Myofascial Pain: What to Know With Trigger Point Injections

Trigger point injections may be the solution for myofascial pain. Find out how they can provide lasting relief.

Abstract

Welcome to our educational series. I’m Dr. Alex Jimenez, and today, we will explore the intricate world of musculoskeletal pain, focusing specifically on myofascial trigger points and the advanced therapeutic strategies we use to resolve them. This post will serve as an in-depth guide, taking you on a journey through the physiological mechanisms of muscle spasm, scar tissue formation, and chronic pain cycles. We will discuss the evolution of treatment from traditional dry needling to modern, evidence-based trigger point injections, detailing the specific agents used, such as lidocaine and Sarapin, and the rationale behind our protocols. A significant portion of this discussion will be dedicated to explaining the star pattern injection technique, a method designed to mechanically disrupt adhesions and deliver therapeutic agents directly to the affected tissues. We will also delve into the critical importance of anatomical knowledge, patient management strategies, and safety considerations, such as needle depth and contraindications.

Furthermore, this post will highlight our unique, multidisciplinary practice model at the Injury Medical Clinic. We will explain how the collaborative expertise of myself, Dr. Alex Jimenez (DC, APRN, FNP-BC, CFMP, IFMCP, ATN, CCST), and our Medical Director, Dr. Maria Guadalupe Cardenas (MD, Board Certified in Internal Medicine), creates a comprehensive and integrated system of care. This synergy between chiropractic, internal medicine, functional medicine, and rehabilitation provides a powerful framework for treating complex conditions, ensuring that our patients receive holistic, patient-centered care that addresses the root causes of their pain.

Our Collaborative Care Model: Integrating Chiropractic and Internal Medicine

At the Injury Medical Clinic PA, also known as Mission Plaza Injury Medical Clinic, located in El Paso, Texas, we have cultivated a unique and powerful healthcare environment built on the principles of integrative and multidisciplinary care. This model is specifically designed to address complex health issues, particularly those related to personal injury, chronic pain, and functional disorders, by combining the expertise of different medical disciplines under one roof.

I am Dr. Alex Jimenez, and my background spans several fields, including being a Doctor of Chiropractic (DC), an Advanced Practice Registered Nurse (APRN), a Board-Certified Family Nurse Practitioner (FNP-BC), a Certified Functional Medicine Practitioner (CFMP), and an Institute for Functional Medicine Certified Practitioner (IFMCP), among other specializations. My role focuses on the biomechanical, neurological, and functional aspects of health. I use chiropractic adjustments to restore spinal alignment and nervous system function, employ functional medicine to uncover the root biochemical and metabolic causes of disease, and draw on my nurse practitioner training to provide a broader scope of primary and specialized care.

Working alongside me is our esteemed Medical Director and Collaborative Physician, Dr. Maria Guadalupe Cardenas, MD. Dr. Cardenas is Board Certified in Internal Medicine (NPI #1164426749, Texas MD License #J2933) and brings over 40 years of invaluable experience as an internist. Her profound knowledge of internal medicine provides the essential medical oversight and diagnostic acumen that anchors our practice. As the collaborative physician, she works closely with our team and me to ensure that all treatment plans are medically sound, safe, and comprehensive. This collaborative relationship is common and highly effective in integrative settings, where a Medical Doctor provides medical direction and supervision for services that may bridge the gap between conventional and complementary therapies.

Our team-based approach means that a patient’s journey is not limited to a single perspective. When a patient presents with a condition like chronic back pain from a car accident, for example, our process is multifaceted:

1. Comprehensive Diagnosis: I will conduct a thorough physical and neurological examination, including chiropractic and functional movement assessments. Simultaneously, Dr. Cardenas will review the patient’s medical history, order and interpret necessary diagnostic imaging (X-rays, MRIs) or lab tests, and rule out any underlying medical conditions or “red flags” that could be contributing to the pain.
2. Integrated Treatment Plan: Together, we formulate a treatment plan. I might perform chiropractic adjustments to address vertebral subluxations and improve mobility. We may then decide that the patient would benefit from trigger point injections to release painful muscle knots. Dr. Cardenas provides the medical authority and oversight for such procedures.
3. Holistic Services: The plan is further enriched by our other services. Our rehabilitation specialists guide the patient through corrective exercises. At the same time, our functional medicine protocols may address systemic inflammation through diet and nutritional supplementation, a crucial factor in healing and pain reduction.

