Trigger Point Injections: What They Are, When They’re Needed and How They’re Performed

Find out how trigger point injections work, what the procedure entails, and what the post-procedural care requires. This treatment option for myofascial pain syndrome could help restore your quality of life.

Trigger point injections are designed as pain management for myofascial pain syndrome.  We’re helping you decide if trigger point injections are right for you by providing an in-depth definition of the procedure, when it’s medically justified, how it’s done, and what the potential side effects may be.

What Is a Trigger Point Injection?

Trigger point injections are intended to provide pain relief by inactivating (basically stunning or inhibiting) certain trigger points involved in the symptoms of myofascial pain syndrome. To do this, a health care professional inserts a small needle containing a local anesthetic or saline, and possibly a corticosteroid, into the trigger point causing the muscle pain in order to subdue it.

What Is Myofascial Pain Syndrome?

Myofascial pain syndrome is a muscle disorder that causes pain around what’s known as myofascial trigger points. It’s a distinct syndrome from fibromyalgia, which also causes tender points throughout the body, though both of these conditions could occur in the same patient at the same time, making each of them more difficult to diagnose and treat.

Myofascial trigger points are hyperirritable spots that create musculoskeletal pain. They may have palpable nodules that exist in taut bands of muscular fibers, and they are still not widely understood even in the medical community. Treatment of these trigger points can involve ultrasound therapy, manipulative therapy, spray and stretch therapy using a topical anesthetic, or trigger point injections.

Trigger point injections are not required for every case or even every trigger point, especially if noninvasive physical therapy is effective. However, if a trigger point experiences chronic pain in certain areas like the lower back, a small needle injection may be the most effective treatment. The injection may be a corticosteroid, an anesthetic like lidocaine or bupivacaine, or a mixture of both.

Indications for Trigger Point Injections

Trigger point injections are indicated for those patients who have health care findings consistent with active trigger points (distinct from latent trigger points that don’t need treatment as they are asymptomatic). Other widespread pain disorders such as endocrine disorder or fibromyalgia are not eligible for trigger point injections unless they have myofascial pain trigger points also.

Seek medical advice to decide if injecting these points of muscle spasm is the safest way to treat painful areas, including the trapezius muscle (upper back and neck pain), the erector spinae muscles (along the spinal cord), the iliocostalis muscle (low back pain), and other areas of muscle which, if afflicted, can cause referred pain (pain felt in other areas that are not the origin spot), tension headaches, and a decline in quality of life.

Your doctor will examine your skeletal muscles for a local twitch response (a contraction or dimpling of the skin as muscle fibers tense), take into account your pain level and “jump response” to the exam, and discuss your various treatment options.

Contraindications for Trigger Point Injections

Trigger point injections have contraindications for:

  • Those with bleeding disorders or those on anticoagulants
  • Pregnant patients
  • Patients who are ill or who have conflicting medical conditions
  • Those with a higher risk of infection (such as those with diabetes mellitus or who are debilitated)
  • Patients on steroids

While a steroid injection can act as a nerve block, there have nevertheless been studies that show dry needling (needling without injection, akin to acupuncture for musculoskeletal disorders) may provide some relief, though a scientific consensus has not yet been reached. Researchers also warn against “sham needling” practices that are not done by properly trained medical personnel.

Trigger Point Injection Procedures: What to Expect

Here’s what you can expect at a trigger point injection procedure.

  • The needles involved will be long enough to reach the deepest muscles requiring treatment.
  • The area will be sterilized before injection.
  • Your health care provider will prepare the injection with local anesthetics and/or steroids.
  • The doctor will position you for best access to the affected muscle groups, and may also use ultrasound guidance to precisely pinpoint the injection.
  • Your clinician will isolate the trigger point area by pinching the skin between their fingers to keep it in place during the injections (the needling and injecting will be repeatedly redirected without removing the needle from the subcutaneous level of the skin).
  • This treatment of trigger points will include post-procedural care on your part: resting for 1-2 days and avoiding strenuous activity and pain-provoking activities that could overstress the muscles.

Your doctor will make sure you’re aware of potential complications resulting from trigger point injections, which could include vasovagal syncope (sudden fainting), hematoma formation, skin infection, pneumothorax (a collapsed lung), or needle breakage.

Trigger point injections: how they work.

Post-procedural Care

To ensure the best success with trigger point injections, post-procedural care may include the following.

