We believe that the current use of Trigger Point Injections leads to limited results based on problems identifying the proper source of the pain as well as the lack of a uniform approach to treat the identified painful region. Instead, at NMPI we perform muscle-tendon injections, which target the true source of the patient's pain, thereby eliminating that pain and allowing the patient to return to a normal, healthy, active and pain-free life.

What is a Trigger Point Injection?

Trigger points, which are also called myofascial trigger points, are tender nodules in the muscle belly which are often believed to be a source of pain. Trigger Point Injections are injections into these identified nodules, usually of a corticosteroid, an anesthetic (such as lidocaine), or botox, in order to treat the perceived source of the patient's pain.

Why are TPI's flawed?

The problem with this approach is that there is no generally accepted way to diagnose and treat pain that is thought to be related to trigger points. All clinicians use pressure to the suspected painful muscle to find the painful nodule.

The treatment for the trigger points is generally some form of injection. Injection techniques vary from doctor to doctor - one doctor may use a tiny needle and inject botox, and another may use a large needle and inject many areas with lidocaine; both will say that they are doing Trigger Point Injections.

The Source of the Pain isn't Necessarily the Trigger Point

The nerves that transmit pain from the muscles are mostly found in the parts of the muscle that are connected to the tendon, and to the region where the tendon attaches to bone, not in the muscle belly where the trigger points are found. These true sources of pain  are not readily available to detection, especially in deeper muscles, by palpation alone. Injections only into the trigger point which ignore these other areas will generally result in only partial and temporary pain relief. This leads to the patient having to return for repeat injections into the same muscle.

How The M.P.D.D. Can Help

Our electrical instrument, the Muscle Pain Detection Device (MPDD) can detect pain in all the areas mentioned above that cause pain in a muscle. A recent study at the NYU School of Medicine demonstrated the superiority of MPDD over palpation in finding the muscle that was causing pain in a region of the body.  

Muscle-Tendon Injections

Muscle injections at the Norman Marcus Pain Institute are so different that we refer to them as Muscle-Tendon Injections rather than Trigger Point Injections. Our main targets are the parts of the muscle attaching to tendon and bone, while also injecting the muscle belly. We NEVER use steroids, cortisone or botox. The only thing we inject is lidocaine in order to make the injection more comfortable. Each muscle that is injected receives three days of a post-injection Physical Therapy protocol that allows the muscle to relax, limber, and regain its normal length.

By identifying and injecting the true source of pain, rather than the perceived source, we can eliminate the patient's source of pain, allowing them to return to a normal, healthy, active, and pain-free life.

December 8, 2009 - 2:54pm — Posted by Dr. Norman Marcus