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Q What is the treatment called?
A The treatment is trigger point injection therapy. This is a short acting local anaesthetic. Injured muscles contain taut bands. The needle disrupts the taut band, the local anaesthetic helps the muscle to relax.
 
Q What happens when the local anaesthetic wears off?
A The local anaesthetic is used to assist the muscle to relax. It is not used to anaesthetise the area. Successful treatment depends on the skilled placement of the needle by the doctor.
 
Q Can trigger point injections injure the muscle?
A Repetitive injections of local anaesthetic into the muscle has no negative long term effects. It will not cause any scarring in the muscle.
 
Q What will the area treated feel like after the injections? What can I do to help recovery?
A
Initially the treated area feels sore and stiff. Intensive sessions can result in significant post treatment pain and it is always good to have a driver to take you home.
 
The very best thing to do as soon as possible after treatment is to soak for 20 minutes in a hot bath or spa. This consistently reduces the stiffness and soreness. Hot packs can then be used as frequently as desired and other sessions in the bath or spa will help over the next few days.
 
If your stomach can tolerate anti inflammatory medication this will help. If possible start the day before treatment and continue on the day of treatment and the next 2 days.
 
Regular stretching and heat is the key to quick recovery. Stretch for 30 seconds or longer to the point of discomfort, not severe pain. Hold the stretch steady. Do not “bounce” the stretch. Breathe deeply and slowly and let the rest of your body relax. This allows you to stretch a little further each time you breathe out.
 
Do your stretches as frequently as you can. Every two to four hours is good. If you want to stretch every 30 minutes that is better, but most people find this difficult.
 
Each stretch session should include two or three long stretches.
 
Avoid strenuous exercise or weight lifting of the part treated for two to four days. As a general rule when the injection pain has decreased to the point you feel comfortable you can resume normal activity. You can rely upon your common sense.
 
No danger will come to you if you resume too early. The pain might return but this can be attended to at the next session.
 
Q
Will I get any bruising?
A
Yes. In almost all cases some bruising will occur. This can be small or it can be large and impressive. In the arm and leg the bruise may track down and cause swelling of the wrist or ankle.
 
The bruising looks bad but is not a problem.
 
Note: the pain from the injections normally lasts four to seven days. The visible bruising may last two to three weeks. Patients commonly return to the next treatment, point to the bruise, and say “it is still sore because of the bruise”. The bruise is no longer sore, it is tight muscle beneath the bruise that needs to be released.
 
Taut bands often require several sessions to make them let go completely. Pain in the area treated after seven days means more injections are required into the same area. It is safe to inject through the bruise to release these stubborn taut bands.
 
Q
What if the needle hits a nerve?
A
This happens occasionally. When a taut band is injected the patient feels a deep intense grabbing pain. When the needle touches a nerve the pain is like electricity, very sharp and clearly different.
 
The doctor injecting can see this difference and the needle is immediately withdrawn.
 
The nerve does not suffer any permanent injury by being touched by the needle. The “nerve pain” subsides immediately or within a few seconds in almost all cases. A smaller group may take several minutes.
 
Occasionally the “nerve pain” may persist until the next session. This is usually intermittent and is a sharp catching pain with certain movements. There may be an area of skin nearby or at some distance from the injection site that is tingling or numb. This normally releases by a further injection into the same area where the nerve was touched. It is usually caused by a very focal segment of a taut band and the second injection produces a very brisk twitch response with intense deep pain plus the sharp nerve pain component. Following this the nerve symptoms normally are completely gone immediately following the procedure.
 
Very rarely the nerve will suffer injury that requires two to three weeks to recover. In 17 years of doing this specialist work I (Dr Whiteside) have not seen any nerve problem persist beyond that point, and I have only seen it once.
 
Q
Who is allowed to do trigger point injection therapy?
A
Only qualified medical practitioners can do trigger point injection therapy.
 
Q What is the technique called dry needling?
A Dry needling is better termed intramuscular stimulation (IMS). This is the use of acupuncture needles to release taut bands. It can be used by practitioners who are not doctors. Some physiotherapists use this technique. The IMS technique is a variation of the myofascial acupuncture described in the next section.
 
Q
Is trigger point injection therapy the same as acupuncture?
A
Traditional acupuncture is based on knowledge built up over many years and is directed to lines of energy within the body. Most acupuncturists in Australia use traditional acupuncture. This is totally different to trigger point injections in general and trigger point injection therapy in particular.
 
Trigger point injection therapy is a physical technique directed at palpable taut bands in skeletal muscles. When the needle penetrates the trigger point the taut band twitches (twitch response) and then relaxes with the assistance of anaesthetic.
 
There is a new acupuncture needle technique called Modern, Western or Myofascial Acupuncture. In Australia this is mainly practised by medical practitioners trained by Dr Simon Strauss in Queensland (www.pain-education.com.au). With this technique the acupuncture needle is inserted into the trigger point producing objective deqi (pronounced derchi). It is a complex and sophisticated method. This technique and Trigger point injection therapy will become integrated.
 
Q
What is myofascial medicine?
A
The study of those symptoms caused by myofascial trigger points. The main symptom is pain. Trigger points can also produce dizziness, nausea, changes in vision and hearing, increased nasal or sinus congestion, jaw problems, teeth pain, heart palpations, irritable bowel and altered menstrual cycle.
 
Q What is a taut band?
A
A taut band is a line of tightness within the belly of the muscle. It forms when the muscle suffers too much work over a period of time or after an acute injury.
 
It can be thought of as a type of fuse box mechanism. When the power coming into your house surges, the fuse breaks first to protect your electrical appliances. When a muscle is asked to do too much work, a taut band develops to restrict further use.
 
A myofascial practitioner can feel these taut bands by palpating your muscle. They can be very fine, like pieces of string in small muscles or large and thick in big muscles.
 
Q What is a trigger point?
A
This is the tightest segment along a taut band. It can be felt as a nodule or a longer part of the taut band. It is the most sensitive part of the taut band and when it is pressed it often refers pain into another area.
 
A trigger point exists where the nerves attach to the muscle at the motor end plate. The injury to the muscle causes continual irritation at this point. The muscle fibres bunch up and a taut band develops along that particular anatomical line.
 
Trigger point injection therapy is aimed at the trigger point. Accurate placement of the needle destroys the injured motor end plates and the unaesthetic cuts off their nerve supply to the spinal cord and the brain.
 
Q
Does Trigger point injection therapy produce a permanent recovery?
A
In a young fit individual with a local injury the recovery is normally quick and permanent. Chris Scott of the Brisbane Lions Football Club was treated at the beginning of 1998. During 1997 Chris played a total of two hours of football because of chronic hamstring problems. He travelled to Perth and stayed for two weeks and had four treatment sessions. He had no hamstring problems, and never missed a game through injury, for the next three years until he re-injured in the finals of 2000.
 
In those who are older or less fit it depends on the total health and attitude of the individual. Myofascial medicine is holistic. It asks why has this person failed to recover from this injury? Using advice about diet, stress and fitness the therapeutic environment can be improved.
 
If the patient really wants to make a full recovery, myofascial therapy can assist the return to good health.