Trigger Points & Soft Tissue
Trigger Point Injections
Trigger point injections involve injecting local anesthetic (and sometimes corticosteroid) directly into myofascial trigger points — painful, taut bands within muscles that cause localized and referred pain patterns.
Conceptual illustration
Medically reviewed by Joshua L. Hare, DO, Founder & Medical Director
Updated October 2026
Conditions Treated
Myofascial pain syndrome, tension headaches, fibromyalgia tender points, chronic neck and back muscle pain, TMJ-related myofascial pain
| What it treats | Myofascial trigger points, focal "knots" located in a taut band of skeletal muscle[1] |
|---|---|
| What is injected | Local anesthetic, which may include a small amount of corticosteroid, such as triamcinolone[1] |
| Visit length | 10 to 20 minutes, depending on how many trigger points are treated |
| Afterward | Mild muscle soreness for a day or two; normal activities right away |
| Evidence | Four randomized trials in acute muscle pain: results significant and consistent in favor of trigger point injections[2] over medical management alone |
| Works best with | Stretching and physical therapy, which injections can make possible for patients otherwise intolerant of physical therapy or stretching[3] |
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Insurance we acceptWhat a Trigger Point Is
Myofascial trigger points are focal "knots" located in a taut band of skeletal muscle first described by Dr. Janet Travell in 1942.[1] These points are usually palpable and produce a characteristic referred pain upon palpation, along with pain locally and occasionally a local twitch response.[1] Referred pain means that pressing on a knot in one muscle is felt somewhere else: for example, myofascial pain in the infraspinatus muscle typically refers to the anterior deltoid area, the lateral aspect of the arm, and the radial half of the hand,[4] that is, the front of the shoulder, the outer arm and the thumb side of the hand.
Trigger points may be formed after acute trauma or by repeated micro-trauma, leading to stress on muscle fibers.[1] Risk factors include muscle injury, overuse and poor posture, spinal problems such as scoliosis and arthritis, and systemic factors, such as hypothyroidism, vitamin D deficiency, and iron deficiency.[4] Estimates of how often myofascial pain is the problem range from 30% to 93% of patients seeking care for musculoskeletal pain,[4] and the most frequently affected areas include the neck, shoulders, and back.[4]
The most common muscle groups treated using trigger point injections include the masseter, levator scapulae, gluteus medius, quadratus lumborum, trapezius, sternocleidomastoid, and temporalis muscles.[1] The masseter and temporalis are jaw muscles, which is how trigger points take part in jaw (TMJ) pain, and trigger points affecting the trapezius muscle may clinically manifest as tension headaches, pain in the neck, shoulders, and proximal arms.[1]
The treatment explained
How Trigger Point Injections Work
Pathogenesis of trigger points is thought to be related to abnormal motor end-plates within a muscle where the motor and nociceptive nerves co-exist,[1] the junctions where nerve meets muscle. One of the most accepted theories is the energy crisis of muscle fibers:[4] overload leaves the fibers short of oxygen, their calcium pumps falter, and the result is increased intracellular calcium and sustained muscle contraction responsible for taut band development.[4]
Injections are believed to cause a temporary relaxation of the taut muscle cord, which in turn allows for improved perfusion,[1] restoring blood flow and clearing waste from the muscle, and these factors assist in breaking the pain-tension cycle.[1]
Stimulation of the local twitch response in direct needling of the TrP is valuable in achieving immediate effect,[3] and across the injection studies the key component involved placing the needle into a taut band, which resulted in improved pain compared with baseline.[3] The brief twitch you may feel during the injection is a good sign, because it shows the needle has reached the trigger point. Afterward, less post-needling soreness is associated with the injection of local anesthetic.[1]
Candidates
Who Is a Candidate for Trigger Point Injections
Injections are used for an identifiable palpable tender area that produces a referred pain pattern,[1] and common concomitant symptoms include chronic or episodic headaches,[1] jaw (temporomandibular joint) pain, back pain, groin pain and reduced range of motion.
Myofascial pain syndrome is primarily a clinical diagnosis,[4] made by examination: the physician feels for taut bands of contracted muscle in the affected region[4] and for the spot that reproduces your usual pain. Imaging is used to look for other causes, since diagnostic ultrasound can exclude bursitis and tendinopathy,[4] and TPIs should be considered in patients once a thorough evaluation is completed to rule out other causes of back pain,[3] such as a disc problem, a fracture or spinal stenosis.
TPI is best used as part of a comprehensive multimodal treatment plan,[3] and it can be particularly beneficial when TPI is initially used to reduce pain in patients otherwise intolerant of physical therapy or stretching.[3]
Treatment day
What to Expect During Trigger Point Injections
A visit takes 10 to 20 minutes, depending on how many trigger points are treated. You sit or lie down depending on where the trigger points are, the skin is cleaned with alcohol pads or chlorhexidine 2%,[1] and some providers prefer to mark each trigger point with a skin marker[1] before starting.
