Trigger points are “knots” in muscles that can create nerve-like symptoms like numbness, tingling, pain, weakness, burning, a sense of stiffness or heaviness, etc., at distant sites on your body. These knots are made of normal muscle that is overly contracted. Trigger points are not “growths,” even though they feel like marbles under the skin. Historical point: the definitive textbook on trigger points was published by the White House doctor to John F. Kennedy (we now know that JFK had back problems, so we can guess that he got trigger point injections!).
Trigger points can come about due to muscle trauma, overuse, cold exposure, a blood salt abnormality, emotional stress, muscle fatigue or imbalance, underlying structural abnormality in the spine or other joints (bad discs, arthritis, etc.), muscle weakness from a true pinched nerve, and underlying soft tissue disorders (mechanical dysfunction or somatic dysfunction). The latter problem (mechanical dysfunction) is VERY commonly associated with trigger points.
Trigger points can be massaged out by hand or using a device like a “Theracane” (which we sell), by applying heat (e.g. using Thermacare heating pads, which you can buy at a drug store), or patients can be sent to physical therapy for heat treatments and/or a technique called “spray and stretch.” However, those techniques take a long time to accomplish and can leave patients sore. A much faster way to make trigger points go away is via “trigger point injections.”
TPIs are numbing medicine shots into the trigger points. Typically, while a trigger point is being injected, symptoms like numbness and tingling or pressure are felt at distant sites, confirming that the trigger point is why you felt symptoms in those distant sites in the first place. The symptoms in the far-away place are typically aggravated for a few seconds (maybe even a minute or two), but the area should quickly feel better than before the shot. Note: “dry-needling” can also be done by PTs or by Dr. Hancock if you can’t have numbing medicine for some reason, because the act of sticking a needle into a trigger point, even without medicine, can be helpful.
The medicine is “xylocaine” or “lidocaine”, which is the same medicine that most dentists use to numb your mouth, except there is no epinephrine in it, so it won’t make your heart race. This medicine is NOT a steroid. You don’t need a steroid because trigger points are NOT “inflamed.”
When injected into the knot, the medicine forces the trigger point to relax. The medicine washes away soon…faster than at the dentist’s office because there’s no epinephrine in the shot. However, the act of shutting down that knot even for a half hour is all it takes to “reset” the muscle’s tension regulator, the “muscle spindle,” at a lower level of tension. Think of it as being like when your computer starts acting weird and you power it down, wait ten seconds, and then power it back up. The computer supposedly “dumps” it’s short-term memory and wakes up refreshed and acting more normal. Similarly, after the trigger point injection, the muscle wakes up way more relaxed, with less of a knot or with the knot gone or at least less painful.
The duration of relief is typically MUCH, MUCH longer than the amount of time your face is numb at the dentist’s office. The relief can be permanent after one round of injections, and this is especially true if the muscle “twitches” on insertion of the needle. However, more commonly, the shots must be repeated on a few visits. It’s also possible that the shots will work for only a few hours. It’s impossible for Dr. Hancock to know until she tries them on you because everyone is different.
A twitch on injection is a sign that the knot was a bad one and really needed to be injected. When you get a twitch, the relief is usually impressive and immediate.
It is common for patients to feel a little “tipsy” starting about ten minutes after trigger point injections. For that reason, we tell patients that they should not drive for a while after the shots, for safety’s sake. On average, over half of the patients report feeling tipsy after the shots, and most say they feel the sensation starting to go away after another ten minutes or so. Still, we advise patients to allow for an hour or longer after the shots before they drive, depending on their reaction. Another thing to expect after the shots is a little post-injection soreness and some bruising or even a lump at the area from bleeding. Usually, this sets in by the next day. However, the soreness doesn’t typically last more than a half day or a day or two after that. It’s good to ice the area where you receive the injections right after the visit to minimize soreness the next day.
Trigger points are sneaky ninjas. They create symptoms that are nerve-like, so they “fool” doctors (and patients) into thinking the problem is pinched nerves. For this reason, it is quite common for patients to be sent for MRIs and EMG nerve tests and even spinal injections before they are sent here for Dr. Hancock to address their trigger points.
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