Proper Stretching

While it’s important not to overstress the muscle, it is still recommended that you use your muscles to their full range of motion to help relieve stiffness and reclaim normal muscle functioning. To help your muscles relax and optimize the effects of the injections, stretching after your trigger point injections is an integral post-procedure component.  Your doctor will most likely stretch you as soon as the procedure is complete, and then send you home with instructions to continue proper stretching on your own.

Active Exercise

The whole purpose of undergoing trigger point injections is to restore full use of your muscles, and active exercise will help determine whether or not the treatment was effective. These exercises will target muscle stretching, muscle strengthening, and muscle conditioning to help relieve myofascial pain. Staying active with exercise will also help reduce the chances of developing more trigger points in your muscle fibers as you increase your muscle endurance.

Once you’ve built up enough strength via training, conditioning exercises like jogging, jumping rope, tennis, swimming, and/or bicycling are encouraged at least twice a week going forward.

Don’t Be Triggered

Alleviating neck, back, and shoulder pain are major aspects of physical medicine, and getting expert help with treating myofascial pain syndrome can help improve your quality of life while living with this musculoskeletal disorder. Trigger point injections are the last hope for pain relief for many, and they may finally bring you the treatment you need.

Building Muscle After 50: Top 7 Tips to Go from Sedentary to Stacked

Discover how to build muscle and maintain strength after turning 50: types of workouts, frequency of workouts, and how to supplement effectively now that you’re half a century strong.

One of the biggest concerns that face us as we age is muscle loss. Age-related muscle loss begins in our 30s and ramps up after 50. In advanced years that muscle loss can ultimately contribute to frailty if it’s not combated with proactive muscle building along the way. While those who have kept up with physical activity throughout their 20s and 30s have a much better foundation to build on, it’s never too late to begin weight training or resistance training, gaining muscles that get stronger the more they’re used. Because of these reasons, building muscle after 50 is necessary to keep you healthy and active for the rest of your life.

Sarcopenia: The Silent Breakdown

Age-related muscle loss is known as sarcopenia, and it’s one of the reasons that some of our grandparents lose their independence. The muscle loss that begins in our 30s and doubles down in our 50s gets even more aggressive after 70, but it’s not necessarily a downward slope. Studies show that we can gain muscle clear into our 90s, so not only is building muscle after 50 in the cards, but building muscle after retirement is a go as well. So what’s the holdup?

The issue is aging, and the fact that while we’re young we often don’t have to work as hard to stay fit and recover quickly. Side effects of aging come on gradually, and muscle-building efforts need to increase along with it. Maintenance just won’t cut it: to build muscle we have to challenge ourselves to workouts that are hard to perform at first, and when that level is mastered, we have to go harder.

Octogenarian bodybuilder Ernestine Shepherd was interviewed by The Independent, and revealed that she didn’t start her targeted muscle-building efforts until she was 56 years old, and this was after a lifetime of no exercise and even being exempt from phys. ed. in school because of car accident injury she’d had as a child. Nevertheless Ernestine says that she went from being a receptionist (a sedentary job) to a professional bodybuilder, in better shape and with more energy in every new year. In 2010 she was declared the oldest competitive female bodybuilder by the Guinness Book of World Records.

If, like Ernestine you’re starting from scratch after 50, how do you begin? Read on for some starter tips.

Top tips for building muscle after 50.

The Top 7 Tips to Begin Building Muscle After 50

When a young man or woman decides to build muscle, it often takes no more effort than just trying. Some weight lifting, some cardio, and before these youngsters know it they’ve got muscle groups popping up in places they didn’t even know they had. But for older adults, building muscles is not just about losing weight and looking good, muscle gain starts to become vitally important to staying healthy and independent as we approach our 60s, 70s, 80s, and 90s.

As you age, not only do your joints creak and your hairs turn gray, but your muscle cells start to get eaten up and then not replaced. The younger we are, the more quickly the metabolic process revolves between catabolism (metabolism involving molecular breakdown to access energy) and anabolism (the metabolism of building new complex molecules like muscle proteins with that energy). When we get older, that process—along with so many others—slows down.

Reaching 50 is ideally the halfway point of a long and healthy life, and maintaining muscle strength is important if we want another strong 50 years on this earth. So without further ado, here are seven ways you can optimize your protein intake and start building muscle after 50.

1. Come to the Light

If you want to safely begin to build muscle after years of a largely sedentary lifestyle, you don’t want to head straight to the bench press. It’s not fun but it’s true: a twinge or a tweak to any one of your joints in these early days could snowball into a very severe injury if you’re not careful, derailing your efforts before you even really get going. You’ll get to the deadlifts and barbells soon enough after you’ve built up sufficient strength, but when starting out, start light.

