Trigger Points & Myofascial Pain: The In-Depth Truth You Need to Know
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- Опубліковано 3 сер 2022
- Myofascial pain syndrome and trigger points are incredibly common and incredibly difficult to treat. They are a common cause of chronic and persistent pain and contribute greatly to mental and physical disability. The problem is that I’ve found many patients who have trigger points are often underdiagnosed, misdiagnosed, and undertreated. So the purpose of this video is to teach you why trigger points matter, what they are, and my current approach to treating them.
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► ABOUT ME
Jeffrey Peng MD is a nonoperative orthopedist and sports medicine specialist. He created a UA-cam channel and blog to translate cutting edge medical knowledge and clinical research to benefit all those looking to live an active and healthy lifestyle. He focuses on maximizing non-surgical treatments for sports injuries and orthopedic conditions. He specializes in using orthobiologics and ultrasound guided minimally invasive techniques to treat osteoarthritis, tendinopathies, and musculoskeletal disorders.
Dr. Peng is board certified in sports medicine and family medicine. He completed residency with the Stanford family medicine residency program and completed his sports medicine training with the Stanford primary care sports medicine fellowship in San Jose. He is an active faculty member for both programs and is excited about training the next generation of physicians.
Dr. Peng’s sports medicine clinic is located in Campbell, California.
Twitter: @JeffreyPengMD; / jeffreypengmd
Website: www.jeffreypengmd.com/
► Disclaimer
My content reflects my own opinion and does not represent the views or opinions of my employers or hospital systems I am affiliated with. They are meant for educational purposes only. They do not substitute for the medical advice of a physician. Always seek the advice of your physician with any questions you may have regarding your health.
Hello Doctor, your information regarding this really can save a lot of lives! Although Myofascial pain isn't life threatening it really cost the quality of life & will have an heavy toll on one's mental health. I have unexplained pain for nearly 14yrs now & although I'm 35y.o my body feels like a 90y.o. When you're in a situation like this with nothing seemingly working & no proper help it really makes a person question whether it's worth living like this. Thank you for your information & keep up the great work. We need more doctors like you here in the UK.
Thanks for sharing your experiences! It is consistent with so many other people I have seen in my own clinic who suffer through chronic pain due to myofascial trigger points. This is a misunderstood and underdiagnosed condition that hopefully we get more research and emphasis in the future. Thanks for your comment!
YES I UNDERSTAND YOU SO MUTCH
@@tomsale5142 it is in my right masseter i have lived for about 2-3 years in intens pain
I suffer from persistant upper back pain.Just below my shoulder blade. The pain can be so intense sometimes and stresses me so much 😢😢😢. I tried all sort of exercises and Physio but no relief..😢😢😢
Absolutely brilliant video. Grateful and thankful for posting this. Especially the hypothesis on cause.
Dear Dr Peng, thank you soooo much for this video, the most complete explanation of the dynamics of the myofacial pain and action of trigger points I've found so far. A true must-see for sufferers of common sports injuries and cronic pain. Again many, many thanks... 🙏
Mate, i'm in absolute tears... im 21 years old, and you just described the last 2 years of my life as if you were there every day. I've been suffering from this, and i've constantly been undermined by our shit british healthcare service. It's take over my life, taken over my will. When you started talking in the first 2 mins, i was shocked that you described every last thought on my brain. I have aspirations of being a professional athlete, and all this has made me be on standby for the last 2 years. I cannot describe what kind of impact it's had. Listen, I live in london but i'll drop everything to get rid of this, and be under the care of someone WHO GETS IT LIKE YOU. Please reccomend a way we can talk on the phone, ill he in Cali in a heartbeat if you can guarantee you''ll sort this out for me. THANK YOU FOR YOUR HELP.... SAVING FUCKING LIVES ILL TELL YA
Thanks for your comment. There are plenty of providers all over the world who are treating people who suffer from myofascial pain. Hopefully you can find one that is in the UK! Best of luck
Well?
Much THANKS and GOD Bless You!!!
Incredible video. I understand so much more and will start looking for a clinician. I’m excited at Relieving my neck/shoulder pain!
Wow amazing stuff! took me years to find this...Bravo Dr. Peng!
Fantastic video! Thank you 🙏🏾
Such great info!! Thanks so much!! I was kind of surprised, though, that you didn't talk about how trigger points actually lead to even more trigger points and can eventually affect multiple areas all throughout the body.