This synergy allows us to offer a spectrum of care—from spinal manipulation and physical rehabilitation to medically supervised injections and in-depth metabolic analysis—all coordinated and integrated. It ensures that we are not just treating symptoms but addressing the whole person, leading to more effective, lasting outcomes for our patients.

The Physiology of Muscle Spasm and Scar Tissue Formation

To truly understand why our treatments are effective, we must first journey into the microscopic world of muscle tissue and explore what happens when it becomes injured or chronically stressed. When a muscle is overworked, experiences a sudden trauma (like in a whiplash injury), or is held in a contracted state for prolonged periods (e.g., poor posture at a desk), it can enter a state of metabolic crisis.

Here is a step-by-step breakdown of this pathological process:

1. Initial Injury and Contraction: The process begins with an event that causes the muscle fibers, specifically the sarcomeres (the basic contractile units), to lock into a shortened, contracted state. This initial contraction is a protective reflex, but when it persists, it becomes problematic.
2. Blood Flow Restriction: These tightly contracted muscle fibers act like a vise, compressing the tiny blood vessels—the capillaries—that run through the muscle tissue. This compression severely restricts blood flow to the immediate area.
3. Local Ischemia and Hypoxia: Reduced blood flow leads to ischemia (an inadequate blood supply) and hypoxia (an oxygen deficiency). The muscle cells in this region are starved of the oxygen and nutrients they need to function and produce energy.
4. Energy Crisis: Muscle relaxation is an active process that requires energy in the form of adenosine triphosphate (ATP). In this hypoxic environment, the muscle cells cannot produce enough ATP. This creates a vicious cycle: the muscle is stuck in a contracted state, but it lacks the energy (ATP) required to release itself. This is often referred to as an “energy crisis” at the cellular level.
5. Accumulation of Metabolic Waste: Without adequate blood flow to flush them out, metabolic waste products—such as lactic acid, bradykinin, and prostaglandins—begin to accumulate in the affected area.
6. Nociceptor Sensitization: These acidic waste products are highly irritating to the nerve endings responsible for sensing pain, known as nociceptors. The constant chemical irritation sensitizes these nerve endings, causing them to fire more easily and send a barrage of pain signals to the brain. This is why trigger points are so tender to the touch and can cause deep, aching pain.
7. Inflammation and Fibroblast Activation: The body perceives this area of sustained contraction and chemical irritation as an injury site, triggering a localized inflammatory response. As part of this response, specialized cells called fibroblasts are activated. Fibroblasts are the body’s repair crew; their job is to lay down collagen fibers to create scar tissue and patch up damaged areas.
8. Scar Tissue (Fibrosis) Formation: In a normal healing process, this is beneficial. However, in the context of a chronic trigger point, the fibroblasts deposit collagen fibers in a haphazard, disorganized manner around the contracted muscle knot. This forms a dense, fibrous band of scar tissue, or fibrosis. This scar tissue is less flexible and more rigid than healthy muscle tissue. It further restricts the muscle’s ability to stretch and contract properly, physically “locking” the trigger point in place and perpetuating the entire cycle.

This scar pattern is a key target of our therapies. It is the physical manifestation of a chronic muscle spasm. When you feel a “knot” in a muscle, you are feeling this combination of tightly contracted muscle fibers and the surrounding fibrotic scar tissue. Simply stretching or massaging the area may provide temporary relief, but it often fails to break down this underlying scar tissue, which is why the pain frequently returns. Our goal with treatments like the star-pattern injection is to mechanically and chemically disrupt this entire pathological cascade at its core.

