The Ultimate Guide to Trigger Point Injections

Clinically reviewed by Evish Kamrava, MD — Interventional pain management specialist at Commons Clinic Updated: March 2026 | Read time: 12 minutes

The Tight Knots That Won't Let Go

You feel it as a tight knot in your muscle — a tender point that seems to radiate pain across an entire region of your body. You press on it and the pain shoots down your arm, across your back, or down your leg. You stretch, you roll, you massage it, and it provides only temporary relief. The next day, the knot is back, and the pain returns with it.

This is a trigger point, and millions of people live with them, often without understanding what they are or why they form. A trigger point is a localized area of muscle tightness — a sustained contraction of muscle fibers — that becomes hypersensitive and can refer pain to distant areas of the body. A trigger point in the neck muscles might refer pain into the temple or behind the eye. A trigger point in the hip muscles might radiate pain down the entire leg. A trigger point in the shoulder might create pain that spreads across the entire upper back.

Trigger points develop from muscle overuse, poor posture, trauma, stress, or sometimes seemingly for no reason at all. They are the hallmark of myofascial pain syndrome — pain that originates from muscle and the connective tissue surrounding muscle (fascia). For people with persistent trigger points that don't respond to stretching, massage, or physical therapy, trigger point injections offer a targeted, minimally invasive way to deactivate these problematic knots and break the cycle of chronic muscle pain.

This guide covers what trigger points are, why they form and persist, how trigger point injections work, and when this treatment offers relief.

What Are Trigger Points and Myofascial Pain Syndrome?

A trigger point is a hyperirritable spot in a taut band of skeletal muscle. Under a microscope, you would see something unusual: while most of the muscle is relaxed, the muscle fibers in the trigger point are stuck in a state of sustained contraction. This sustained contraction creates a local energy crisis — the muscle fibers cannot relax because they have exhausted the chemical signals needed for relaxation.

This taut band of contracted muscle compresses blood vessels and nerves. Waste products accumulate locally because the muscle's metabolic demands exceed the available blood supply. The trigger point becomes hypersensitive to stimulation. Pressing on it or stretching it can trigger an entire cascade of referred pain that radiates far from the trigger point itself.

Myofascial pain syndrome is the clinical condition that results from multiple trigger points, usually in muscles related by anatomical proximity or function. For example, a patient with myofascial pain syndrome in the shoulder girdle might have trigger points in the trapezius, the levator scapulae, the rhomboids, and the pectoralis major — all muscles that work together to move and stabilize the shoulder.

Characteristics of myofascial pain and trigger points:

• Localized pain at the site of the trigger point, often described as a knot or tightness
• Referred pain that radiates away from the trigger point — often to adjacent regions or along predictable referral patterns
• Reproduction of pain with direct pressure on the trigger point (often described as "that's exactly where it hurts")
• Limited range of motion in the affected joint, due to muscle tightness and pain inhibition
• Palpable taut band of muscle that a skilled examiner can feel on physical examination
• No associated nerve root involvement — meaning no true radiculopathy (numbness, tingling in a nerve distribution)
• Symptoms that improve with rest, warmth, and stretching — but often return when the trigger point has not been truly deactivated

Myofascial pain is distinct from nerve-mediated pain (radiculopathy), joint pain (arthritis), or referred pain from visceral organs. Understanding this distinction is critical because trigger point injection is specifically designed to address muscle-generated pain, not nerve compression or joint disease.

Common Causes of Trigger Points

Trigger points develop through various mechanisms:

Muscle overuse and fatigue. Repetitive activities, sustained postures, or intense exercise can create muscle fatigue. If a fatigued muscle is subjected to additional stress before fully recovering, a trigger point can develop. Office workers hunched over desks, athletes overtrain without adequate recovery, and laborers in physically demanding jobs frequently develop trigger points.

Acute trauma. A fall, motor vehicle accident, or direct blow to a muscle can create immediate muscle damage and trigger point formation. These trigger points may persist long after the acute injury has healed.

