What Are Trigger Point Injections?

Ultrasound-guided trigger point injections can be an important part of pelvic floor treatment. Ultrasound is a safe, non-invasive technology that helps pinpoint the muscle locations requiring relief. The injections are a natural anti-inflammatory medication with the gentle pain reliever lidocaine. The result is an improvement in the muscular and nerve-based disarray, along with increased blood flow which returns healthy levels of oxygen to the site. Peripheral nerve blocks are also used in some cases.

 

What Is a Trigger Point?

Trigger points are painful knots or nodules of muscle spasm that form when muscles do not relax. Many times, such knots can be felt under the skin. Muscle Overload, acute trauma or even a series of minor injuries can cause trigger points to form. In some cases, trigger points may irritate the nerves at a distance and cause referred pain – that is, pain felt in another part of the body, instead of where the underlying cause is located.

Watch How and Why Pelvic Floor Trigger Point Injections Work

How Does a Trigger Point Injection Work?

We perform external ultrasound guided trigger point injections.  Trigger point injections are able to get medication directly into the muscle knot and can often release the spasm immediately. These injections are an important part of pelvic floor treatment at our practice. The technique is also used when the pain in the body’s fascia does not respond to other treatments.

What To Do Before an Ultrasound Trigger Point Injection

Before coming in for a trigger point injection make sure to stay hydrated and do NOT come on an empty stomach. If needed take prescription strength ibuprofen 1 hour before treatment.
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What to Expect with Trigger Point Injections

Injections are given in our office and usually take a few minutes. Several pain locations may be injected in one visit. The result is increased blood flow, which returns healthy levels of oxygen to the site. This typically leads to improvement in muscular and nerve-based pain and discomfort.
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Do we go inside with the ultrasound probe?

No. In an ultrasound exam, a transducer (probe) is placed directly on the skin.  A thin layer of gel is applied to the skin so that the ultrasound waves are transmitted from the transducer through the gel into the body.

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Why do we use ultrasound guidance for our procedures?

Typically when we see a patient for the first time we do not use ultrasound to diagnose the patient as the ultrasound would not be able to show us the tone of the pelvic floor. The best diagnostic tool is our physical examination including internal examination through the vagina or rectum. However, we do use ultrasound for guidance. Ultrasound imaging helps the doctors during procedures (intraarticular joint injections, trigger point injections as well as peripheral nerve blocks) to locate where our needle is in relationship to the nerves, arteries and muscles. Ultrasound guidance has been recently associated with a reduction in complication rates and an increase in success rates.

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Which nerve blocks are you using the ultrasound for?

We use the ultrasound to help guide us in our injection for all of our nerve blocks. Based on physical examination findings we are able to selectively block the branches of the Pudendal nerve including, the Dorsal Nerve to the Clitoris, the Perineal nerve and the inferior rectal nerve. If necessary we also use ultrasound guidance to block the ilioinguinal, iliohypogastric, genitofemoral and posterior femoral cutaneous nerve and its branches.
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Which trigger point injections do you use the ultrasound for?

Often times trigger point injections can be done “blind” without ultrasound, however, the accuracy of these injections decreases when they are done without ultrasound guidance. It is important to do all the trigger point injections with ultrasound guidance “live” to ensure we are reaching the correct muscle in the levator ani (puboretalis, pubococcygeus, iliococcygeus) as well as obturator internus and piriformis muscles.

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What are the risks and benefits of using ultrasound?

Ultrasound imaging has been used for over 20 years and has an excellent safety record. It is based on non-ionizing radiation, so it does not have the same risks as X-rays or other types of imaging systems that use ionizing radiation.
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Why a series of injections?  

Trigger point injections work best in a series, as it can take multiple injections to reset the length tension curve of the muscle, and retrain it to remain in the lengthened state. There is a positive accumulative effect with each treatment.  Due to the large size of the pelvic floor, and the large number of branches off of the pudendal nerve, the best chance for pain relief is by doing a series of nerve blocks so that all of the branches off the nerve can be treated
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What To Do After Injection  

Patients are able to carry on with normal daily routines except wait to perform heavy exercise until the following day. Patients are encouraged to do physical therapy the same day but strongly recommended with 7 days. Sexual Intercourse is not limited from the injection series. Ice and heat as needed for the first 24 hours.
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Relevant Publications/Citations

[/et_pb_text][et_pb_blurb url=”https://www.youtube.com/watch?v=4ZCmLX5LmC0″ url_new_window=”on” image=”https://www.pelvicrehabilitation.com/wp-content/uploads/2019/07/Pelvic-Rehab-icon-65px.gif” icon_placement=”left” image_max_width=”65px” content_max_width=”100%” admin_label=”A6 – AS – CPPS” _builder_version=”3.26.6″ body_text_align=”left” global_module=”9718″ saved_tabs=”all”]

Allyson Augusta Shrikhande, MD. Interviewee on Pelvic Health Summit – CPPS. Pelvic Health Summit. 2018 May. Link to Interview.

[/et_pb_blurb][et_pb_blurb url=”https://www.pelvicpain.org/IPPS/Content/About/Medical-Education-Committee.aspx” url_new_window=”on” image=”https://www.pelvicrehabilitation.com/wp-content/uploads/2019/07/ipps-logo-for-medical-education-chair-Allyson-Shrikhande-65.png” icon_placement=”left” image_max_width=”65px” content_max_width=”100%” admin_label=”A8 – AS – IPPS” _builder_version=”3.26.6″ link_option_url=”https://www.pelvicpain.org/IPPS/Content/About/Medical-Education-Committee.aspx” link_option_url_new_window=”on” global_module=”9670″ saved_tabs=”all”]

Allyson Shrikhande, MD sits as the chair of the Medical Education Committee for the International Pelvic Pain Society. Link to Medical Committee.

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