Is a trigger point injection the same as a cortisone injection?

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No, trigger point injections and cortisone shots are not the same thing, though they can sometimes use similar medications.

Key Differences

  • Target Area:
    • Trigger Point Injections (TPI): Injected directly into painful muscle knots (myofascial trigger points) to relax tight muscle fibers.
    • Cortisone Shots: Injected into joints (like a knee or shoulder), bursae, or around tendons/nerves to treat localized joint or tissue inflammation.
  • Ingredients:
    • Trigger Point Injections: Usually contain a local anesthetic (like lidocaine) or saline. They may include a corticosteroid, but often do not. Some even use dry needling with no medication at all.
    • Cortisone Shots: Always contain a corticosteroid (cortisone) to suppress inflammation, often mixed with a short-acting anesthetic.
  • Tissue Impact:
    • Trigger Point Injections: Designed to release muscle tension without harming healthy tissue.
    • Cortisone Shots: Can weaken or break down surrounding soft tissue or tendons if used repeatedly in the same spot.

How painful is a trigger point injection?

A trigger point injection causes mild to moderate discomfort, usually described as a brief sharp pinch or sting followed by a deep, dull ache.

What the Sensation Feels Like

  • Initial pinch: The needle going through the skin feels like a quick prick or blood draw.
  • Muscle twitch: When the needle hits the tight muscle knot, the muscle may briefly twitch or jump, which can feel sharp for a split second.
  • Pressure or burning: Injecting the liquid medicine can cause a brief stinging, burning, or heavy pressure feeling in the muscle as it spreads.
  • Aftercare soreness: The treated area often feels bruised, tight, or sore for 24 to 72 hours after the procedure.

Learn more about the process and what to expect from the Department of Health or a specialized center like Advanced Spine and Pain.

What are the long-term side effects of trigger point injections?

Trigger point injections generally do not cause permanent long-term side effects when performed correctly, though repeated or steroid-based injections carry a small risk of localized tissue changes or systemic effects.

Local and Tissue Effects

  • Skin dimpling or discoloration: Repeated steroid injections in the exact same spot can cause localized fat atrophy, leaving a small indent or lighter patch of skin.
  • Localized tissue irritation: Repeatedly piercing the same muscle fibers with pure local anesthetics presents minimal long-term risk, but can occasionally lead to minor, localized tissue irritation.
  • Myonecrosis: In rare cases, local anesthetics can cause temporary muscle fiber damage, though this typically heals within a few weeks.

Systemic Effects (When Steroids are Used)

  • Hormonal and metabolic shifts: Frequent injections containing corticosteroids can lead to temporary increases in blood sugar (especially for people with diabetes), higher blood pressure, or weight gain.
  • Bone density concerns: Long-term, repeated use of high-dose corticosteroids over many months or years can negatively impact bone mineral density.

What kind of doctor does trigger point injections?

Several types of doctors perform trigger point injections to treat painful muscle knots and myofascial pain.

Types of Doctors

  • Pain management specialists: Doctors who focus entirely on diagnosing and treating chronic pain conditions.
  • Physical medicine and rehabilitation (PM&R) doctors: Physicians who specialize in restoring physical function related to muscle, bone, and nerve conditions.
  • Family medicine doctors: Primary care providers who offer comprehensive healthcare and may perform these injections in-office.
  • Sports medicine physicians: Doctors who treat musculoskeletal injuries and overuse issues related to physical activity and sports.
  • Orthopedic surgeons: Specialists focused on the skeletal system and connected soft tissues, including muscles.
  • Obstetricians-gynecologists (Ob/Gyns): Specialists who sometimes perform these injections for chronic soft-tissue and muscle pain in the pelvic region.

You can consult resources like Healthgrades to learn more about the providers who offer this care.

Where is the most painful place to get a cortisone shot?

Injections into the sole of the foot (such as for plantar fasciitis) and the palm of the hand are widely reported as the most painful places to get a cortisone shot.

Why These Areas Hurt More

  • Tight spaces: These regions have very little soft tissue and tiny, confined anatomical structures. Forcing fluid into a tight space stretches the tissue and builds high pressure.
  • Dense nerve endings: The hands and feet have a very high concentration of sensitive nerve endings compared to larger joints.
  • Lack of room: Larger joints like the knee or shoulder have more space to absorb the fluid and fewer surface nerves.

Managing Discomfort

  • Local anesthetic: Doctors often mix a numbing agent like lidocaine into the syringe to reduce pain during and right after the procedure.
  • Post-injection pain: You might experience a temporary increase in soreness (a "steroid flare") once the numbing agent wears off before the anti-inflammatory medicine kicks in. You can learn more about what to expect from Ramsay Health Care.

Myofascial Pain Trigger Point Injections Explained

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What should you not do after a trigger point injection?

You should avoid strenuous physical activity, aggressive massages, and applying heat immediately to the injection site after a trigger point injection.

Activities to Avoid

  • Strenuous exercise: Avoid heavy lifting, high-intensity workouts, or rigorous sports for the first 24 to 48 hours to prevent straining the treated muscle.
  • Aggressive massage: Do not use deep pressure, aggressive kneading, or massage tools on the injection site, as this can increase inflammation.
  • Immediate heat application: Avoid hot packs, heating pads, or hot baths right after the procedure, as heat can worsen swelling and irritation during the first day.
  • Alcohol consumption: Refrain from drinking alcohol for the first 24 hours, as it can interfere with the body's healing process and increase inflammation.
  • Ignoring warning signs: Do not overlook worsening pain, spreading redness, fever, or other signs of infection at the injection site.

