Sports Medicine / Pain Management

From young to old, people are trying to develop and maintain an active lifestyle for as long as possible. Exercise has been shown to be of great value and is an important component of overall wellness. It is prescribed for many health conditions including depression, obesity, heart disease, elevated cholesterol, high blood pressure, arthritis and osteoporosis. As people aim to increase their level of activity and/or extend their sporting careers, many orthopedic and musculoskeletal injuries, can impede these goals.

Treatment of musculoskeletal injuries requires a multifaceted approach addressing a patient’s biomechanics, posture, activity modifications, flexibility, and supporting muscle strength. Focused therapies and rehabilitation can be quite helpful, and in some cases, might be all that is needed. In cases that do not respond to these methods, a therapeutic injection and/or 'needling' may be offered by a physician. 

The most common type of injection involves a combination of a local anesthetic medication called lidocaine, with an anti-inflammatory medication called a corticosteroid. This is what is known as the traditional “cortisone injection.” Although these injections do not heal the injured tissue, the goal of these injections is to decrease the inflammation allowing patients to continue with rehabilitation and conservative measures so it might heal on its own.  

In the case where such conservative and traditional measures have been exhausted, Regenerative / Orthobiologic therapies might offer a more definitive and healing solution. 

Trigger Point Injections/Dry-Needling

Whether you are a competitive body builder or sit at your computer for eight hours a day, you might be susceptible to getting muscle knots. A “muscle knot” is the lay term for what are also known as TRIGGER POINTS. These points are areas of spasm within a muscle, and occur when your muscle fibers cannot relax. They’re commonly found in sensitive points on the body such as the head, neck and back, as well as the trapezius muscle, a large muscle that extends from the base of your skull down your back and out to your shoulder causing chronic neck tightness and subsequent pain.

Learn more about trigger point injections/dry needling

Commonly treated conditions: 
Chronic neck/low back pain, Tension Headaches, Myofascial Pain, Scapular Dyskinesis, Fibromyalgia, Piriformis Syndrome, 

Joint and Tendon Injections

Intra and peri-articular and soft-tissue injections to relieve pain and inflammation and improve mobility have been an important adjunct for the management of musculoskeletal pathology for more than 60 years.
 
Injections can provide diagnostic information and are commonly used to control pain during  rehabilitation from injuries such as rotator cuff syndrome and lateral epicondylitis (tennis elbow). They are the preferred and definitive treatment for soft-tissue conditions such as de Quervain tenosynovitis and trochanteric bursitis. Intra-articular steroid injection provides pain relief in rheumatoid arthritis and osteoarthritis. 

As with any procedure, success depends on knowing the right diagnosis (who to inject), performing the correct procedure (how to inject), and using the most appropriate pharmacologic or biologic agent (what to inject).

Commonly treated conditions: 
Shoulder/Elbow/Wrist/ Hip/Knee/Ankle/Finger/Toe Arthritis, Rotator Cuff Tendonosis, Subacromial Bursitis, Biceps Tenosynovitis, Tennis/Golfer's Elbow, TFCC, Trigger Finger, Hip/Shoulder Labrum Tear, SI Joint Arthritis, Greater Trochanter Bursitis, Gluteus Medius Tendinopathy, ITB Syndrome, Pes Anserine Bursitis, Baker's Cyst, Achilles Tendonosis, Plantar Fasciitis

Nerve Blocks

There are different kinds of nerve blocks used for various purposes.

Diagnostic nerve blocks typically contain an anesthetic agent and are used to determine sources of pain. 
Therapeutic nerve blocks are used to treat painful conditions. 
Prognostic nerve blocks are used to predict the outcomes of given treatments. For example, a nerve block may be performed to determine if more permanent treatments (such as surgery) are indicated.

Nerve blocks can be used, in some cases, to avoid surgery.

Commonly treated conditions: 
Occipital Neuralgia, Trigeminal Neuralgia, Suprascapular Nerve Impingement, Carpal Tunnel, Ilioinguinal Neuropathy, Sciatic Neuropathy, Tarsal Tunnel, Morton's Neuroma

Ultrasound-guided Injections

 Traditionally, injections have been given "blind," based on anatomic landmarks; meaning that a physician feels for certain bones, muscles, or tendons, and then injects into the desired area. The concern with this method of injection is that there is no way of definitively knowing   where the tip of the needle is, and where that injection is going.  Many of the structures that we are aiming for are only millimeters in size. 

 More recently, ultrasound-guided injections have been gaining in popularity. In this method, ultrasound imaging using high frequency sound waves helps to visualize the body structure of the injection. Studies show that ultrasound-guided injections are associated with significantly less procedural injection pain and provide significantly more pain relief. The needle can be seen on the ultrasound screen and the precise location of the injection is assured. Nearly every single injection is performed under ultrasound guidance at Regeneration Pittsburgh.

 If you are experiencing joint pain that could be helped by an injection, ask your doctor for a referral to a provider with experience in musculoskeletal ultrasound-guided injections.

Insurances Accepted:

  • UPMC
  • Highmark/ Blue Cross Blue Shield
  • United Healthcare
  • Cigna
  • Aetna
  • Medicare
  • Tricare
  • Gateway
  • Auto & Workers Comp claims 
** All insurance plans are unique. We can not guarantee in network status, benefits & coverage and advise you to check with your individual insurance plan. 

