigger Point Injections Chandler Arizona

Trigger Point Injections Chandler Arizona
Trigger Point Injections (TPI's) 

Trigger points are discrete, focal, hyperirritable muscles. They produce pain locally and in a referred pattern and often accompany chronic musculoskeletal disorders. Acute trauma or repetitive microtrauma may lead to the development of a trigger point. Lack of exercise, prolonged poor posture, vitamin deficiencies, sleep disturbances, and joint problems may all predispose to the development of microtrauma. Occupational or recreational activities that produce repetitive stress on a specific muscle or muscle group commonly cause chronic stress in muscle fibers, leading to trigger points. Patients may have persistent pain resulting in a decreased range of motion in the affected muscles, including muscles used to maintain body posture. The most common areas include the muscles of the neck, shoulders, and pelvic girdle. Trigger points may also manifest as tension headache, tinnitus, temporomandibular joint pain, decreased range of motion in the hips and low back pain. Palpation of the trigger point will elicit pain directly over the affected area and/or cause radiation of pain. 

Various modalities can be employed, such as the medications, Spray&Stretch technique, physiotherapy, manipulation, massage, dry needling, acupuncture, and trigger point injections. Trigger-point injection has been shown to be one of the most effective treatment modalities to inactivate trigger points and provide prompt relief of symptoms as per the American Family Physician 2002;65:653-60. Trigger-point injections with an anesthetic (lidocaine, procaine, marcaine), steroid (kenalog), and saline are commonly used. However, botulinum toxin type A (Botox), vitamin B12 and homeopathic medicinals can also be used. Trigger-point injection has become widely accepted and is one of the most effective treatment options available to achieve the best results. A simple, nearly painless, injection can often either correct or diminish pain associated with TPI's. Treatment time is 15 minutes and typically requires 3 sessions, 1 week apart. The treatment is very affordable and many insurance may cover the service. 


Trigger points are described as hyperirritable spots in skeletal muscle that are associated with palpable nodules in taut bands of muscle fibers. Trigger point researchers believe that palpable nodules are small contraction knots and a common cause of pain. Compression of a trigger point may elicit local tenderness, referred pain, or local twitch response. The local twitch response is not the same as a muscle spasm. This is because a muscle spasm refers to the entire muscle entirely contracting whereas the local twitch response also refers to the entire muscle but only involves a small twitch, no contraction.

The trigger point model states that unexplained pain frequently radiates from these points of local tenderness to broader areas, sometimes distant from the trigger point itself. Practitioners claim to have identified reliable referred pain patterns, allowing practitioners to associate pain in one location with trigger points elsewhere. Many chiropractors and massage therapists find the model useful in practice, but the medical community at large has not embraced trigger point therapy. Although trigger points do appear to be an observable phenomenon with defined properties, there is a lack of a consistent methodology for diagnosing trigger points and a dearth of theory explaining how trigger points arise and why they produce specific referred pain patterns.


The term "trigger point" was coined in 1942 by Dr. Janet Travell to describe a clinical finding with the following characteristics:
Pain related to a discrete, irritable point in skeletal muscle or fascia, not caused by acute local trauma, inflammation, degeneration, neoplasm or infection. 
The painful point can be felt as a tumor or band in the muscle, and a twitch response can be elicited on stimulation of the trigger point. 
Palpation of the trigger point reproduces the patient's complaint of pain, and the pain radiates in a distribution typical of the specific muscle harboring the trigger point. 
The pain cannot be explained by findings on neurological examination. 


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