What is a Trigger Point?
A trigger point is an irritable, painful, taut muscle band or palpable knot in a muscle that can cause localized pain or referred pain. Referred pain from trigger points can mimic pinched nerves in the neck or lower back. They can occur from direct muscle injuries, poor posture, repetitive strain or secondarily from spine conditions such as a herniated disc.
Trigger point injections are injections of local anesthetic (numbing) medication, saline and/or corticosteroids (anti-inflammatory medication). The basis for a trigger point injection is to relax the area of an intense muscle spasm. By relaxing the muscle spasm, blood flow to the area is improved, thus allowing the washout of irritating metabolites (the body’s exhaust products). Trigger point injections can be a tool to treat myofascial pain syndromes and fibromyalgia.
Hyaluronic acid is a key component of healthy joint fluid that lubricates the joint, much like oil lubricates engine components. The knee continuously produces its own hyaluronan. In osteoarthritis, there is a decrease in the amount of hyaluronan in the joint fluid and the hyaluronan molecules break down, becoming less effective at lubricating the joint.
There are several types of replacement hyaluronic acid medications that can be injected into the joint after removing the old fluid. Think of it like an oil change for the joint.
How do viscosupplementation injections work?
The injections are thought to work by helping the knee normalize the hyaluronan in the joint fluid. The injections may also reduce inflammatory cells in the knee and reduce nerve impulses that cause pain. Hyaluronan injections are very safe. The chances of a significant adverse reaction (severe knee swelling, hypersensitivity reaction) are about 3 in 1000. This is much lower than the risk associated with gastrointestinal problems from taking anti-inflammatory medications such as ibuprofen.
Corticosteroids are powerful anti-inflammatory medications that are very effective for decreasing inflammation in the body triggered by acute injuries. By injecting cortisone into a specific area of inflammation pain can be lessened quickly to help facilitate physical rehabilitation and recovery from an injury.
This treatment is used sparingly in our Regenerative Medicine and Functional Medicine model only to “rescue” the patient from pain and facilitate other treatments to address the underlying problems.
Corticosteroids used repeatedly can suppress your body’s natural healing mechanisms and actually weaken tissues in time leading to accelerated degeneration.
Common conditions where inflammation is an underlying problem may include, but are certainly not limited to, shoulder bursitis, arthritis, trigger finger, tennis elbow, carpal tunnel syndrome, SI joint dysfunction.
This procedure is done under fluoroscopic (X-ray) guidance and the medication is directed at irritated nerves often times from lumbar (low back) disc injuries causing back pain and radiating pain into the leg or legs.
A nerve block is an anesthetic or anti-inflammatory injection targeted toward a certain nerve or group of nerves with the intent to treat pain. The purpose of the injection is to “turn off” or reset the pain signals coming from a specific location in the body. The nerve block allows a damaged nerve the time needed to heal itself from a state of constant irritation, or can also allow the nerve and nervous system to “reset” and not cause as much pain.
Ultrasound guidance is commonly used to place a needle in the precise location to safely block the nerve. Conditions with acute or chronic pain might have a nerve block injection to achieve temporary pain relief.