From Dry Needling to Injections: The Evolution of Trigger Point Therapy

The concept of using a needle to treat muscle pain is not new. The practice has evolved significantly over the years, moving from a purely mechanical intervention to a more sophisticated, targeted therapeutic delivery system.

The Origins: Dry Needling

Initially, the primary technique was dry needling. As the name suggests, this involves inserting a thin, “dry” filiform needle—the same type used in acupuncture—directly into the myofascial trigger point without injecting any substance. The underlying theory is primarily mechanical and neurological.

When the needle is inserted into the trigger point, it elicits a local twitch response (LTR). This LTR is an involuntary spinal cord reflex in which the muscle fibers in the taut band contract and then relax. This response is considered a crucial sign that the needle has accurately targeted the trigger point. The therapeutic effects of dry needling are believed to stem from several mechanisms:

• Mechanical Disruption: The physical presence of the needle and the act of manipulating it (e.g., pistoning it up and down or rotating it) helps mechanically break up tightly contracted muscle fibers and surrounding fibrotic scar tissue. We used to perform what we called a “star pattern” with just the dry needle, moving it in different directions from a central insertion point to break up the adhesion.
• Neurological Reset: The LTR is thought to “reset” the dysfunctional neurological loop between the muscle and the spinal cord that maintains the contraction. By stimulating the muscle spindles and Golgi tendon organs (sensory receptors in the muscle), it helps to normalize nervous system input and allow the muscle to return to its resting length.
• Pain Modulation: The needle insertion creates a micro-trauma, which can stimulate the release of endogenous opioids (the body’s natural painkillers) and trigger descending pain inhibitory pathways from the brain, effectively reducing the perception of pain.

While dry needling can be very effective, and many practitioners, including acupuncturists, still use it with great success, we found that we could achieve even better, more lasting results by adding therapeutic agents to the process. This led us to adopt trigger point injections.

The Advancement: Trigger Point Injections

Trigger point injections build upon the mechanical principles of dry needling but add a powerful chemical component. Instead of just disrupting scar tissue, we now deliver substances directly into the heart of the metabolic crisis to actively resolve it.

The procedure involves injecting a small amount of a solution into the trigger point. In our practice, we have refined our injectate to a specific combination that addresses multiple facets of the pathology. Some practitioners might use a local anesthetic like lidocaine or Marcaine by itself, and that can certainly be helpful. The anesthetic numbs the over-sensitive nerve endings, providing immediate pain relief and helping to break the pain-spasm-pain cycle.

However, in my clinical experience, I have found that a simple anesthetic is not enough to resolve the underlying issue fully. The inflammation and tissue dysfunction remain. This is why I always combine the anesthetic with a potent, natural anti-inflammatory. By doing so, we are not just masking the pain; we are actively treating the inflammation that drives the process. This synergistic approach gives us a much better, more comprehensive, and longer-lasting result.

The Therapeutic Cocktail: Lidocaine and Sarapin Explained

The success of our trigger point injections hinges on the specific combination of agents we use. Our standard formula is a one-to-one ratio of Lidocaine and Sarapin. This isn’t an arbitrary choice; each component is selected for its unique physiological effects, and together, they create a powerful synergy that targets the trigger point from multiple angles.

Lidocaine: Breaking the Pain Cycle

Lidocaine is a local anesthetic belonging to the “caine” family of drugs. Its primary mechanism of action is the blockade of voltage-gated sodium channels on the neuronal cell membrane. Let’s break down what that means in the context of a trigger point:

1. Nerve Signaling 101: For a nerve to fire and send a pain signal, sodium ions must rush into the nerve cell through special channels. This influx of positive charge creates an electrical impulse, or action potential, that travels along the nerve to the spinal cord and then to the brain, where it is interpreted as pain.
2. The Lidocaine Blockade: Lidocaine physically blocks these sodium channels. When it is injected into the trigger point, it saturates the sensitized nociceptors (pain-sensing nerve endings). With their sodium channels blocked, these nerves are unable to depolarize and generate an action potential.
3. The Result: The transmission of pain signals from the trigger point is effectively stopped at the source. This provides rapid and profound pain relief for the patient.

