Muscle tendon injections, dry needling, trigger point injections, steroid injections. It seems as if everyone is doing some form of muscle injections. Are they all the same?

The simple answer is no. There are multiple variables that make each injection different.

Injectate:

The substance injected into the muscle can vary. Lidocaine, or another local anesthetic, steroids, botox, or nothing (dry) are used. Studies are inconclusive in determining which, if any drug, is most effective. At NMPI we use a dilute solution of lidocaine only for comfort, not with the idea that the treatment is the injection of lidocaine. There is no good evidence that the other substances make a difference, so we don’t use any of them.

 

Location of injection:

Trigger point injections are directed at painful nodules in a muscle that are found through palpation or pressing on the muscle and are often associated with a tight band of tissue. However, when a muscle causes pain, the ends of the muscle (where it attaches to tendons) is where most of the pain is generated. Therefore, needling or injecting a muscle only into tender spots misses the main pain generators. The needle in the painful tissue causes an increase in blood flow to that area and we believe is the active ingredient in relaxing the muscle tissue and decreasing the pain. Muscle tendon injections that we provide treat the belly of the muscle, as well as the ends of the muscles. Injecting the entire identified muscle produces lasting relief, sometimes never having to reinject a muscle.

 

Identification of the muscle causing pain:

It is a challenge to identify which specific muscles in the area where you hurt is the source of pain. Pressing on a tender spot stimulates several muscles that are in layers in that spot.

At NMPI we don’t identify a painful muscle with pressure/palpation. We use a patented electrical instrument to identify which entire specific muscle is causing pain.

 

Post injection care:

We follow each injection with 3 days of a specific physical therapy protocol to normalize the muscle. We also recommend a home exercise program to help keep the muscles limber and strong.

 

 

Published Articles on our technique:

Marcus, Norman J., Edward J. Gracely, and Kelly O. Keefe. “A comprehensive protocol to diagnose and treat pain of muscular origin may successfully and reliably decrease or eliminate pain in a chronic pain population.” Pain Medicine 11.1 (2010): 25-34.

Objective. A comprehensive protocol is presented to identify muscular causes of regional pain syndromes utilizing an electrical stimulus in lieu of palpation, and combining elements of Prolotherapy with trigger point injections.

Methods. One hundred seventy-six consecutive patients were evaluated for the presence of muscle pain by utilizing an electrical stimulus produced by the Muscle Pain Detection Device. The diagnosis of “Muscle Pain Amenable to Injection” (MPAI), rather than trigger points, was made if pain was produced for the duration of the stimulation. If MPAI was found, muscle tendon injections (MTI) were offered to patients along with post-MTI physical therapy, providing neuromuscular electrical stimulation followed by a validated exercise program [1]. A control group, evaluated 1 month prior to their actual consultation/evaluation when muscle pain was identified but not yet treated, was used for comparison.

Results. Forty-five patients who met criteria completed treatment. Patients’ scores on the Brief Pain Inventory decreased an average of 62%; median 70% (P < 0.001) for pain severity and 68%; median 85% (P < 0.001) for pain interference one month following treatment. These changes were significantly greater (P < 0.001) than those observed in the untreated controls.

Conclusion. A protocol incorporating an easily reproducible electrical stimulus to diagnose a muscle causing pain in a region of the body followed by an injection technique that involves the entirety of the muscle, and post injection restoration of muscle function, can successfully eliminate or significantly reduce regional pain present for years.

 

Marcus, Norman J., et al. “A preliminary study to determine if a muscle pain protocol can produce long-term relief in chronic back pain patients.” Pain Medicine 14.8 (2013): 1212-1221.

Objective. To assess the effectiveness of a muscle protocol to treat patients diagnosed with neuraxial low back pain (LBP) before and after invasive treatments.

Design. Patients with chronic (>6 months) LBP – postinvasive treatment and pre-spine surgery – were assessed and treated. An electrical device rather than palpation was used to determine muscle(s) as possible sources of pain. Patients testing positive for muscle pain were treated with a comprehensive protocol and were followed for >3 months to determine the effect of treatment on pain severity and interference in function.

Results. Study 1: In 56 (postinvasive treatment) patients who had failed back surgery, epidural steroid injections, facet blocks, and/or trigger point injections, mean Brief Pain Inventory (BPI) pain severity dropped from 5.54 at baseline to 3.96 (P < 0.001) at a median follow-up of 77 weeks; mean BPI interference dropped from 6.09 to 3.4 (P < 0.001). Fifty-two percent of respondents reported over 50% relief. Study 2: Three of seven patients originally scheduled for spine surgery completed a substantial part of the muscle protocol, canceled their surgeries, and obtained significant relief at the 16–19 month follow-up point.

Conclusion. In patients thought to have neuraxial pain, identification and treatment of painful muscles had statistically significant long-lasting and clinically meaningful reductions in pain and improvement in function. Muscle and tendon attachments may be an important and treatable  source of pain in patients diagnosed with pre and postsurgical neuraxial pain.