Trigger Point Injections FAQ’s

Trigger Point Injections have become a popular treatment option for those with pain, numbness, muscle tenderness and decreased range of motion. I have seen great success with the use of Trigger Point Injections to help patients recover more quickly and improve healing outcomes. If you’re interested in learning more about this treatment option, continue reading as I answer some of the most frequently asked questions.

What is a Trigger Point?Trigger Point Injections

Trigger points, also known as “muscle knots” or “myofascial muscle pain” commonly occur in the neck and back. They can also occur in other muscles including those in the shoulders, arms, legs, and buttocks. They are hypersensitive, contracted muscles that cause a person pain and tenderness. Trigger points often form as the result of overuse or an injury. Sometimes trigger points can cause something called referred pain. This occurs when the taut muscle fibers compress or irritate a nerve causing pain in other regions of the body.

 

What is a Trigger Point Injection? What medications may be used in a Trigger Point Injection?

A Trigger Point Injection (TPI) is a procedure in which a needle is inserted into the painful trigger point to help break up the taut muscle fibers that have caused the trigger point to occur. Medications used in a TPI procedure usually include lidocaine and bupivacaine, which are both local anesthetics. These medications help to provide a numbing sensation to the injected region and provide pain relief for a short time. It is the needling procedure that actually helps to break up and alleviate the myofascial muscle pain over time, though. Corticosteroids are not used in TPI’s at Team Health Care Clinic.

 

When/why is a Trigger Point Injection used?

Trigger Point Injections are most often used in conjunction with physical therapy (PT) or massage therapy. Trigger Point Injections are usually performed prior to PT or massage therapy because we have found that the combination of these therapies allows us to work as a team to provide our patients with a better outcome from their myofascial muscle pain. After a Trigger Point Injection has been administered, the taut muscle fibers begin to break apart, then muscle work performed in either PT or massage helps to loosen the painful “knots” even more, giving our patients greater relief of pain.

 

What is the benefit to the patient?

There are a number of benefits that patients can achieve from TPI’s. Trigger Point Injections can help to alleviate pain by relaxing tight muscles, improve flexibility, improve range of motion, alleviate stiffness and weakness from the affected muscle, and alleviate referred pain.

 

What are complications and side effects of Trigger Point Injections?

The most common side effects of Trigger Point Injections include a “pinching” pain during the injection, numbness at the injection site for a few hours from the local anesthetic, mild bruising, and increased soreness for the first 24 to 48 hours. The soreness should then subside and benefit from the injection should be noticed after that time period. It is important to stay well hydrated prior to and for the first 24 hours after your Trigger Point Injection.

 

How frequently do Trigger Point Injections need to be administered?

Trigger Point Injections are usually administered one time per week for 3-4 weeks in conjunction with physical therapy or massage therapy appointments. The series of injections is necessary as positive results continue to build with additional injections to provide patients with the most benefit.

Tiffany Watson, CNP

Tiffany Watson, CNP

 

 

Hip Flexors and Low Back Pain: A Surprising Connection

Hip flexor tightness can affect many individuals, young, old, active, and sedentary. Many of the patients in our clinic that suffer from low back pain don’t realize that tightness in the hip flexors can be a contributing factor. In this blog, we explore mechanics of the hip flexor, what you can do to prevent hip flexor tightness and treatment techniques for those who are experiencing pain.

 

The hip flexors are a group muscles that cross the front of the hip.

Some of the muscles are:

Iliacus: this one attaches from the iliac crest to the femur (leg bone)

Psoas Major: attaches from your lumbar vertebra to your femur

Rectus Femoris: this quad muscle crosses the hip and the knee and controls hip and knee movement.

 

The muscles need to keep a balance to hold the bones of the body together. If there is tightness in a muscle group it causes imbalanced for on the bones, and pulls the bones out of a neutral alignment. Poor alignment places strain and stress on the affected joints and causes pain.  When the hip flexors are tight this causes a pull on the spine resulting in an anterior tilt of the pelvis. This anterior pelvic tilt causes an increase in lordosis or curve in the low back. Because the psoas attaches to the lumbar vertebra, hip flexor tightness is often a contributor to chronic low back pain. If not addressed, eventually the increased lordosis and anterior pelvic tilt can also weaken the abdominal muscles. Our abdominal muscles are needed to support the pelvis and the lumbar spine. Think of them as a natural corset for the trunk providing stability.

Preventing Injury

We all know what stretching is, and most of us have probably done some stretching movements at some point in our lives. We hear about stretching to prevent injury, to warm up, and to gain flexibility but is it really that necessary? Stretching and flexibility is especially important when it comes to hip flexors and back pain.

Sitting can cause an increase in hip flexor tightness as well as running or biking without performing stretches needed to maintain muscle length.