But the role of lidocaine goes beyond simple numbing. By silencing the overactive nerve endings, it helps to break the vicious pain-spasm-pain cycle. This cycle works as follows: pain from the trigger point causes a reflexive muscle contraction (guarding), which worsens the ischemia and metabolic crisis, which in turn generates more pain signals. Lidocaine’s anesthetic effect interrupts this feedback loop, allowing the muscle to relax more easily and preventing the central nervous system from being bombarded with nociceptive input. This quiets the entire system down, paving the way for healing.

Sarapin: A Natural Anti-Inflammatory Powerhouse

While lidocaine handles the pain and neurological component, Sarapin addresses the underlying inflammation and tissue dysfunction. Sarapin is a biological medicine, a sterile aqueous solution derived from the pitcher plant (Sarracenia purpurea). It has been used in medicine for decades as a safe and effective alternative to corticosteroid injections for pain and inflammation.

The key advantage of Sarapin is its unique mechanism of action. Unlike corticosteroids, which can have significant side effects like tissue degradation, immune suppression, and metabolic disruption, Sarapin works in a more targeted and gentle way. Its primary effect is on sensory nerves (C-type nerve fibers), which transmit dull, aching pain. Sarapin causes a mild, localized irritation to these nerve fibers, which paradoxically leads to a long-lasting analgesic (pain-relieving) and anti-inflammatory effect.

The proposed mechanism involves:

• Neuromodulation: Sarapin is believed to selectively affect the function of the C-type sensory nerves, effectively “retuning” them to a normal, non-painful state without causing any tissue damage. It does not affect motor nerves, so there is no muscle weakness, nor does it affect the sense of touch or proprioception.
• Breaking the Inflammatory Cascade: By modulating the activity of these sensory nerves, Sarapin helps to downregulate the release of pro-inflammatory neuropeptides (like Substance P) at the site of injury. This disrupts the neurogenic inflammation that perpetuates the trigger point’s existence.

I prefer Sarapin to steroids for several reasons. Steroids are potent anti-inflammatories, but they are also catabolic, meaning they can break down tissue. With repeated injections, steroids can weaken tendons and cartilage and may even hinder the long-term healing process. Sarapin, on the other hand, provides powerful anti-inflammatory and analgesic effects without these detrimental side effects. It supports the body’s natural healing process rather than suppressing it. It is an all-natural product that aligns perfectly with our functional and integrative medicine philosophy of working with the body.

By combining lidocaine and Sarapin in a one-to-one ratio, we achieve a multi-pronged attack: immediate pain relief from the lidocaine, which breaks the pain-spasm cycle, and sustained, deep-acting anti-inflammatory and neuromodulatory effects from the Sarapin, which promotes true tissue healing and resolution.

The Star Pattern Technique: A Masterclass in Mechanical Disruption

The way we deliver this therapeutic cocktail is just as important as the cocktail itself. We don’t simply inject a single bolus of fluid into the center of the knot. Instead, we employ a meticulous technique known as the star pattern or fanning technique. This method is a direct evolution of the mechanical disruption principles of dry needling, enhanced by the delivery of our therapeutic agents.

