What Are Trigger Points & Where Do These Muscle Knots Form?

Trigger points occur when the thick muscle bands, within the musculoskeletal system, are stretched too taut due to overuse, strain, or injury to those muscle band areas. Those stressed muscle points become fatigued and may develop spasms, scar tissue, tics, twitches, or other damage to the muscle which increases both the acute site pain while also often causing referred pain to another body area.

Trigger points occur most often in those groups of muscles that are often strained on a regular basis, and the exact location of these points varies depending on what muscles are involved. The small discrete area where trigger points develop is considered hyperirritable causing inflammation, increased tautness, and painful shortening contractions of the involved muscles.

Repetitive movements and ongoing strain of the muscles can eventually damage the fibers of the muscles leading to knots that cause extreme discomfort, limited range of motion and a decrease of mobility in the affected region.

It should be noted that trigger points often accompany other chronic conditions that negatively impact the musculoskeletal system in some way.

What Are the Common Causes of Trigger Point Pain?

  • Excess strain or overuse of muscle or group of muscles
  • Injury to the muscle – common in sports injuries
  • May occur alongside other chronic musculoskeletal disorders
  • Stress – emotional, mental, or physical
  • Awkward sleep position
  • Poor posture
  • Lifting injuries

List of Possible Symptoms Related to Trigger Points

Symptoms vary depending on the location of impacted muscles and differences in potential underlying causes or risk factors.

Symptoms include:

  • Pain felt in muscle bands – may hurt when palpated/pressed or can be chronic in nature
  • Referred pain is also common – pain in different areas due to the trigger points
  • Palpable nodules upon exam
  • Headaches – stress headaches
  • TMJ
  • Low back pain common
  • Tinnitus – ear ringing
  • Decreased mobility/flexibility in lower legs

Three Main Reasons for Using Trigger Point Injections for Pain Relief

Close-up of young physiotherapist doing a trigger point injection in patient back.Reason #1: May Provide Immediate Relief of Pain That Continues to Improve Over Time

Many, but not all, patients often feel some relief from their acute localized discomfort immediately or soon after the injection. Some treated individuals may take longer for the effects to occur or gradually feel relief within 48 to 72 hours, after several days or even weeks out from the injection date.

Reason #2: May Decrease Referred Pain, Improve Range-of-Motion & Needs No Recovery Downtime

Along with the localized pain decrease felt at the palpable knot site, patients often note improvement of referred pain and symptoms too. This usually safe and effective, minimally invasive treatment procedure also requires little recovery downtime.

Patients often report increased range of motion and flexibility of the treated area back to its pre-trigger point status.

Reason #3: Has Minimal Side Effects, May Be Used Alone or as an Adjunctive Therapy

If present at all, side effects from the injection usually entail minor soreness at the injection site, some bruising, and localized swelling that will decrease within a short time.

Refer to the contraindication list for cautions and restrictions on who should undergo this procedure.

What Exactly Is a Trigger Point Injection?

Trigger point injections are an effective treatment for pain and other discomforts related to myofascial trigger points. This treatment involves the use of needles injected into the trigger point where muscle pain and other symptoms originate.

This has been shown to be especially helpful for patients who are currently experiencing symptoms. Usually, a cortisol steroid, local pain relief medication, and/or other substances, designed to reduce area inflammation and relax the taut muscles, are added thereby disrupting the pain cycle often giving prompt relief of pain and other symptoms.

Sometimes, a trigger point injection will not have any medication, often referred to as dry needling, which is an acupuncture treatment. Dry needling is often preferred for patients who may have allergies to medications.

Patients may have more than one trigger point, and these may often be treated in the same session. This treatment is also helpful for the referred pain often felt by trigger point pain patients.

How to Prepare for Trigger Point Injections & What to Expect During the Process

Trigger Point Injections

Your healthcare provider will tell you if you need to stop any medications or prepare for the treatment in any specific manner. It is important to convey all medications, including over-the-counter drugs or supplements, that could interfere with the treatment. This generally refers to allergies, sensitivities, and any supplements or medications taken to prevent blood clotting.

Patients should also tell their healthcare provider if they have a phobia related to needles.

Wear loose and comfortable clothing to the treatment session. Most patients can drive themselves home afterward, but it is a good idea to have a driver at least for the first session until you know how the treatment will affect you.

Patients may be lying or sitting during the injections depending on the area of the painful muscle knot. After insertion of the needle, the provider will gently stretch the taut muscle and might apply pressure for about 2 minutes. The needles may be inserted in the same area a few times until the muscle stops twitching.

Many patients feel an immediate relaxation and relief of muscle pain, and most will note continued pain relief improvement over the next several days. Some patients do not notice the full effects of the treatments until weeks later.

Trigger point injections do not require extensive recovery time. However, strenuous activity, especially at the injection site, should be avoided for a day or two.

These injections may be performed concurrently or adjunctly with other treatment measures that include chiropractic stretches and adjustments among others. These injections may need to be repeated several times for full improvement and maximum level of success.

Contraindications for Trigger Point Injections

Patients who have allergies, especially with regard to pain relief medications, should not be given local anesthetics. Caution should be used for pregnant patients and those with pain trigger points in certain body areas like near the lungs or in hard-to-access regions.

While rare, serious complications, like lung deflation, may occur if injections are close to these organs. Other side effects could include dizziness or feeling faint during the procedure, slight injection site sting, or a serious life-threatening allergic reaction to medications or supplies such as an allergy to latex used in medical gloves and other items.

Persons with a history of certain psychiatric disorders, dementia or confused patients and those with needle phobias, history of keloid scar development, severe fibromyalgia pain, or suffering from a current illness, infection, or open wounds, especially at/near injection site, may require extra caution and special treatment related attention.


Trigger point injections can be an effective, fast-acting, and generally well-tolerated treatment for pain and muscle tightness symptom relief, and can be done in an office setting for most patients. This treatment may also help to restore usual mobility, ROM, and flexibility of body areas negatively impacted by trigger point discomfort.

Learn more about trigger point pain and injections or schedule a consultation appointment by contacting Louisville Medical Center located at 892 W. South Boulder Rd. Ste 101 in Louisville, CO 80027. Call for an appointment (970) 344-9551 or visit online anytime.