Treating Hip Flexor Tightness

There are many pieces to the puzzle that tight hip flexors can affect with the balancing act our body does with muscles and bones. Tightness in the muscles can be treated with myofascial release, soft tissue mobilization, stretching, and kinesiotaping. Targeted exercises are given for the areas that are weak to help return muscle balance. Therapists in our clinic assess the posture, muscle lengths and weaknesses. We determine what muscles groups need to be addressed as well as what is causing the imbalance. Treating the cause of the imbalance causing the symptom is what will make life long changes.

 

Andrea Newport, PT

Andrea Newport, PT

Spinal Decompression for Back Pain, Herniated and Degenerative Lumbar Discs

Non-surgical spinal decompression was introduced to Minnesota by Team Health Care Clinic years ago.  Since then, we have continued to successfully perform this treatment protocol for people with back pain with Vertebral Axial Decompression (VAX-D).  In our clinic alone, there have been hundreds of patients that were spared surgery by completing VAX-D services.

Since that time we have seen many clinics come and go claiming they have spinal decompression services.  It was the “wild west” with even simple traction units being touted as spinal decompression. But what is spinal decompression and how is better or different than simple traction?

Spinal Decompression Reduces Pressure on Lumbar Discs

When it comes to spinal decompression, it’s all about the pressure reduction achieved. Much like gauging the air pressure in a car tire, scientists have been able to measure the pressure on a disc in various positions. What they found is as follows:

Vax-D spinal decompression achieves negative pressure on the disc.

Notice that traction does not create a negative pressure on the disc. In other words, traction in the form of inversion tables, intersegmental traction units and many other devices claiming to be spinal decompression, are creating pressure reductions similar to lying down.  No negative pressure means no suction effect and that means little chance of decompressing degenerative and herniated discs.

VAX-D is Superior to Others

Non-surgical spinal decompression uses a machine that is proven to create a negative pressure on lumbar discs. There are few, if any, other thank VAX-D.  Beware —  many will claim they have research that proves negative pressure is achieved. However, when pressed to see the research, a few different schemes are discovered to overstate the research.

One technique is to use VAX-D research as their own.  They will show the research only when pressed for it and explain that the copycat device is similar to VAX-D so they claim it as their own.

A second approach is to do research on cadavers.  Other than the fact that any positive effect from decompression is too late for these subjects, there are obvious flaws in drawing any conclusions from this research.

Our bodies have receptors that create a stretch reflex when a force is applied to it.  For example, if someone is pulling your leg to stretch your hamstring, at some point your muscle will resist the force to avoid injury.  In cadavers, this reflex is absent so the researches can apply any distractive force and find erroneous positive results.  Don’t be fooled by this scheme.

Be an educated consumer and ask questions before agreeing to proceed with your doctor’s recommendation for non-surgical decompression.  Determine how they define “decompression” and ask for research to support their claims.

Finally, investigate its track record and its success rate.  Look past splashy marketing and grand claims. Five years ago, the Twin Cities metro was saturated with full page ads for decompression services. Almost 100% of those marketing campaigns were not able to stand the test of time and are now noticeably absent.

Consider VAX-D for non-surgical spinal decompression.  It is well researched, has a greater than 15-year track record, and is 80% successful in patients that had failed all conservative treatments.  It also has research that confirms it creates negative pressure on the discs of live subjects.

Is it Right for Me?

VAX-D has been a proven “positive negative” for hundreds of our patients. If you have been diagnosed with a lumbar disc degeneration or herniation, consult your provider to determine if VAX-D is right for you.

Joe Bertsch, DC

Joe Bertsch, DC

Piriformis Syndrome: A Pain in the Butt

You have probably heard the phrase “What a pain in the butt!” There are many for whom this becomes quite literal as they experience pain, numbness, tingling or a combination of these in the buttocks and can also radiate into the back of the leg and even into the foot. These symptoms can have a variety of causes but one less common one is Piriformis Syndrome.

The piriformis is a flat band-like muscle in the buttocks that originates just above your tailbone(sacroiliac region) and attaches to the top portion of the femur or upper thigh bone. With overuse from things such as long distance running, prolonged sitting, dehydration or even electrolyte abnormalities the piriformis muscle may spasm. The sciatic nerve is nearby which can be affected by the muscle spasm and nerve irritations cause symptoms such as numbness and tingling along the back of the leg and into the foot.

One way to help a muscle in spasm is to gently stretch it out. To stretch the piriformis, lay on your back with your knees bent. Cross your right ankle over your left knee and pull right knee up towards chest angled towards left shoulder. Repeat other side.

Other conditions can produce similar symptoms so it is important to consult your doctor if you experience any of the symptoms described in this post. The providers at Team Health Care Clinic have experience with a variety of conditions including Piriformis Syndrome and will recommend a treatment plan to help you recover as quickly as possible.

Emily Franklin, PTA