For more detailed aftercare steps, you can check the guidelines from Atlas Pain Specialists or review official instructions provided by the Cleveland Clinic.

What is the next step if trigger point injections don't work?

If trigger point injections do not work, the next step is usually re-evaluating the diagnosis and starting or adjusting targeted physical therapy.

Reassessing the Diagnosis and Source of Pain

  • Look Deeper: Your doctor may check if the pain actually comes from a joint, a nerve, or a deeper structural issue in the spine rather than just a surface muscle knot.
  • Imaging or Tests: Additional imaging (like an MRI) or nerve studies may be ordered if your symptoms are radiating or persistent.

Alternative Treatments

  • Physical Therapy (PT): If you have not tried structured physical therapy for that specific muscle group, it is a primary next step to address weakness and movement patterns.
  • Dry Needling: A practitioner inserts thin needles into the muscle knot without injecting any medication to help release tension.
  • Alternative Therapies: Options like targeted massage, chiropractic care, acupuncture, or oral medications (such as muscle relaxants or anti-inflammatories) may be introduced.
  • Repeating the Injection: In some cases, if placement was off or a series is needed, a doctor may try a repeat injection with precise technique.

How long does it take to feel better after trigger point injections?

You can feel some relief right away from the local anesthetic, but significant and lasting pain improvement usually happens within 24 to 72 hours.

Recovery and Relief Timeline

  • Day 1 (Immediate to 24 hours): You may feel immediate numbness or partial relief while the numbing medicine works. As it wears off, mild soreness, tenderness, or bruising at the injection site is common and can last 24 to 48 hours.
  • Days 1 to 3: Post-injection muscle soreness steadily decreases. If a corticosteroid was included in your injection, it begins reducing deep inflammation during this window, leading to noticeable pain reduction.
  • 1 Week: Most people experience their full therapeutic benefit and significant pain relief by this point.
  • 2 to 12 Weeks: Total lasting relief from a successful injection generally persists for several weeks or months, especially when combined with stretching or physical therapy. You can review Healthline's guide to trigger point injections for more details on managing recovery.

Aftercare Tips

  • Apply ice: Use cold packs on the injection site for 15-minute intervals during the first 24 hours to manage minor soreness.
  • Stay active gently: Engage in light movement and gentle stretching, but avoid heavy lifting or strenuous workouts for the first 24 to 48 hours.
  • Stay hydrated: Drink plenty of water to help your muscles recover and function properly.

How many times can you have trigger point injections?

How many times you can receive trigger point injections (TPIs) depends primarily on whether the injection contains a corticosteroid (steroid) or only a local anesthetic (like lidocaine or bupivacaine).

Injections WITH Steroids

If your injections contain corticosteroids to reduce inflammation, they are strictly limited to prevent tissue breakdown, skin dimpling, or systemic side effects.

  • Maximum limit: Usually capped at 4 to 6 times per year in a single muscle area.
  • Spacing: They are typically spaced 6 to 8 weeks (or about 2 months) apart.

Injections WITHOUT Steroids (Anesthetic-Only or Dry Needling)

If the injection uses only a numbing agent or saline (or if your provider uses dry needling), there is much more flexibility because the risk of long-term tissue damage is minimal.

  • Maximum limit: There is no universal maximum ceiling, but they are usually capped at 10 to 12 sessions per year.
  • Spacing: In an acute stage or during initial diagnostic stabilization, they can be given as frequently as every 1 to 2 weeks for a very short period. For long-term or chronic maintenance, they are generally administered every 4 to 6 weeks as needed.

Medical and Insurance Restrictions

Insurance companies and government health programs (like Medicare) tightly regulate how often you can get these procedures:

  • The 50% Rule: Most insurance policies will only approve a repeat injection if the previous one provided at least 50% pain relief that lasted for a minimum of several weeks.
  • Session Limits: Many strict payer guidelines restrict coverage to 3 to 4 sessions per rolling 12 months total, regardless of the medication type used.
  • Diminishing Returns: If a series of 2 or 3 injections provides no relief, your doctor will likely stop the treatment to explore alternative underlying diagnoses.

Why do I feel worse after trigger point injections?

Feeling worse after a trigger point injection is common and usually temporary, often caused by needle irritation or a mild post-injection inflammatory response.

Why Pain Increases

  • Needle Trauma: The needle must enter and move through tight, sensitive muscle knots, which causes minor localized trauma and temporary soreness.
  • Post-Injection Flare: Disruption of the muscle knot can trigger a brief inflammatory response as the tissue adjusts and begins to heal.
  • Anesthetic Wear-Off: If an initial numbing medicine wears off before the underlying muscle fully relaxes, the area may feel temporarily sore.

Normal Recovery vs. Warning Signs

  • Expected Timeline: Increased soreness typically peaks in the first 24 to 48 hours and improves within 3 days.
  • Red Flags: Seek medical attention immediately if you experience severe, worsening pain after 48 hours, a fever, increasing redness, warmth, or signs of an infection.