Trigger Point Injections for Muscle Pain

Hans Kraus introduced a great advancement in the treatment of muscle pain in 1937 when he pioneered the use of vapocoolant spray to treat muscle pain and relieve trigger points. In 1970, Kraus published a book on the beneficial effects of exercise on patients with back pain.

Janet G. Travell, M.D., reached prominence as the personal physician to Presidents John F. Kennedy and Lyndon Baines Johnson. David Simons, M.D., was a U.S. Air Force flight surgeon conducting experiments in the nascent field of Aerospace Medical Research when he and Travell met at the School of Aerospace Medicine.

Together they produced one of the most comprehensive reference manuals in the history of pain medicine, “Myofascial Pain and Dysfunction: The Trigger Point Manual,” an exhaustive presentation covering every practical aspect of trigger point therapy. It included descriptions of techniques and ingredients to maps of all the known trigger point reference patterns.

Diagnostic procedures include testing for taut bands of muscle fiber, twitch response, and applied pressure to check for referred pain triggers. There is evidence to suggest that trigger points are caused by impaired circulation and/or an increased metabolic demand.

Skeletal muscle tissue accounts for about 40% of our body weight, and includes nearly 700 individual muscles. When active trigger points are present, passive or active stretching of the muscle produces pain. This pain can occur with the slightest activity or even at rest. Biofeedback has proven that muscles are in a state of contraction and activity even when we believe we are at rest.

When myofascial pain is related to a single muscle trauma, or exhibits a stable pattern over any length of time, it is usually easy to diagnose and treat.

In cases where pain appears in multiple muscles, spreads to other areas, or there is evidence of increasing fibrosis or other contributing factors, pain can be very difficult to diagnose and treat. Once the proper diagnosis is ascertained, however, various treatments are available to deal with the problem effectively.

Knowledge of the referred pain pattern characteristic of each muscle is often the most important single source of information used in diagnosing pain.

The patient’s examination begins with observation of their posture, movements, body structure and symmetry. It progresses with specialized screening movements to isolate the problem areas and identify trigger points.

However, tendons, ligaments and joint capsules may also refer pain to areas distant from the actual trigger point. Tender points, which are points that are sore with pressure or palpation of the doctor’s hand, may also be treated with trigger point injections or Prolotherapy. Unlike the dry needle of acupuncture, the trigger point or Prolotherapy needles deliver fluid to the target area to be treated. By puncturing the tissue, trauma to the area is caused, resulting in a rush of white blood cells to the area that provokes an anti-inflammatory reaction and stimulates the healing process. Frequently, in trigger point therapy the physician will use a local anesthetic solution such as lidocaine to relieve the pain as well.

The deep tissue injection of the trigger point attacks the problem directly, causing physical changes and subsequent, histological composition of the tissue provoked by the needle.

Prolotherapy takes trigger point theory a step further, by adding an irritant solution, like dextrose or phenol to the injection process.

This irritant solution helps speed up the proliferation of new collagen tissue.

It is highly effective for rejuvenation of joints, muscles, tendons and ligaments. Acupuncture, trigger point therapy, and Prolotherapy are basically variations of the same therapeutic process, all originating from ancient medical arts, best known in China and Greece.