The physician pinches the muscle between finger and thumb to hold the trigger point steady, then inserts the needle, attached to a small syringe, at a 30-degree angle into the trigger point,[1] needling the spot by repeatedly inserting and retracting the needle without completely withdrawing the needle from the muscle.[1] That continues until muscle twitching has subsided, or until the muscle feels adequately relaxed.[1] Before injecting, the physician aspirates, pulling back on the plunger to ensure the needle is not in a vascular structure,[1] then injects 0.2 to 1 mL of selected solution into the point.[1]
The injection is usually lidocaine or bupivacaine without epinephrine,[1] sometimes with a steroid such as triamcinolone added. Ultrasound guidance can be used to confirm desired structure and depth while avoiding neurovascular structures.[1]
Clinical evidence
How Well Trigger Point Injections Relieve Muscle Pain
A 2023 meta-analysis pooled four randomized controlled trials[2] comparing trigger point injections with medical management alone for acute myofascial pain, and found that trigger point injections were effective in reducing pain scores compared to medical treatment.[2]
An emergency department trial compared injections with intravenous anti-inflammatory medicine for low back muscle pain: of 54 patients enrolled in this RCT, TPIs were found to have superior analgesic effect compared with IV NSAIDs at all studied time points up to 60 minutes after intervention.[3]
Systematic reviews confirmed that dry needling and local anesthetic injection have therapeutic effects on myofascial pain syndrome,[4] and the StatPearls chapter calls trigger point injections an effective primary or adjunctive therapy aimed at decreasing pain in the musculoskeletal system,[1] noting that patients can have significant improvement in range of motion and overall functionality, without the need for taking pain medications.[1]
Afterward
Recovery and Keeping Trigger Points Away
Mild muscle soreness for a day or two is expected, and you can go back to your usual activities right away. Stretching and heat are recommended in the days afterward.
The goals of myofascial pain syndrome treatment are pain relief and, more importantly, the correction of precipitating factors to avoid relapse in symptoms.[4] All patients should be educated about stretching exercises and ergonomic modifications,[4] and some causes are medical: patients with vitamin D deficiency require vitamin D supplementation to achieve a curative effect.[4]
Because depression can lower the pain threshold, psychological interventions such as biofeedback and cognitive behavioral therapy are options to consider.[4]
Safety
Risks and Side Effects of Trigger Point Injections
Although serious complications are rare, there have been case reports of complications particularly in the cervical and thoracic region.[3] The complications listed in the StatPearls chapter are pain, bleeding, infection, allergic reaction to the anesthetic agent,[1] systemic anesthetic toxicity,[1] the formation of a hematoma[1] and vascular injury;[1] a 2022 review adds that other complications that can occur include vasovagal syncope,[3] a brief faint. When a steroid is added, the risks also include cutaneous atrophy, bleaching of the skin,[3] meaning thinning or lightening of the skin over the injection.
The most commonly reported serious complication is pneumothorax,[3] a collapsed lung, reported especially when treating trigger points in the cervicothoracic region using a needling technique.[1] Specific attention to TrP technique and use of ultrasound guidance can help avoid this complication in the cervical and thoracic injections,[3] and for points along the rib cage the StatPearls authors recommend use of a pincer grip to bring the affected tissue away from the intercostal spaces.[1]
Single case reports describe severe hypokalemic paralysis[1] (hypokalemic: a sudden drop in blood potassium); a rare possibility of intrathecal injection[3] after a trapezius injection, meaning medicine reaching the spinal fluid; and a cervical epidural abscess. Local anesthetics can also injure muscle tissue (myotoxicity), although this effect has been seen in only a few case reports of myotoxic complications after local anesthetic administrations causing clinically relevant myopathy and myonecrosis after TPIs.[3]
Health Conditions to Mention Before Trigger Point Injections
The absolute contraindications in the StatPearls chapter are patient refusal,[1] active infection over the site of trigger point,[1] a local open skull defect,[1] and a trigger point that a needle cannot reach safely. Under anticoagulation guidelines, TPIs classify as a low-risk procedure,[3] but blood thinners, pregnancy and anatomy that is hard to identify all call for extra caution.
Relative contraindications include severe fibromyalgia,[1] a history of keloid formation[1] (raised, overgrown scars), a poorly controlled psychiatric disorder,[1] and being highly anxious or needle-phobic.[1] Tell us about any allergy to local anesthetic, because the chapter's advice is to avoid local anesthetics in those with known allergies.[1]
References
Clinical sources for this page.
- Hammi C, Schroeder JD, Yeung B. Trigger Point Injection. StatPearls [Internet]. StatPearls Publishing; updated July 24, 2023. Back to first citation ↑
- Hamzoian H, Zograbyan V. Trigger Point Injections Versus Medical Management for Acute Myofascial Pain: A Systematic Review and Meta-Analysis. Cureus. 2023;15(8):e43424. Back to first citation ↑
- Appasamy M, Lam C, Alm J, Chadwick AL. Trigger Point Injections. Physical Medicine and Rehabilitation Clinics of North America. 2022;33(2):307–333. Back to first citation ↑
- Dua A, Chang KV. Myofascial Pain Syndrome. StatPearls [Internet]. StatPearls Publishing; updated April 13, 2025. Back to first citation ↑
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