Trigger Point Injections

What is a Trigger Point Injection?

A trigger point is a hyperirritable spot within a taut band of skeletal muscle that is painful on compression and that refers pain in a predictable pattern to a remote area. Trigger point injection places a small volume of local anaesthetic, such as lidocaine, directly into this knot under ultrasound guidance. The needle mechanically disrupts the contracted sarcomeres and abnormal motor endplate activity that sustain the trigger point, while the anaesthetic reduces the chemical irritant buildup that sensitises local pain receptors. The result is release of the taut band, immediate reduction in local tenderness, and resolution of the referred pain pattern.

A local twitch response, a brief visible contraction of the taut band when the needle engages it, confirms accurate placement and is associated with better outcomes. Some protocols add a small amount of corticosteroid when there is a significant inflammatory component, or use botulinum toxin for trigger points in conditions like cervicogenic headache where more durable muscle relaxation is needed.

What conditions does it treat?

Trigger point injections treat myofascial pain syndrome: a condition defined by active trigger points producing regional pain and restricted movement. In the neck, active trigger points in the upper trapezius, levator scapulae, and suboccipital muscles are a common driver of cervicogenic headache and the referred neck-shoulder pain that accompanies cervical spondylosis. Shoulder trigger points in the infraspinatus, subscapularis, and rotator cuff muscles cause deep shoulder pain that persists even after primary shoulder pathology has been treated. They are most effective as part of a combined programme that includes physiotherapy, as the underlying muscle imbalance that created the trigger points needs to be corrected.

What to expect

Before: No special preparation is needed. Wear comfortable clothing that allows easy access to the neck, shoulder, or back. Tell us about any blood thinners or known allergy to local anaesthetics.

During: You sit or lie in a position that relaxes the target muscle. The therapist palpates to locate the taut band, then under ultrasound guidance inserts a fine needle. You may feel a brief deep ache or see a muscle twitch. Multiple trigger points can be treated in one session. The full procedure takes 10 to 20 minutes.

After: Mild muscle soreness for 24 to 48 hours is normal, similar to delayed-onset muscle soreness after exercise. Heat and gentle stretching help. Some patients notice immediate relief; others see gradual improvement over a few days. A course of three to six injections, spaced one to two weeks apart, combined with physiotherapy and postural correction, gives the most durable results.