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  • Writer's pictureNitish Mandal

Myofascial Trigger Point Injection With Minimal Dose Steroid. the Truth!

What is a Myofascial trigger point?

Myofascial Trigger point ( MTrP) is a firm knot in a muscle which is painful on light to firm pressure. It causes pain, stiffness and tightness in the muscle and surrounding area. The pain can be quite severe.

Which muscles commonly get Myofascial Trigger points?

These are commonly found in muscles that maintain posture. Hence they are common in back and neck muscles, followed by hips, hamstrings and calf muscles. The most common is the trapezius muscle.

What causes this Myofascial Trigger point?

The main cause is repeated or prolonged stress on a muscle. For example, bad posture puts prolonged stress on the posture muscles. That's why IT professionals get pain in the neck muscles (prolonged looking down) and back muscles (prolonged sitting). Injury and trauma may also cause MTrP.

What really happens to the muscle at the Trigger Point?

The outdated, overly simplistic belief was that it is just a knot-like structure where muscle fibres have become tight. But in reality, it is a complex structure with neuroinflammation at its heart. Repeated or prolonged stress at a point leads to tightness in the beginning. But it progresses into inflammation of the nerve to that point. In more advanced stages, peripheral and central sensitisation occurs, which means that the nerve and its connection all the way up to the brain become hyper-reactive. The nerve keeps telling that muscle area to keep contacting, not letting it relax.

How is MTrP diagnosed?

The traditional way is to find a painful knot by carefully pressing the painful muscle. Some knots are not painful, called latent MTrPs, they may become painful later. Sometimes a very thin needle is inserted into the trigger point. A twitch will confirm that the knot is indeed a trigger point. But the most useful way to diagnose is a DIAGNOSTIC BLOCK. Here a very low dose of a local anesthetic is injected into the trigger point. This works within a few seconds to numb the trigger point. If the pain goes away completely, all of it is coming from that trigger point. If it goes away partially, then there are more points in that muscle. In this way, a diagnostic block not only confirms the trigger point but can also indicate how much of the pain is coming from that point, and how much pain relief will come by treating that point.

What are the treatment options for myofascial trigger point, MTrP?

The treatment options are many, from simple measures in the early stages to targeted injections in later stages Simple measures like massage, stretching and manual release of knots work in very early stages, when the changes are limited to the muscle. A slightly more effective option is dry needling where only a needle is inserted into the Myofascial Trigger Point repeatedly. This works in early to slightly later stages. The most effective treatment in all stages, but necessary in later stages, is a low-dose injection of a depot steroid directly into the Myofascial Trigger Point. This steroid is designed to stay where it is injected. It stays in the Myofascial trigger point and reduces the nerve-muscle inflammation.

Should I try other methods before taking a depot steroid?

Yes, but not for too long, because the nerve sensitization keeps increasing if effective pain relief is not provided quickly. Some patients keep getting stretching and dry needling for weeks without any significant relief when the pain keeps increasing and spreading to other areas. This may lead to central sensitization, and the pain becomes very difficult to cure. If the stretching, massage or dry needling becomes too vigorous, that itself may lead to a shooting up of the pain.

What are the side effects of this injection?

This special steroid is directly injected into the trigger point, hence the dose is very low. Secondly, it does not get absorbed, so it does not harm the liver, kidney or other organs. The side effects of steroids occur when taken in higher doses or for longer times. They don't occur when taken once, in low doses.

But they say there are a lot of side effects of steroids.

Who are they? Doctors who are using this don't say this. Only a proper doctor, with at least an MBBS degree is eligible to give this injection. Any other medical professional cannot do this procedure. So they have neither studied it nor have any experience with it. Discuss the side effects with your doctor. He is the best person to tell you.

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