Embracing lighter free weights can spur muscle growth without putting your wrist, elbow, and shoulder joints in any risk whatsoever. Studies show that more reps with lighter weights can stimulate protein synthesis just as well as lower amounts of reps with heavier weights. Lighter-weight training not only helps prevent initial injuries, but it also serves as a useful tool for repairing injuries. Similarly, higher reps with lighter weights leads to real muscle gain in older adults, so the only thing you’re losing out on is risk, not reward.

Once you build up a foundation of muscle, you and your joints will be strong enough to load up a barbell with ever-increasing weights, but as you begin, light is alright. Play to your strengths when it comes to strength training, and you’ll invariably improve as you age.

2. Stay on the Move

A sedentary lifestyle is dangerous to people at any age, but the damage done by inactivity compounds as we get older. To gain muscle, you have to not only incorporate a strength training program but also keep up with cardiovascular health. If your blood isn’t pumping well, you’re not getting the steady supply of oxygen and nutrients needed to build new protein for your muscles.

The cardio impact of walking and running changes in older adults, as seen in this 2010 study comparing younger (24 +/- 3 years) and older (64 +/- 6 years) participant groups. If you’re starting from scratch, begin with walking, increase to jogging and then treat yourself to new pair of running shoes, and know that you’re contributing to your muscle-building efforts with every new mile you cover.

3. HIIT Back

High-intensity interval training (HIIT) is a great way to burn calories and build muscle quickly for all ages and fitness levels. HIIT is characterized by alternating short bursts of intense physical activity with periods of rest, and according to the Mayo Clinic, it can particularly benefit seniors down to the cellular level, and even reverse certain symptoms of aging.

While experts don’t recommend that every workout be a HIIT workout, cycling it into your workout regimen can help push your abilities to higher heights. And if you’re in a HIIT class full of athletes, just remember that your high intensity is different from their high intensity, and that’s a-okay!

4. Rest to Recover and Rebuild

Regular exercise doesn’t mean constant exercise, and in fact research shows that rest days are just as valuable for muscle building as workout days are. Recovery time means rebuilding time for your muscles, while overtraining syndrome occurs when excessive exercise is paired with an inadequate amount of resting time. The results of overtraining come with side effects that disturb the body’s neurologic, endocrinologic, and immunologic processes, along with the unwelcome symptom of mood changes.

Your recovery times over 50 may be longer than they would be if you started working out in your 20s or 30s, but you’ll know your body best: rest as long as you need, and then get back at it with the gains you’ve made.

5. Stretch It Out

If your muscles are tight, it’s imperative that you stretch them. Stretching before (particularly dynamic stretches) and after your workout helps to limber up the muscle fibers and reduce the risk of muscle strains and sprains, whether you’re working out on your own or under the guidance of a personal trainer.

A full-body workout is not complete without stretching, so be sure to pencil it in, as increased flexibility can help you avoid injury and perform better in your workouts.

6. Good Things Come in Threes

Have you heard of the rule of thirds? It’s a photography guideline for visually pleasing picture compositions. Do you know what “omne trium perfectum” means? It’s Latin for “everything that comes in threes is perfect.” Those rules apply to your strength-training workout frequency too: 3 days a week is a perfect minimum.

While the more’s the better, especially if you’re diversifying your workouts (lift weights on one day, go for a run on the next, etc.), it’s nevertheless true that strength training at least 3 days a week can lead to good progression in muscle building and is a great place to start.

7. Feed Your Need

You cannot make muscles without protein. More specifically, you cannot synthesize new muscle protein without a proper amount of all nine essential amino acids. Most people looking to build muscle know that a high-protein diet and possibly consuming whey protein supplements will help them in gaining muscle, but just because you’re getting enough protein doesn’t necessarily mean you’re getting all the amino acids required to build lean muscle without your body cannibalizing the other muscle cells you have to supply the demand.

Research shows that consuming protein regularly throughout the day and especially after a workout helps stimulate muscle protein synthesis to its optimal degree in elderly people who are well advanced beyond age 50. To gain muscle while maintaining what you already have built, we recommend choosing a muscle-building protein supplement that has a full host of balanced amino acid content so you have all the ingredients you need to create new muscle.

You’ll Muscle Through

Building muscle mass is far from being a young person’s game: it’s everyone’s game to play and to win. While it’s important to start cautiously if you’ve never worked out before, it’s never too late to start building muscle, and the more you gain, the younger you’ll feel, as it’s been scientifically proven that proper fitness can reverse certain aspects of the aging process.