Poor posture. Sustained poor posture — forward head position, rounded shoulders, anterior pelvic tilt — keeps muscles in a partially contracted state. Over weeks and months, these chronically shortened muscles develop trigger points.

Psychological stress. Emotional stress causes involuntary muscle tension. People under chronic stress often develop trigger points in the shoulder and neck muscles as a result of sustained unconscious muscle bracing.

Referred pain from other structures. Trigger points sometimes develop in muscles distant from the initial pain source. For example, a patient with a nerve root irritation might develop protective muscle tension and secondary trigger points in muscles adjacent to the nerve root.

Immobility. Prolonged immobility — from casting, bracing, or simple disuse — can lead to trigger point formation.

Sleep disturbance. Poor sleep and fatigue impair the muscle's ability to recover and reset, making trigger point development more likely.

When to Consider Trigger Point Injections

You May Be a Candidate If:

• You have localized areas of muscle tightness and tenderness (trigger points) that you or your healthcare provider can identify on physical examination
• You experience pain that radiates from these trigger points to adjacent regions (referred pain pattern)
• Your symptoms have persisted for at least four to six weeks despite conservative treatment
• You have tried stretching, massage, physical therapy, and rest without adequate relief
• You do not have signs of nerve compression or joint disease (your pain is myofascial in origin)
• You are motivated to combine injection with physical therapy and activity modification for lasting improvement
• You do not have active infection, uncontrolled bleeding, or contraindications to local anesthetic

When Conservative Care Is Appropriate

Many trigger points respond well to conservative care. Stretching specific to the affected muscle, massage (self-massage with foam rollers, lacrosse balls, or professional massage therapy), heat application, and gradual return to activity often resolve trigger points. Physical therapy designed to address the underlying cause (poor posture, muscle weakness, overuse patterns) can prevent recurrence.

For trigger points that have been present for only a few weeks, or those that respond well to conservative measures, injections may not be necessary. Patients should exhaust appropriate conservative options before considering intervention.

"Most trigger points improve with the right combination of stretching, activity modification, and addressing the underlying cause," says Dr. Evish Kamrava, an interventional pain management specialist at Commons Clinic. "Our philosophy is to use injections when conservative care isn't working, not as a first resort. But when someone has tried everything and their trigger points persist, an injection can be the tool that finally deactivates the muscle and breaks the pain cycle."

Understanding Trigger Point Injection Options

Trigger point injections can be performed using different medications and techniques, each with specific indications.

Local Anesthetic Injection

The simplest trigger point injection uses only local anesthetic (typically lidocaine). The anesthetic temporarily interrupts the pain signal and disrupts the sustained muscle contraction through a process called the "needle effect" — the insertion of the needle itself can mechanically disrupt trigger point dysfunction.

Local anesthetic injections typically provide relief lasting hours to a few days. They are useful as a diagnostic tool (to confirm that the trigger point is the pain source) and for acute pain relief.

Steroid-Enhanced Injection

A trigger point injection combining local anesthetic with a small amount of corticosteroid (typically methylprednisolone or triamcinolone) reduces local inflammation. While the dose is much smaller than in joint injections, the steroid can help if inflammation is contributing to the trigger point dysfunction.

Steroid-enhanced injections may provide relief lasting weeks to months in some patients, longer than anesthetic alone.

Dry Needling

Dry needling is a technique in which a thin needle is inserted into the trigger point without injecting any medication. The mechanical disruption of the needle, combined with stimulation of the trigger point, can cause the muscle to release its sustained contraction. This technique is often performed by physical therapists and is based on the "needle effect."

Dry needling does not use any medication and is based purely on the mechanical benefit of needle insertion and stimulation.

Botulinum Toxin (Botox) Injection

In some cases, particularly for trigger points that are refractory to other treatments, botulinum toxin (Botox) can be injected directly into the trigger point. Botox works by blocking the release of acetylcholine at the neuromuscular junction, preventing muscle contraction. Relief from Botox is delayed (typically 3 to 7 days to onset, maximum effect at 2 to 4 weeks) but can last 3 to 4 months.

