Acute & Chronic Muscle Pain

Trigger Point Injections
(aka myofascial trigger point therapy)

Trigger points are discrete, hypersensitive muscle pains which are located within a taunt band of muscle fiber. Trigger points can be palpated & feel like a tight bundle of muscle fiber that is more tender & concentrated compared to surrounding tissue. Pain is local, but can also be referred to nearby anatomical structures. Persistent pain generally results in decreased range of motion to the affect muscles; to include those muscles which are utilized to provide posture (spine, hip, neck & shoulder muscles). Trigger points develop due to acute trauma or repetitive micro trauma which stress muscle fibers.

Trigger point injection therapy is utilized to soothe muscle pain & break the chronic pain cycle. A combination of injectable anesthetic, dextrose & vitamins are used to numb & soothe painful muscles; with the goal of inactivating the trigger point. Trigger point injections are a short term therapy. Injections are administered 1-2 weekly for 4-8 weeks, depending on extent & age of injury. The goal is to increase therapeutic responsiveness to other treatment modalities (massage, acupuncture, chiropractic adjustments, regular stretching, exercise) in order to restore pain free functionality of affected muscles and joints.

An injection session begins with an interview, followed by a physical exam to assess your musculoskeletal concerns. Injections into your muscles are performed in a quick procedure, generally patients lie down when these are administered. Anesthetic effects are noticeable within 10-60 minutes. Results last 24-72 hours, depending on extent of injury & number of injections administered. Stretching & mild exercises are encouraged after treatment.

Other treatments for trigger points include acupuncture, massage therapy, chiropractic manipulations, hydrotherapy, physical therapy & therapeutic lasers & ultrasound.

Chronic pain cycle:
With an injury or trauma, our body perceives an immediate onset of pain, this short term onset is called acute pain; if this pain continues, it becomes chronic pain. With pain, we avoid activities & motion which aggravate us, or we continue our normal range of motion, despite the pain, in order to live our lives. This leads to a progressive deconditioning of our body which increases pain perception. This chronic pain cycle is a target of trigger point therapy.

Perineural Injection Therapy (PIT)

Perineural Injection Therapy (PIT) is a proven safe, effective treatment for patients who may not be candidates for joint replacement surgery or biologic options such as stem cell injections or PRP. Perineural injection therapy treats inflamed and injured nerves. Chronic nerve pain is often due to trauma, arthritis, sports, overuse, occupational, and surgical injuries.

Any sensation that is perceived by the brain is transmitted to the brain via the sensory nervous system. This is true for sensations like pain, temperature, vibration, or pressure. For example, when a nerve is stimulated by pain, the individual nerve cells generate an electrical current that is carried by the nerve to the spinal cord and then to the brain.

Imagine the individual nerve cell as being a room with a door (scientifically termed a receptor). When the nerve cell is stimulated, the door (receptor) opens and let sodium, potassium, calcium, and other molecules in and out of the cell such as shown in the illustration below. When this occurs and moves from one room to the next, an electrical current is created termed an action potential. When the stimulation is complete, the door once again closes. If the nerve is injured for whatever reason, this mechanism is disrupted.