Trigger Point Therapy and Dry Needling
Frequently Asked Questions

What the physiology of a muscle knot/trigger point

When an injury occurs from repetitive use or acute trauma, inflammation is produced. The damaged tissues will also go into a protective tension state or contracture to guard against further damage.

This contracture and inflammation inhibit microcirculation which limits both the oxygen rich blood reaching the injury and the waste products leaving the injury.

The injury site becomes hypoxic (decreased in oxygen) subsequent resulting in fibrosis or scar tissue. This fibrosis builds up around the muscles and tissues limiting the ability to fully function (lengthen/shorten) and can also cause compression and irritation of nerves (such as carpal tunnel syndrome) – all of which inevitably lead to myofascial pain and biomechanical disturbances in joint movement and function.

What can trigger point therapy treat?

Trigger Point Therapy is used to treat many areas of the body and Symptoms, including:

Shoulder Pain
Tennis Elbow
Muscular Chest Wall Pain
Low Back Pain
Sciatica
Knee Pain
Ankle Pain
HEADACHES
Fibromyalgia

What are common applications of treatment?

A common application is in the treatment of myofascial pain syndrome, a chronic musculoskeletal pain condition commonly seen with chronic neck and back pain (spinal arthritis or stenosis, sciatica, degenerative disc disease, disc herniation as well as after spinal fusion or surgery) in which painful trigger points develop within muscle and fascia, resulting in local and referred pain, restricted range of motion, and autonomic nervous system dysfunction.

Several common repetitive strain sports or work-related injuries can be treated with trigger point injections and/or dry needling. Neck, back, shoulder, elbow, hip and knee pain commonly have pathology rooted in chronic muscle spasm resulting in faulty movement pattern and secondary pain. This technique is designed to release the restrictions and dysfunction in soft tissue that may cause pain and limit motion in all parts of the body. It has shown success in decreasing pain and increasing mobility to optimize competitive performance.

How can trigger point therapy help my headaches?

Patients with chronic headaches sometimes receive Trigger Point Injections to assist in relieving the pain from chronic tension-type headache, chronic migraine headache and chronic cluster headaches. One theory is that referred pain from trigger points in head, neck, and shoulder muscles produces headaches.

What else can trigger point therapy treat?

Another pain syndrome commonly treated with Trigger Point Injections is fibromyalgia, a chronic condition involving widespread pain, fatigue, and sleep abnormalities.

Additionally, TPI is commonly used in the treatment for whiplash, an acute condition involving neck pain after sudden backwards and forwards motion, as may occur in an automobile accident.

What should I expect from the trigger point injections procedure?

In the TPI procedure, a health care professional exerts gentle pressure upon a trigger point to observe muscle twitch and evaluate the patient’s pain. The purpose of this examination is to allow the provider to identify muscles causing pain that could benefit from injections.

The procedure then involves the process of inserting a small hypodermic needle through the skin and into to spasmodic muscle with subsequent injection of a very small amount of lidocaine. In some cases, no medication is injected; this is called a trigger point dry needling and is effective in certain patients [see linked page]. This helps to break up the knot and the pain is alleviated. It essentially loosens muscle knots allowing improved blood flow to the chronically spasmodic areas.

As a result, the areas begin to heal. As soon as the knots are relieved, there is often an immediate increase in range of motion and a remarkable reduction in pain, soreness, and discomfort, as well as the beginning of long-term relief. Injections are given in a patient’s room at Regeneration Pittsburgh and usually take just a few minutes to administer.

What types of conditions can trigger point dry needling treat?

Trigger point dry needling can treat:

Neck/Back Pain
Cervicogenic Headaches
Shoulder Pain
Tennis/Golfers Elbow
Hip and Gluteal Pain
Sciatica
Knee Pain
Achilles Tendonitis/Tendinosis
Plantar Fasciitis
Muscular Strains/Ligament Sprains
Chronic Pain

What should I expect from the trigger point dry needling procedure?

In the TPI procedure, a health care professional exerts gentle pressure upon a trigger point to observe muscle twitch and evaluate the patient’s pain. The purpose of this examination is to allow the provider to identify muscles causing pain that could benefit from injections.

The procedure then involves the process of inserting small solid filament needles through the skin and into to spasmodic muscle without injection of medication (“Dry”). In some cases, medication is injected; this is called a trigger point injection and is effective in certain patients [see linked page]. This helps to break up the knot and the pain is alleviated. It essentially loosens muscle knots allowing improved blood flow to the chronically spasmodic areas. Dry needling results in the deepest tissue release allowing for improvements in movement and pain. With Dry Needling, the needle itself and the effects it produces within the tissue is the treatment.

As a result, the areas begin to heal. As soon as the knots are relieved, there is often an immediate increase in range of motion and a remarkable reduction in pain, soreness, and discomfort, as well as the beginning of long-term relief.

What's the difference between dry needling and acupuncture

Because it involves a needle, dry needling is often misunderstood as acupuncture. The difference lies in the approach — same needle, different technique.

The ultimate goal of dry needling is different than acupuncture. Acupuncture is typically used in holistic medicine. Dry needling, in contrast, is used for a musculoskeletal purpose. Designed to reset a dysfunctional muscle, dry needling releases tension and quiets an overstimulated muscle.

Acupuncture is based on eastern medicine, and acupuncturists insert needles based on body meridians. Dry needling, in contrast, is based on western medicine and the science of neuromuscular function. It’s a professional physical therapy technique that gets to the root cause of the pain and is designed not only to decrease muscle pain, but also to increase mobility and stability.

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