Botox is reserved for refractory trigger points or for patients with specific conditions like chronic migraine associated with cervical myofascial trigger points.

How Trigger Point Injections Work

Before the Procedure

You will meet with Dr. Kamrava to discuss your pain history, activities, and posture. He will perform a physical examination to identify trigger points and assess your muscle function. Based on this assessment, he will recommend which trigger points to target and which injection approach is most appropriate.

On the day of the procedure, wear comfortable, loose-fitting clothing that allows easy access to the affected area. Most trigger point injections are performed in the office without sedation, though some patients prefer light sedation for multiple simultaneous injections.

During the Procedure

Trigger point injections are straightforward office procedures. You will be positioned to allow easy access to the affected muscle group. The skin is cleansed with antiseptic solution. A thin needle is inserted directly into the trigger point.

Once the needle is positioned in the taut band (you will typically feel a local twitch response — a brief, involuntary contraction of the muscle — which confirms proper needle placement), the medication is injected. The volume is small — typically 0.5 to 2 mL.

For a local anesthetic injection, lidocaine alone is injected.

For a steroid-enhanced injection, a combination of lidocaine and a small amount of steroid (typically 5 to 10 mg) is injected.

For dry needling, no medication is injected; the needle stimulation alone provides the benefit.

Multiple trigger points can be treated during a single session if needed. The entire procedure typically takes 10 to 20 minutes.

After the Procedure

You will likely feel immediate relief from the local anesthetic. Some soreness or slight bruising at the injection site is common and resolves within a few days. Ice intermittently for the first 24 hours if desired.

Gentle stretching of the affected muscle is beneficial and should begin the day of the procedure. Avoid intense activity or aggressive stretching for 24 to 48 hours after injection, but gentle movement and light activity are encouraged.

Recovery and Results Timeline

Day of procedure: Immediate numbness and pain relief from local anesthetic. Soreness at injection site possible. Gentle stretching encouraged.

Days 1 to 3: Anesthetic effect wears off. Assess pain relief. Mild soreness at injection site. Continue gentle stretching. Return to light activity as tolerated.

Days 3 to 7: For local anesthetic injections: effects completely worn off. Assess duration of relief and plan next steps.

For steroid-enhanced injections: anti-inflammatory effect begins to develop. Many patients notice gradual improvement.

Weeks 2 to 4: For steroid-enhanced injections: maximum benefit usually achieved. Use this window for aggressive physical therapy and stretching.

Weeks 4 to 12: Assess whether relief is sustained or if trigger points are returning. This feedback determines whether repeat injections are needed or whether conservative care maintenance is sufficient.

Benefits and Risks

Benefits

Trigger point injections offer significant advantages:

• Targeted treatment. The injection directly addresses the problem — the hypersensitive, contracted muscle.
• Immediate relief. Pain relief often begins within minutes of the injection, due to local anesthetic.
• Rapid recovery. Office-based procedure with no downtime. Most patients resume normal activity immediately.
• Bridge to rehabilitation. Relief from trigger point injection creates a window of opportunity for aggressive stretching, physical therapy, and correction of underlying causative factors (posture, muscle weakness, overuse patterns).
• Low risk. Serious complications are rare due to the superficial nature of most trigger point injections and the small volume of medication used.
• Diagnostic value. Successful injection confirms that the trigger point is a pain source and guides future treatment decisions.

Risks

Risks are generally very low:

• Infection. Rare (less than 1:10,000) but can occur at the injection site.
• Bleeding or bruising. Common at the injection site; usually resolves within a few days. Significant bleeding is rare.
• Nerve or blood vessel injury. The needle may contact a nearby nerve or blood vessel, causing temporary numbness, tingling, or swelling. This typically resolves within days to weeks. Serious injury is very rare.
• Allergic reaction. True allergy to local anesthetic is rare but possible. Always inform Dr. Kamrava of any previous anesthetic reactions.
• Steroid side effects. Systemic side effects from the small steroid dose used in trigger point injection are minimal.
• Lack of expected relief. Not all injections provide significant relief. Some patients have minimal response.
• Persistent muscle soreness. Some patients experience muscle soreness for a few days after injection. This typically resolves and should not deter future treatment if the injection was otherwise beneficial.