Here is a detailed, step-by-step walkthrough of the procedure:

1. Locating the Epicenter: The first and most crucial step is precise palpation. I use my fingers to explore the muscle carefully, identifying the taut, rope-like band and then pinpointing the area of maximum tenderness within that band—the epicenter of the trigger point. This is the spot that, when pressed, reproduces the patient’s specific pain, sometimes referring it to other areas.
2. Central Insertion: Once the target is locked, I insert the needle directly into this epicenter. The needle size is chosen based on the location and depth of the muscle. For cervical (neck) and upper thoracic (upper back) regions, we typically use a 30-gauge, 1-inch needle. For the larger muscles of the lower thoracic and lumbar (low back) regions, a slightly larger needle may be used to reach the appropriate depth.
3. The First Injection: After aspirating to ensure we are not in a blood vessel, a small amount of the lidocaine-Sarapin solution is injected at this central point.
4. Creating the “Rays” of the Star: Now, the core of the technique begins. Without fully withdrawing the needle from the skin, I angle it in a new direction—say, superiorly (upwards)—and advance it through the fibrotic tissue. As I slowly withdraw the needle along this new track, I gently and continuously inject a small stream of the solution.
5. Reposition and Repeat: I then pull the needle back to just beneath the skin, redirect it to a new angle—for example, inferiorly (downwards)—and repeat the process: advance, then inject while withdrawing.
6. Completing the Pattern: This process is repeated multiple times, angling the needle in a 360-degree radius around the central insertion point, creating a pattern that resembles the rays of a star or the spokes of a wheel. We go superior, inferior, medial, lateral, and in the diagonal planes in between.

The Why Behind the Technique

This methodical approach is far superior to a single-point injection for several reasons:

• Mechanical Scar Tissue Disruption: Each pass of the needle acts like a tiny scalpel, physically cutting through and breaking up the disorganized, fibrotic scar tissue that has formed around the muscle knot. This is the “mechanical release” component. By breaking up these adhesions, we restore the muscle’s ability to move and stretch freely.
• Comprehensive Fluid Distribution: The star pattern ensures that the therapeutic solution isn’t just deposited in one spot. Instead, it is distributed throughout the entire volume of the trigger point and the surrounding dysfunctional tissue. This allows the lidocaine to numb all the sensitized nerve endings in the area and enables the Sarapin to exert its anti-inflammatory effects across the entire pathological zone.
• Enhanced Healing Response: The multiple passes of the needle create a controlled micro-trauma. This stimulates a localized healing response, increasing blood flow to the area (a phenomenon known as hyperemia) and attracting the body’s repair cells. This renewed circulation helps to flush out the accumulated metabolic waste and bring fresh oxygen and nutrients, finally resolving the energy crisis at the cellular level.

The injection volume is carefully calibrated. In the more delicate areas of the neck and upper back, we typically inject about one milliliter (1 ml) per trigger point. In the larger, bulkier muscles of the lower back, we might use up to two milliliters (2 ml) to ensure adequate saturation of the tissue. The goal is to use enough solution to be effective but not so much as to cause excessive pressure or discomfort.

By combining the chemical action of our injectate with the mechanical action of the star pattern technique, we are addressing both the software (neurological signaling) and the hardware (physical tissue) of the problem, leading to a more complete and durable resolution of myofascial trigger points.

The Root Causes of Pain- Video

The Critical Role of Anatomical Mastery

Performing trigger point injections, especially in complex areas like the neck and upper back, is not a task to be taken lightly. It demands a profound and constantly refreshed understanding of human anatomy. I cannot stress this enough: whether you are a practitioner focused on orthopedics, aesthetics, or pain management, you must go back and review your anatomy.

When I was in school, I’ll admit, I was not an anatomy whiz. It’s a daunting subject for many students. But in clinical practice, it becomes the absolute foundation of everything we do safely and effectively. You are not just injecting into a “sore spot”; you are navigating a complex three-dimensional landscape of muscles, nerves, blood vessels, and organs.

Following Muscle Patterns

To effectively treat trigger points, you must know the muscles intimately: their origins, insertions, fiber direction, and actions. When a patient presents with pain, I visualize the underlying musculature. Is the pain coming from the levator scapulae, which commonly refers pain to the base of the neck and the shoulder blade? Or is it the rhomboids, which cause pain between the scapulae? Perhaps it’s the deeper multifidus or rotator muscles that are contributing to spinal segment dysfunction.