The health benefits of building muscle after 50 go far beyond improving your body weight and maintaining a trim physique. The strength-training efforts you start today can help you lose weight and, according to the American Bone Health organization, also help improve your bone density, which will matter more and more in the coming decades. Lifting weights or engaging in HIIT exercises 3 times a week could mean staying strong for the rest of your life.

Muscle Atrophy: Causes, Treatment and Prevention

Learn about what causes muscle wasting or muscle atrophy, and how best to prevent and treat this condition, including through the use of physical therapy, medical intervention, and staying active. 

Muscle atrophy is essentially muscle wasting: it’s what happens when your muscles waste away, frequently as a result of a lack of physical activity. This article will explore the causes and symptoms of muscle atrophy, as well as preventative steps people can take if they’re immobile or bedridden due to illness. Loss of muscle mass or muscle strength can be particularly devastating for those who are already in positions of compromised health, and so in an effort to help you maintain your quality of life, we’ve compiled the relevant information here.

Muscle Atrophy: Definition

Atrophy of the muscles occurs when a person is inactive for so long that their skeletal muscles (these are the muscles attached to your bones which literally make your skeleton move) begin to break down, and the muscle protein is cannibalized by the body. This can happen in small instances or large, catastrophic instances.

Muscle atrophy of the hand or forearm may occur if you spend weeks in a cast to heal a broken arm, which is why people in casts are given exercises to do while they’re immobilized to prevent protein degradation in their muscles and muscle wasting. Muscle atrophy of the legs or muscle atrophy of the thighs can happen on a much larger scale to those who become wheelchair-bound, either temporarily or due to becoming permanently paraplegic. In even more extreme cases, those who have been held as prisoners of war may have full-body muscle wasting due to confinement and malnutrition for significantly long periods, sometimes years.

Muscle atrophy is a decrease in muscle mass, either partial or complete, which is most commonly suffered when a person becomes disabled or their movements severely restricted. This makes it difficult or impossible to move the part of the body where the muscle has atrophied, and medical advice should be sought for solutions.

Muscle atrophy: causes, treatment, and prevention.

Muscle Atrophy: Causes

Significant decreases in activity levels can lead to muscle atrophy, and there are many situations where that can occur, causing what’s known as disuse atrophy. There are also instances of muscle atrophy due to medical conditions that inhibit the use of a body part, and even rarer causes like the muscle atrophy experienced by astronauts after relatively short periods (a few days) of weightlessness. Muscle atrophy in situations of being bedbound or ceasing intense physical training can come on in as little as 2 weeks. Some of the other causes of muscle atrophy are as follows.

  • Lack of physical activity
  • Advanced aging
  • Malnutrition
  • Stroke
  • Alcohol-associated myopathy
  • Burns
  • Temporary disabling injuries (broken bones, torn rotator cuff)
  • Permanently disabling injuries (severed spinal cord, peripheral nerve damage)
  • Prolonged corticosteroid therapy

Some of the diseases and medical conditions that can disrupt or restrict movement, thus leading to muscle atrophy, include:

  • Spinal muscular atrophy: A hereditary wasting disease of the limbs.
  • Osteoarthritis: Degeneration of bones and joint cartilage that leads to decreased movement.
  • Polymyositis: An inflammatory disease of the muscles.
  • Amyotrophic lateral sclerosis (ALS or Lou Gehrig’s disease): Compromises the nerve cells of the spinal cord.
  • Muscular dystrophy: A hereditary disease that causes muscle weakness.
  • Multiple sclerosis (MS): An autoimmune disease that destroys the protective sheathing of brain and spinal nerves.
  • Rheumatoid arthritis (RA): A chronic inflammatory disease of the joints.
  • Dermatomyositis: Inflammation of the skin and underlying muscle tissue.
  • Polio: A virus afflicting muscle tissue, which can lead to paralysis.
  • Cancer cachexia: The weight loss, lack of energy, and loss of appetite in someone undergoing cancer treatment.
  • Guillain-Barré syndrome: An autoimmune disease and form of polyneuritis, which leads to paralysis of the limbs.
  • Neuropathy: Nerve damage that results in loss of sensation or functioning.

Muscle Atrophy: Symptoms

Regardless of the cause, these are the symptoms that may alert you to possible muscle atrophy, after which a trusted medical professional should be sought for advice.

  • One of your limbs (arms, legs) appears markedly smaller than the other one.
  • You’ve spent a long time physically inactive (bedridden, hospitalized).
  • You’re experiencing noticeable weakness in one limb.

