Myofascial pain — pain from tight, irritable bands in muscle — is one of the most common and least understood sources of chronic pain. It is rarely visible on imaging. It is often dismissed as “muscle strain.” And it frequently gets mistaken for other pain syndromes, delaying effective treatment. This guide explains what myofascial pain is, how trigger point injections work, and when they are the right treatment.
What Myofascial Pain Is
Myofascial pain refers to pain that originates in muscle tissue, particularly in small, focal areas of muscle that have become abnormally tight. These areas, called trigger points, feel like firm “knots” in the muscle. When pressed, they are tender, and they often produce referred pain — pain that is felt in a location different from where the trigger point is.
Myofascial pain is widespread. Most adults have felt it at some point — the stiff, tight area in the shoulder after a long drive, the knotted spot in the upper back after a stressful week. For most people, those acute episodes resolve on their own. When they persist, they become a chronic problem that can significantly affect function.
Common Locations and Referred Pain Patterns
Some of the most commonly treated trigger points and their referred pain patterns:
Upper trapezius. The large muscle running from the base of the skull to the top of the shoulder. Trigger points here often refer pain up the side of the neck and into the temple, sometimes mimicking a tension headache.
Levator scapulae. The muscle running from the upper cervical spine to the top of the shoulder blade. Trigger points produce a “stiff neck” feeling with pain radiating into the shoulder blade area.
Rhomboids. The muscles between the shoulder blades. Trigger points produce pain across the upper back and between the shoulder blades.
Infraspinatus. One of the rotator cuff muscles. Trigger points produce pain felt in the front of the shoulder, sometimes mimicking rotator cuff tendinitis.
Quadratus lumborum. A deep low back muscle. Trigger points produce lower back pain, sometimes with a pattern that mimics other sources.
Piriformis. A muscle deep in the buttock. Trigger points produce deep buttock pain and sometimes radiating leg pain that can mimic sciatica.
Gluteus medius and minimus. Side-of-hip muscles. Trigger points produce lateral hip pain.
Identifying trigger points requires a hands-on physical examination. The referred pain pattern often maps the trigger point to a predictable location, which is part of why an experienced physician can often identify the trigger point even when the patient’s chief complaint is pain somewhere else.
How Trigger Point Injections Work
A trigger point injection involves a small amount of local anesthetic (sometimes with a small amount of steroid) injected directly into the trigger point. Two mechanisms are thought to contribute:
- Mechanical disruption. The needle itself passing through the trigger point can help release the taut band.
- Pharmacologic effect. The anesthetic provides immediate pain relief, which may help break the cycle of pain and muscle tension.
For patients who respond, the effect is often noticeable during or shortly after the injection: a sense of the knot releasing, a reduction in the referred pain, improved range of motion in the surrounding joint.
Who Is a Good Candidate
Trigger point injections are typically a good fit for patients who:
- Have persistent muscle-based pain with identifiable trigger points on examination
- Have tried basic measures (stretching, heat, over-the-counter medication) without enough relief
- Have pain that is limiting activity, disrupting sleep, or interfering with work
- Are willing to engage in physical therapy and home care after the injection
They are less useful when:
- Pain is primarily driven by another source (a disc problem, joint arthritis) that has a secondary muscular component
- The patient is unable or unwilling to engage in physical therapy and activity modification, which are usually essential for durable improvement
What a Typical Visit Involves
A trigger point injection appointment typically includes:
- A brief review of your pain and the plan
- Physical examination to identify the active trigger points
- The injections themselves, each taking a minute or two
- Brief observation
- Post-procedure guidance
Most patients drive home afterward. Some experience mild soreness at the injection sites for a day or two.
Results and Expectations
Immediate effect. Many patients notice some improvement within hours.
Duration. Variable. For some, a single session combined with physical therapy produces durable improvement. For others, a short series of injections is more effective.
The broader plan. Injections alone rarely produce lasting improvement. The most durable results come from combining injections with physical therapy, home stretching, ergonomic adjustments, and sometimes stress management.
When Repeat Injections Make Sense
If a first injection session produces meaningful but incomplete relief, a second session is sometimes appropriate. A pattern of strong but short-lived relief from repeated injections usually signals that the underlying cause is not being fully addressed by the injections alone — the other components of the plan need more attention.
If a first session produces no benefit at all, repeating the injection is unlikely to help and the plan should be reconsidered.
Trigger Point Injections at Southwest Pain Management
Our clinics use trigger point injections for patients whose examination confirms active trigger points as a meaningful source of pain. We pair injections with physical therapy coordination and a broader plan tailored to your specific situation.
Frequently Asked Questions
Do trigger point injections hurt? The injection itself is briefly uncomfortable but typically well-tolerated. Soreness at the injection site for a day or two is common.
How is this different from dry needling? Both involve a needle placed into a trigger point. Dry needling does not include injected medication; trigger point injections do. They overlap in mechanism but differ in who performs them and what is delivered.
Is the effect immediate? Often partly. Many patients feel some immediate relief from the anesthetic component. The full effect, when present, usually develops over several days.
How many injections will I need? Varies by patient. Some get durable improvement from one session combined with physical therapy. Others benefit from a short series.
Are trigger point injections covered by insurance? Most insurance plans cover trigger point injections when they are used for appropriate indications. Specific coverage varies by plan.
What activities should I avoid after? Your physician will give specific guidance. Light activity is generally fine; avoid heavy use of the injected muscle for a day or two.
Request a Consultation
Contact Southwest Pain Management to discuss whether trigger point injections are the right treatment for your situation.
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The mission of Southwest Pain Management is to empower you to restore function, decrease pain, and live your life to its fullest.
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