Knowing the muscle patterns is essential for accurate diagnosis and effective treatment. You have to follow the path of the muscle fibers to understand how and why they are in spasm. This knowledge guides my hands during palpation and directs the needle during the injection to ensure I am targeting the precise source of the patient’s pain.

Navigating the “Danger Zones”: Safety and Needle Depth

Beyond just knowing the muscles, a practitioner must have a crystal-clear mental map of the structures to avoid. The body is full of “danger zones” where a misplaced needle can have serious consequences.

A primary concern, particularly when working on the thoracic region (the chest and upper back), is the risk of causing a pneumothorax, or a collapsed lung. The lungs lie just beneath the rib cage. If a needle is inserted too deeply between the ribs, it can puncture the pleural membrane that surrounds the lung, allowing air to enter the pleural space and causing the lung to collapse.

This is why needle depth is a critical parameter that we control with extreme care. Here are the general guidelines we follow:

• The “One-Inch Rule”: For most individuals, a one-inch needle provides sufficient depth to reach the target muscles of the back (like the trapezius, rhomboids, or erector spinae) without posing a significant risk to the lungs. Even in a very thin, small-framed elderly patient, a one-inch needle inserted perpendicular to the skin over a muscle belly is highly unlikely to reach the pleura.
• The “One-and-a-Half-Inch” Caution Zone: When you start using a one-and-a-half-inch needle, the margin for error decreases significantly. In smaller or thinner individuals, a 1.5-inch needle could potentially puncture a lung if not used with extreme caution and precise anatomical knowledge. This length is generally reserved for very large, muscular individuals or for specific techniques like injections into the deep gluteal muscles.

To mitigate this risk, we never inject unthinkingly. We use anatomical landmarks, such as the ribs and spine, to guide us. When injecting into the muscles overlying the rib cage, we can often palpate a rib to use as a “backstop,” ensuring the needle does not go too deep into the intercostal space. The angle of insertion is also key; often, a slightly oblique angle, rather than a purely perpendicular one, is safer and more effective for targeting specific muscle layers.

Mastery of anatomy is not a one-time achievement; it’s a career-long commitment. It’s the bedrock that allows us to perform these powerful procedures with confidence, precision, and, most importantly, the utmost safety for our patients.

Patient Experience and Clinical Strategy

The technical skill of performing an injection is only one part of the equation. The other, equally important part, is managing the patient’s experience. Trigger point injections can be uncomfortable, and a patient’s anxiety and perception of pain can significantly impact the treatment’s success and their willingness to continue with a necessary course of care. Over the years, I’ve developed a clinical strategy designed to maximize comfort and ensure patient compliance.

Saving the Worst for Last

One of the most effective psychological techniques I use is what I call “saving the worst for last.” Every patient with multiple trigger points has that one spot—the one that is exquisitely tender and sends a jolt of pain when touched. It’s the “Oh, son of a…” point.

In my early days, I might have logically thought, “Let’s get the worst one over with first.” I quickly learned that this was a mistake. If you start with the most painful injection, the patient’s anxiety skyrockets. Their muscles tense up in anticipation, making the subsequent injections more difficult and more painful. They might even refuse to continue the treatment session. I’ve had patients in the past, when I used to do it that way, who would say, “No, I’m not doing any more.” And then I would be in a position of having to argue or cajole them into completing the therapy they needed. I learned that arguing with patients is not a productive use of anyone’s time.

My current approach is the opposite. I begin with the less sensitive trigger points. This allows the patient to acclimate to the sensation of the needle. They realize, “Okay, that wasn’t so bad.” The lidocaine from the initial injections begins to work, providing some regional pain relief. By the time we get to the most painful trigger point, the patient is more relaxed, trusts the process, and is mentally prepared. We get through the worst one, and the session is over. This simple change in sequence dramatically improves the patient’s experience and ensures they leave the office feeling relief, not trauma.

