Can I inject a tight muscle spasm in the same manner as a trigger point?

Injecting Muscle Spasm vs. Trigger Point

Yes, you can inject a tight muscle spasm using the same technique as a trigger point injection, but only if you can identify a discrete, hyperirritable focal point within a taut band of muscle—otherwise, you're treating a different clinical entity that may not respond to injection therapy. 1, 2

Understanding the Clinical Distinction

The key issue is whether you're dealing with a true myofascial trigger point or simply diffuse muscle spasm:

• Trigger points are discrete, focal, hyperirritable spots located within a taut band of skeletal muscle that produce local and referred pain patterns 1, 2
• Muscle spasm may be diffuse muscle contraction without a discrete focal point of maximal tenderness 3
• Palpation with 2-4 kg/cm² of pressure for 10-20 seconds over a suspected trigger point should elicit characteristic referred pain and possibly a local twitch response 4

When Injection is Appropriate

Trigger point injection is recommended only for temporary, symptomatic relief in selected patients with identifiable myofascial trigger points, as long-lasting benefit has not been demonstrated. 5

Technical Approach

If you identify a discrete trigger point within the area of muscle spasm:

• Insert the needle at the trigger point site to a depth of 10-30mm, appropriate to the muscle targeted 6
• Attempt to elicit a local muscle twitch response using the "sparrow pecking" technique 6
• After eliciting the local twitch response (or making a reasonable attempt), retain the needle for approximately 10 minutes 6
• Both local anesthetic injection and dry needling are effective—anesthetic injection was superior to saline placebo 6

Frequency Limitations

• Do not repeat injections more frequently than once every 2 months 5
• Up to 4 sets of injections may be considered to diagnose pain origin and achieve therapeutic effect 5
• Additional injections are not medically necessary if no clinical response is achieved from previous injections 5

Special Consideration for Severe Muscle Spasm

Deep dry needling (DDN) should be employed specifically in cases where there is severe muscle spasm due to an underlying radiculopathy. 3

• For all other patients without radiculopathy, superficial dry needling (SDN) is the treatment of choice 3
• This distinction is critical because the underlying pathophysiology differs when radiculopathy is present 3

Essential Adjunctive Management

Injection alone is insufficient—you must address perpetuating factors:

• Correct any postural disorders likely to cause trigger point reactivation 3
• Teach appropriate muscle stretching exercises 3
• Address perpetuating factors including posture, body mechanics, psychological stress, poor sleep, and nutrition 4
• Consider physical therapy focusing on stretching and strengthening exercises as first-line approach 5

Common Pitfalls to Avoid

• Do not perform repeated injections without documenting quantifiable improvement in pain scores, function, and duration of relief 5
• Do not inject diffuse muscle spasm without identifying a discrete trigger point—you may be missing an alternative diagnosis 3
• Do not continue the same intervention despite lack of documented significant improvement 5
• Do not use trigger point injections for long-term management of chronic pain—they provide only short-term relief 5

Alternative Approaches

• Dry needling may be as effective as injections containing medications for myofascial pain 5
• Conservative measures (medication, therapeutic exercise, physical therapy) should be tried before receiving injections 5
• Non-invasive measures include spray and stretch, transcutaneous electrical stimulation, physical therapy, and massage 2
• If conservative measures and injection therapies fail after 2-3 months, surgical evaluation may be considered 5