The single most important risk reduction strategy is seeking treatment from a knowledgeable physician who can accurately identify trigger points and has experience with injection technique.

Trigger Point Injections vs. Other Treatments

Treating Specific Myofascial Pain Conditions

Dr. Kamrava's expertise includes trigger point injection for various regional pain syndromes:

Tension headaches and migraines. Trigger points in the neck muscles (trapezius, levator scapulae, sternocleidomastoid) commonly contribute to tension headaches and migraine. Injection of these cervical muscles can reduce headache frequency and intensity.

Neck and shoulder pain. The cervical and shoulder region is a common site for trigger points, particularly in people with poor posture or desk jobs. Multiple muscles (trapezius, levator scapulae, rhomboids, supraspinatus) can be treated.

Lower back pain. Trigger points in the quadratus lumborum, paraspinal muscles, and gluteal muscles contribute to lower back pain and dysfunction. These muscles are frequently involved in myofascial pain after lumbar strain or poor posture.

Sciatica-like pain. Trigger points in the piriformis muscle can compress the sciatic nerve and create leg pain mimicking true nerve root compression. Piriformis trigger point injection often provides significant relief for these patients.

Hip and pelvis pain. The gluteal, hip rotator, and adductor muscles commonly develop trigger points, particularly after childbirth, surgery, or repetitive activity.

Knee pain. Trigger points in the quadriceps, hamstrings, and calf muscles can contribute to knee pain and dysfunction.

Temporomandibular joint (TMJ) pain. Trigger points in the masseter and temporalis muscles can cause jaw pain and dysfunction.

Why Patients Choose Commons Clinic for Trigger Point Injections

Dr. Evish Kamrava is an interventional pain management specialist at Commons Clinic with extensive experience in myofascial pain and trigger point treatment. Dr. Kamrava combines careful physical examination, a comprehensive understanding of muscle anatomy and referred pain patterns, and precise injection technique to deliver consistent results.

What sets Commons Clinic apart:

• Expert diagnosis. Myofascial pain is often misdiagnosed as joint disease, nerve compression, or other conditions. Commons Clinic's thorough examination ensures accurate diagnosis.
• Comprehensive approach. Trigger point injection is always combined with targeted physical therapy, stretching instruction, and identification of underlying causative factors. The goal is not just temporary pain relief but lasting improvement through corrected biomechanics and muscle function.
• Multiple treatment options. From local anesthetic injection to steroid-enhanced injection to dry needling to Botox, Commons Clinic offers the full spectrum of trigger point treatment approaches.
• Coordinated rehabilitation. After injection, Commons Clinic's physical therapy team provides hands-on therapy and detailed stretching and strengthening programs. Your therapist understands trigger point anatomy and can reinforce muscle lengthening and strengthening specific to your condition.
• Patient education. Understanding what triggered your myofascial pain — poor posture, overuse, stress — is critical to preventing recurrence. Dr. Kamrava and the team invest time in teaching patients how to avoid trigger point recurrence.
• Care Guarantee. A two-year warranty covering the full cost of professional follow-up care related to your myofascial pain condition.
• Multiple clinic locations and telehealth. Commons Clinic operates clinics in Santa Monica, Marina del Rey, Beverly Hills, Long Beach, and Lakewood. Initial consultations and many follow-ups can be conducted via telehealth.

Frequently Asked Questions

Will a trigger point injection permanently cure my trigger points?

A single trigger point injection typically provides relief lasting hours to weeks (with anesthetic) or weeks to months (with steroid). However, unless the underlying cause of the trigger point is addressed (poor posture, muscle weakness, overuse pattern, stress), the trigger point will often recur. Long-term improvement depends on combining injection with physical therapy, postural correction, and activity modification. Many patients benefit from a series of injections combined with intensive physical therapy, after which they can maintain improvement through self-care and appropriate activity.

How many trigger point injections can I have?