Contraindications and Alternatives

While trigger point injections are a fantastic tool, they are not suitable for everyone. A thorough patient history is essential to screen for any contraindications. The most significant contraindication is a known allergy to the anesthetic agent.

• Allergy to “Caines”: If a patient has a documented allergy to lidocaine, Marcaine, or any amide or ester local anesthetic, we absolutely cannot inject with our standard formula. The risk of an allergic reaction, which can range from a mild rash to life-threatening anaphylaxis, is not worth taking. It’s been said that about one percent of the population has an allergy to lidocaine, so out of every 100 patients, you can expect to encounter one.
• Other Considerations: Other contraindications include active infection at the injection site, bleeding disorders, or patients on high-dose anticoagulant therapy.

However, a lidocaine allergy does not mean we have no options. In these cases, we can revert to the original technique: dry needling. We can still use the star pattern with just a sterile needle to achieve the mechanical breakup of the scar tissue and elicit the local twitch response. While the patient won’t get the immediate numbing or the anti-inflammatory benefit of the injected solution, the mechanical and neurological reset can still provide significant pain relief. It is a testament to the versatility of our integrative approach that we always have an alternative pathway to help our patients.

This patient-centered strategy—combining psychological management, careful sequencing, and a thorough understanding of contraindications—is what transforms a medical procedure into a therapeutic experience. It builds trust, ensures compliance, and ultimately leads to better clinical outcomes.

Integrating Chiropractic Care with Trigger Point Therapy

Myofascial trigger points do not exist in a vacuum. They are often both a cause and a consequence of underlying biomechanical dysfunction, particularly within the spine. This is where my foundational training as a Doctor of Chiropractic (DC) becomes an indispensable part of our comprehensive treatment model. Integrating chiropractic care with trigger point therapy creates a powerful synergy that addresses both the “software” (muscular) and the “hardware” (skeletal) of the body’s structural system.

The Interplay Between Muscle and Joint

Imagine the spine as a series of building blocks (the vertebrae) stacked on top of one another. The muscles, ligaments, and tendons are the guy wires and support cables that hold this tower upright and allow it to move. If one of the blocks is out of place—what we in chiropractic call a vertebral subluxation—it creates an imbalance in the entire system.

A subluxation is a condition where a spinal joint has lost its normal position and motion, leading to mechanical stress and irritation of the surrounding nerves and tissues. When a joint is misaligned or “stuck,” the muscles that attach to and move that joint are forced to compensate. Some muscles may become chronically tight and overworked as they try to stabilize the dysfunctional joint, while others may become weak and inhibited.

This chronic muscle strain is a perfect breeding ground for the development of trigger points. The constant tension leads to the metabolic crisis, hypoxia, and scar tissue formation we discussed earlier. In this scenario, you can perform trigger point injections all day long, and you will provide temporary relief. However, if you don’t address the underlying skeletal misalignment—the subluxation—that is causing the muscle to be chronically strained, the trigger points will inevitably return. The root cause of the problem has not been fixed.

A Two-Pronged Approach

This is why our treatment protocol is a two-pronged attack:

1. Chiropractic Adjustment: I first assess the patient’s spine for areas of biomechanical dysfunction. Using specific, gentle, and precise chiropractic adjustments, I work to restore normal alignment and motion to the affected vertebral joints. This adjustment takes the abnormal stress off the joint. It sends a powerful neurological signal to the surrounding muscles, telling them they can “stand down” from their state of hyper-vigilant contraction. The adjustment effectively reboots the neuromuscular system and corrects the foundational hardware problem.
2. Trigger Point Therapy: With the underlying joint dysfunction addressed, we can then turn our attention to the soft tissues. The trigger point injections serve to “clean up” the residual muscular damage. By using the star pattern technique with our lidocaine-Sarapin formula, we break down the existing scar tissue, flush out inflammatory chemicals, and release stubborn muscle knots that persist even after the adjustment.