Not to be flippant about the subject, but there is some truth to the phrase “use it or lose it” when it comes to muscle. If you cannot move your muscles with regular physical activity, you will start to lose them.

Muscle atrophy pain may or may not be a symptom, as that depends on the cause of the atrophy. Many people will begin to lose muscle before they are aware it’s happening, and will have to rely on visual muscle size to realize they need medical attention.

Muscle Atrophy: Diagnosis

Once you’ve gotten in contact with a medical professional, the diagnosis may involve your full medical history, a review of any previous injuries, as well as an evaluation of your symptoms. Diagnosing the atrophy may also involve diagnosing the underlying medical condition, which may require blood tests, X-rays, MRIs, CTs, a nerve conduction study, or a muscle and/or nerve biopsy to find out what could be causing muscle atrophy if it’s not readily apparently (as it would be if you’d suddenly become bedbound).

Can Muscle Atrophy Be Reversed?

Depending on the cause, yes. There are some cases where a proper diet, exercise, and physical therapy can not only reverse muscle atrophy, but also prevent it from recurring. However, this will not be the case in some disease-related forms of atrophy, and it is important that you consult your doctor on what your expectations for muscle atrophy recovery should be in restimulating protein synthesis and rebuilding your muscles.

Muscle Atrophy: Treatment

Again, this will depend on the diagnosis of the cause, and also the severity of your muscle loss, but the treatments for reversible muscle atrophy may be as follows.

  • Physical therapy
  • Exercise
  • Ultrasound therapy
  • Dietary changes
  • Surgery
  • Electrical stimulation

If a lack of movement caused this condition, regaining movement will go a long way towards fixing it, and moderate exercise like walking, along with physical therapy, may be a way to regain muscle strength without needing surgery to fix skin, tendons, or ligaments too tight to begin moving again (as in cases of contracture deformity that could be caused by malnutrition or burn injury scar tissue).

Muscle Atrophy: Prevention

There are ways to prevent muscle atrophy before it happens, and ways to guard against it if you were fortunate enough to recover your musculature after one instance of muscle loss. If preventing muscle atrophy is in your control (and, of course, sometimes it will not be), here are a few ways to maintain muscle strength in adverse circumstances.

Stay Active

If you’re in recovery from a severe illness or have just come home from the hospital after a debilitating accident, it’s not as if you’ll take up jogging right away. However, movements as small as walking to your mailbox each day, or around the block, or up and down a single flight of stairs, can truly make the difference in the long run when it comes to maintaining your mobility.

Stay Nourished

Depending on your condition, this may be difficult, but when your body lacks the proper nutrition to stay running, it will start to catabolize your muscles for its needs, which is a form of self-cannibalization or destructive metabolism that literally eats away at your muscles. Make sure you’re getting proper protein, if not from whole foods, then in the forms of protein shakes or supplements, as every little bit may help.

In fact, supplementing with amino acids has been proven to help accelerate muscle recovery in times of sickness and illness and can help boost your muscle-building gains. To learn more about amino acid therapy for muscle atrophy, give this informative article, written by one of the world’s foremost amino acid researchers, a read.

Seek Physical Therapy

Physical therapy is particularly valuable for those with severe injury recovery (such as a car crash survivor) or a neurological condition, as therapists provide professional guidance on what, and how, and how often to stretch your body to build strength.

Try Passive Movement

Another way physical therapy can help you even before you have the strength to help yourself is with passive movement. Passive movement requires the therapist to gently move your legs and arms for you. This is how you can begin to recover from a very deep muscle deficit and build up strength and muscle again.

Preventative Measures

Not only will the above advice help prevent muscle atrophy, but it can also help discourage bedsores in those who are bedridden due to illness, and reduce the chances of developing dangerous blood clots in the limbs. Likewise, these movements may prevent muscle stiffness, retraction, and nerve damage. Consult a medical professional or licensed physical therapist for more advice.

Eliminate Atrophy

If you are in danger of muscle atrophy, take steps to make sure your protein intake and nutrients are sufficient, including the use of a supplement if necessary, like Amino Co.’s essential amino acid supplement, which contains all of the essential aminos required to build new muscle cells and structures. Also, make sure that you stay active, no matter in how small a way, to preserve your muscle function and prevent your muscles from falling into complete disuse. You cannot always control your body’s condition, but if the type of atrophy you fear is the type that’s preventable, it’s well worth the effort to maintain the quality of life and movement you’ve come to expect.