There is no absolute limit to trigger point injections, but guidelines generally recommend no more than 3 to 4 injections per muscle per year, as repeated steroid exposure carries cumulative risks. Many patients benefit from a series of 2 to 3 injections spaced 2 to 4 weeks apart, followed by a period of physical therapy and self-care.

Is dry needling the same as acupuncture?

No. Dry needling targets specific myofascial trigger points identified through physical examination and is based on Western anatomical and physiological principles. Acupuncture is based on traditional Chinese medicine principles and targets acupuncture points based on meridian theory. While both use thin needles, the approach, anatomy, and mechanism of action are different. Dry needling is often performed by physical therapists; acupuncture is typically performed by acupuncturists.

Can trigger point injection help my headaches?

Yes, if your headaches are myofascial in origin — that is, if trigger points in neck and shoulder muscles are contributing to your symptoms. Trigger points in the trapezius, levator scapulae, and sternocleidomastoid muscles commonly cause tension headaches and can even trigger migraines. An examination by Dr. Kamrava can determine whether trigger points are a component of your headache problem.

Should I stretch or rest after a trigger point injection?

Light stretching of the affected muscle is beneficial and should begin the day of the injection. However, avoid aggressive stretching or intense activity for 24 to 48 hours. The goal is to gently lengthen the muscle while allowing time for the initial post-injection soreness to resolve.

Is trigger point injection covered by insurance?

Coverage varies. Trigger point injections are sometimes covered by insurance, though often with prior authorization or after documentation that conservative care has been pursued. Commons Clinic accepts Aetna, Cigna, Anthem Blue Cross, Blue Shield of California, and United Healthcare. Patients covered by Carrum, Transcarent, or LanternCare may qualify for $0 out-of-pocket cost. Call (310) 437-7921 to verify your specific coverage.

Can I get trigger point injections during pregnancy?

Trigger point injections during pregnancy should generally be avoided due to the theoretical risk of infection and unknown effects of medication on the fetus. However, physical therapy, stretching, massage, and postural correction are all safe during pregnancy. After delivery and if you are not breastfeeding, trigger point injection becomes a reasonable option if conservative care has been inadequate.

Key Takeaways

• Trigger points are localized areas of sustained muscle contraction that become hypersensitive and refer pain to distant regions — the hallmark of myofascial pain syndrome
• Trigger points develop from muscle overuse, poor posture, trauma, stress, or immobility
• Trigger point injections using local anesthetic, steroid, or dry needling can deactivate persistent trigger points and provide relief lasting from hours to months
• All trigger point injections work best when combined with targeted physical therapy and correction of underlying causative factors (posture, muscle weakness, overuse patterns)
• A series of injections (typically 2 to 3) spaced weeks apart often provides more durable improvement than a single injection
• Conservative care (stretching, massage, physical therapy) resolves many trigger points and should be exhausted before considering injection
• Trigger point injection is a low-risk procedure with rapid recovery and immediate return to activity
• Long-term success depends on addressing the underlying cause and maintaining proper posture, activity patterns, and muscle flexibility

Take the Next Step

If persistent trigger points are limiting your function and have not responded to conservative care, trigger point injection may help break the cycle of chronic muscle pain.

Dr. Evish Kamrava and the Commons Clinic pain management team see patients at clinics across Los Angeles — including Santa Monica, Marina del Rey, Beverly Hills, Long Beach, and Lakewood.

Not in Los Angeles? Commons Clinic's virtual specialty clinic offers initial consultations nationwide via telehealth.

Insurance: Commons Clinic accepts Aetna, Cigna, Anthem Blue Cross, Blue Shield of California, and United Healthcare. Patients covered by Carrum, Transcarent, or LanternCare may qualify for $0 out-of-pocket treatment.

Schedule a consultation: Call (310) 437-7921 or email hello@commonsclinic.com

Sources: Myofascial Pain and Dysfunction: The Trigger Point Manual, Archives of Physical Medicine and Rehabilitation, Journal of the American Academy of Orthopaedic Surgeons, American College of Sports Medicine, Journal of Pain Research