As I near the end of my residency and reflect on the many things I have learned during my training, trigger point injections are one of the most profound.\u00a0 They have become a bridge that has helped me assist many a patient past a chronic condition into improved mobility and motility and reduced pain.<\/p>\n
My journey began when injecting the suboccipital region of a patient over a year ago.\u00a0 I injected the fluid into the tight area, pushed a little over one ml of fluid in and immediately upon withdrawing the needle re-palpated the tissue.\u00a0 I noticed that the tissue had almost completely normalized in under 3 seconds.\u00a0 I know that this was faster than the action of any medication injected into tissue.\u00a0 Thus, I began to question what I thought I knew and to reason and test my ideas. \u00a0I applied Dr. Ed Stiles\u2019 thinking process to injections.\u00a0 That is, to reason your way through the entire process and understand the principles behind each step.\u00a0 This applies to the type of injection, site selection, fluid selection and depth of injection.\u00a0 It has reaped many dividends and I would like to share that thought development here.<\/p>\n
First palpate the patient.\u00a0 Trigger points are supposed to radiate pain.\u00a0 That means that they are probably tight muscles, stretched ligaments or tendons, irritated nerve fibers, or bruised\/traumatized periosteum\/fascia (connective tissue).\u00a0 Each of these will have a different feel and perhaps a slightly different treatment to obtain the best results.<\/p>\n
Tight muscles will have a muscle belly that has a ropy feel and is usually painful to deep palpation (unless it is severely chronic).\u00a0 These muscle bundles have contracted fascia surrounding them that gives the characteristic \u201cfeel\u201d of a trigger point \u2013 that \u201cpop\u201d like piercing an orange rind with the needle.\u00a0 While dry needling will work here, my observation is that fluid volume matters far more than fluid content.\u00a0 1.5 ml per injection site has given me consistently good results (more on fluid choices later).\u00a0 I utilize the smallest needle I can (typically 25-30 gauge) and inject the tightest\/most painful portion of that muscle belly.\u00a0 Needle length\/depth of insertion will depend on the muscle being injected.\u00a0 I push the fluid over approximately 10 seconds to give the patient a chance to accommodate to the sensation.<\/p>\n
Ligaments and tendons are best mastered by instruction in prolotherapy.\u00a0 In my experience, injections into these areas are either to utilize the irritatve effect of the substance injected to cause inflammation, to reduce inflammation, or to release fascia\/connective tissue.\u00a0 I have found the latter to be the most beneficial in my clinic.\u00a0 Using the same rationale as above, I attempt to inject the tendon\/ligament or its surrounding tissue with approx. 1.5 ml\u2019s of fluid per site.\u00a0 Needle length\/depth of insertion will depend on the tissue being injected.\u00a0 Be careful to have the patient remain still during the process so as not to shear a needle.\u00a0 This has achieved good results.<\/p>\n
Fluid Choices:<\/p>\n
Normal saline \u2013 isotonic, does not irritate local tissue.<\/p>\n
Sterile water \u2013 not isotonic.\u00a0 Will cause local tissue crenation.\u00a0 Perhaps useful in small quantities for tissue inflammation.<\/p>\n
Vitamin B12 \u2013 methylcobalomin>hydroxocobalomin>cyanocobalomin \u2013 has some local tissue pain relief properties.\u00a0 Enhances patient’s energy\/healing ability for a short time.<\/p>\n
Procain (Novocaine)<\/p>\n","protected":false},"excerpt":{"rendered":"
As I near the end of my residency and reflect on the many things I have learned during my training, trigger point injections are one of the most profound.\u00a0 They have become a bridge that has helped me assist many a patient past a chronic condition into improved mobility and motility and reduced pain. My […]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":634,"menu_order":0,"comment_status":"open","ping_status":"open","template":"","meta":{"_et_pb_use_builder":"","_et_pb_old_content":"","footnotes":""},"class_list":["post-654","page","type-page","status-publish","hentry"],"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/osteopathicvision.com\/staging\/wp-json\/wp\/v2\/pages\/654","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/osteopathicvision.com\/staging\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/osteopathicvision.com\/staging\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/osteopathicvision.com\/staging\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/osteopathicvision.com\/staging\/wp-json\/wp\/v2\/comments?post=654"}],"version-history":[{"count":4,"href":"https:\/\/osteopathicvision.com\/staging\/wp-json\/wp\/v2\/pages\/654\/revisions"}],"predecessor-version":[{"id":839,"href":"https:\/\/osteopathicvision.com\/staging\/wp-json\/wp\/v2\/pages\/654\/revisions\/839"}],"up":[{"embeddable":true,"href":"https:\/\/osteopathicvision.com\/staging\/wp-json\/wp\/v2\/pages\/634"}],"wp:attachment":[{"href":"https:\/\/osteopathicvision.com\/staging\/wp-json\/wp\/v2\/media?parent=654"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}