This integrated approach is far more effective than either therapy alone. The chiropractic adjustment creates the proper biomechanical environment for the muscles to heal, and the trigger point therapy accelerates that healing process by directly treating the damaged muscle tissue. It’s a classic example of the whole being greater than the sum of its parts. By correcting both joint function and muscle function simultaneously, we break the vicious cycle of pain and dysfunction at multiple levels, leading to faster, more stable, and longer-lasting relief for our patients. This is the essence of true integrative and holistic care.

Clarifying Common Questions: Prolozone vs. PRP

In the world of regenerative medicine, many different terms and techniques get thrown around, and it can be confusing for both patients and practitioners. Two common therapies that often come up are Prolozone and Platelet-Rich Plasma (PRP). While they are powerful treatments in their own right, it’s important to understand what they are and when they are appropriate.

Platelet-Rich Plasma (PRP) is a therapy that involves drawing a patient’s own blood, processing it in a centrifuge to concentrate the platelets, and then injecting this platelet-rich plasma into an area of injury. Platelets are cell fragments in the blood that are rich in growth factors. When injected into damaged tissue (like a torn tendon or an arthritic joint), these growth factors orchestrate a powerful healing and regeneration response. PRP is excellent for repairing structural damage to tissues like ligaments, tendons, and cartilage.

Prolozone is a therapy that combines the principles of prolotherapy (injecting an irritant solution, often dextrose, to stimulate healing) with medical-grade ozone gas. Ozone has potent anti-inflammatory, antimicrobial, and oxygenating properties. When injected into a joint or tissue, it can reduce inflammation, improve cellular energy production, and stimulate a healing response. Prolozone is often combined with PRP to enhance its effects.

So, how do these relate to trigger point injections?

While you could inject PRP into a trigger point, in my clinical opinion, it’s generally overkill. A trigger point is primarily a problem of a localized metabolic crisis and scar tissue within a muscle, not a major structural tear. The powerful regenerative stimulus of PRP is often not necessary to resolve a standard myofascial trigger point. The combination of mechanical disruption and the anesthetic/anti-inflammatory action of our lidocaine-Sarapin formula is usually more than sufficient to break the pain cycle and restore normal muscle function.

Using PRP for trigger points would be like using a sledgehammer to crack a nut. It’s a more expensive, more invasive, and more time-consuming procedure than is typically required for this specific condition. We reserve powerful regenerative therapies like PRP for more significant injuries, such as moderate to severe osteoarthritis, ligament sprains, or chronic tendinopathies, where true tissue regeneration is the primary goal. For myofascial pain, the targeted, efficient, and highly effective trigger point injection remains our first-line interventional tool.

 

Disclaimer: This post is for educational purposes only and is not intended as medical advice. The information presented reflects the clinical observations and professional opinions of Dr. Alex Jimenez and his team, grounded in evidence-based research. Please consult with a qualified healthcare professional for any health concerns or before making any decisions related to your health or treatment.

References

• Travell, J. G., & Simons, D. G. (1999). Myofascial pain and dysfunction: The trigger point manual (2nd ed., Vol. 1). Williams & Wilkins.

• Shah, J. P., Thaker, N., Heimur, J., Aredo, J. V., Sikdar, S., & Gerber, L. (2015). Myofascial Trigger Points Then and Now: A Historical and Scientific Perspective. PM & R: The Journal of Injury, Function, and Rehabilitation, 7(7), 746–761. https://doi.org/10.1016/j.pmrj.2015.01.024

• Dommerholt, J., & Fernández-de-las-Peñas, C. (2018). Trigger point dry needling: An evidence- and clinical-based approach (2nd ed.). Elsevier.

• Hsueh, T. C., Cheng, P. T., Kuan, T. S., & Hong, C. Z. (1997). The immediate effectiveness of electrical nerve stimulation and electrical muscle stimulation on myofascial trigger points. American Journal of Physical Medicine & Rehabilitation, 76(6), 471–476. https://doi.org/10.1097/00002060-199711000-00004

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