Trigger Point Injections

A trigger point injection is used to relieve muscle pain caused by trigger points — tight, tender knots that send pain to nearby areas. It is most often used in the neck, shoulders, upper back, low back and buttocks when stretching, therapy and medicines have not been enough^[6]. The goal is to calm the knot long enough for you to stretch and strengthen the muscle, which is what helps keep the pain from returning^[2].

No. A trigger point injection goes into a tight muscle knot and usually contains only a local anesthetic such as lidocaine, sometimes with a small dose of steroid^[9]. A steroid or cortisone shot places a corticosteroid into a joint, bursa or tendon sheath to calm inflammation — see cortisone shots. Because muscle knots are not mainly an inflammatory problem, steroid is often unnecessary; guidelines report no evidence that adding medicines improves trigger point results^[2].

A piriformis injection treats piriformis syndrome, in which a tight or irritated piriformis muscle deep in the buttock irritates the sciatic nerve and causes buttock pain that can travel down the leg. Because the muscle is deep and lies next to the nerve, the injection is guided by ultrasound or fluoroscopy. It can both help confirm the diagnosis — if the pain eases quickly — and provide relief that makes physical therapy easier^[8].

Most people feel a quick pinch, then a deep ache or brief twitch as the needle enters the knot — often a familiar version of their usual pain. The numbing medicine works almost immediately, and many people feel the muscle loosen right away^[9]. Treating several points takes only a few minutes in total. Afterward, the area may feel sore or bruised for a day or two, which usually responds to ice or an over-the-counter pain reliever.

The numbing medicine itself wears off within hours to a few days, but relief often outlasts it because the muscle stays looser^[9]. When injections are combined with stretching and therapy, many patients with chronic muscle pain get two to three months of improvement^[9]. Results vary: some people need only one or two treatments, while others find that knots return if posture, workload or muscle weakness are not addressed^[7].

There is no single medical limit, but insurers and guidelines set practical ones. Medicare in New York pays for no more than three trigger point sessions in a rolling 12 months, and repeat injections must have given at least 50% relief lasting at least six weeks^[1]. New York workers’ compensation guidelines allow up to four injections per session and four sessions a year^[2]. Injections are often spaced three to four weeks apart for a short course; if they are not helping, repeating them is unlikely to change that^[9].

Keep moving. Gentle stretching and normal daily activity are encouraged the same day, but avoid heavy lifting for the first 24 hours, because numbness can hide a muscle strain^[9]. Soreness at the injection sites is common for a day or two. Start or continue your home exercise program as soon as the soreness allows, since that is what makes the improvement last. Call us right away for fever, spreading redness, or new shortness of breath or chest pain.

The main downsides are temporary soreness and bruising, and relief that may be short-lived if the cause of the knots is not addressed^[9]. Lidocaine can briefly cause light-headedness, especially when several points are treated, and an added steroid can cause flushing, trouble sleeping or higher blood sugar^[9]. Infection is rare. A collapsed lung (pneumothorax) is a rare but serious risk when muscles over the ribs or upper back are injected^[6].

Usually not. Interventional pain guidelines classify trigger point injections as low bleeding-risk procedures, so many patients continue their blood thinners^[3]. You may bruise more easily. The decision depends on which medicine you take and why, so never stop a blood thinner on your own — we will review it with you and, if needed, with the doctor who prescribed it. Otherwise, no special preparation is needed: eat normally and wear clothing that allows easy access to the area.

Medicare and most commercial plans cover trigger point injections when medical-necessity criteria are met. In New York, Medicare’s contractor, Wellpoint Federal (formerly National Government Services), requires documented trigger points, failed conservative therapy and active participation in an exercise or rehabilitation program^[1]. Commercial plans may require prior authorization. Workers’ compensation follows the New York Medical Treatment Guidelines^[2], and no-fault claims follow their own rules. Our staff will verify your benefits before scheduling.

If a couple of rounds do not help, your physician will look again for the true source of pain. Pain that seems muscular can come from facet joints, a disc or a pinched nerve, which may call for a medial branch block, a facet joint injection or an epidural steroid injection. For muscle pain itself, options include structured physical therapy, dry needling, and medicines such as muscle relaxants or certain antidepressants^[7].

Myofascial pain is treated by several kinds of physicians, including pain medicine specialists, physiatrists (physical medicine and rehabilitation doctors), sports medicine physicians and primary care doctors, often working with physical therapists. Because myofascial pain has no single agreed diagnostic test and overlaps with joint and nerve problems^[7], it helps to see a physician who can examine the muscles and rule out other causes. Our board-certified physicians evaluate and treat myofascial pain in our Gramercy / Kips Bay office.