This video is an excellent explaination of what happens to Myofascial patients. Dr. Peng could have used me as a case study. I was an amateur long-distance runner for years then switched to amateur bicycle road racing for over a decade followed by a few years of daily tennis matches. I developed some serious muscle overuse issues which were misdiagnosed and ineffectively treated for over a year. After spending an insane amount of money visiting orthopedic doctors and countless months in physical therapy and on the chiropractor's table, I was getting worse instead of better. Being totally frusted, I started researching Trigger Points and Myofascial pain on my own which led me to Yoga. It took some extremely long (2-3 hours) stretching sessions before I started seeing results. Two years later, I am pain-free unless performing a deep stretching session which can activate some of my remaining trigger points but that is part of my self-therapy. My most productive stretching sessions are not pain-free.
You have no idea how much I appreciate this video. Where I live, I’ve lost count of the tests I’ve had done, and the specialists I’ve seen… 28, 29, 30? I have been poked, prodded, dismissed, gaslit, and accused of exaggerating.
Every time that I’ve shown up at the ER, I’ve been written off as having a gynaecological issue, being a drug seeker, drama queen, but, ultimately, written off as having mental health problems. The way I’ve been treated in this Pharmacare system bracket (I don’t call it healthcare here anymore), is revolting, and it has certainly given me more stress than I could ever imagine. And somehow I’m to blame? I’m learning more about ACNES, which is likely very similar to what you are talking about. I’ve since learned I may also have an underlying syndrome called Ehlers-Danlos syndrome. The saddest part is that I am still suffering with 10/10 pain every day, and I have no hope that anything will change. I hope more doctors will be open to listening to what you have to say. You are changing lives. Please keep up the awesome work! 🙏❤️
This video is FIRE!!! Thanks so much for posting this. 🙏
You're welcome! Thanks for commenting
Been there, done that from age 16 to 50 for rhomboid TP. Finally I hit a knowledgable PT PhD. who was familiar with Travell and SImons. I'm surprised they didn't send her to a psychiatrist and tell her it's all in her mind. Glad she finally found you. I consider dry needling to be nothing short of a miracle.
This was very informative. Thank you
Glad you found it helpful! Thanks for your comment
Thank you times a thousand for getting this information out here on to UA-cam so that patients like me can get insight on what might be an unknown cause of their pain. I had this chronic debilitating pain for 3 years and not one specialist I saw or even my general doctor told me about this subject I had to find it out on my own, and it's thanks to videos like this one!!! Please keep doing this👏👏👏
You're welcome! Thanks for commenting
Thanks for the video! Really informative and well laid out. I’ve had chronic back pain for over a decade and forearm pain for almost 3 years, and it’s so tough to describe to people what the pain is like or why it’s there… People think I’m crazy for stretching all the time, but I’m just trying to get moments of relief from the tightness and the pain.. It’s hard to even picture it in my head, but this video does a great job. I’ve reached out to a A specialist who does dry needling in the Bay Area and hoping this will help.
I actually came across your video after discovering the specialist, but you gave me more belief that it’s something that can help.
Thank you!
Thanks for your comment, good luck!
This is the most important video in my life as I am suffering from myofascial pain since past 1.5 yrs and got no improvement.
It was very helpful. Thank you so much.
Glad you found it useful, thanks for your comment!
@@JeffreyPengMD I thank you more than words can say... your content gave me hope. I have been dealing with MPS for the last 5 years. I have been to 10 different doctors and no one was able to diagnose my condition. I truly appreciate your video and information. May God bless you!!!
As a soon to be licensed LMT, I have had many of my clients in clinicals tell me they have pain relief after my massage more than any other therapies they've received. They've had a long list of doctors both allopathic and alternative and the only thing they needed with myofascial release and trigger point therapy. I can palpate within minutes the hypotone or hypertone of the musculature and effectively treat most of these trigger points in a one-hour session and then work on the surrounding tissues and help the client to stretch and increase joint mobility where needed. I went into this profession because massage has change my life. I have spent 30 years thinking there was something really wrong with my body on a fundamental level. A combination of massage , chiropractic, PT and energy therapies has been the most effective treatment.
After 6 months of suffering with head pressure and heaviness
I am an athlete(gym and cricket)
I was surfing on UA-cam and found about this I got checked by a chiropractor i have triggers at splenius and scm muscle
Really hope I get a solution now it's been 6 months since I have been a part of any activity
When Jeffrey started telling the story of the 16 yr old girl I literally started weeping. This has been literally my life for the last 3 years ... chronic pain between a 4 and 7 in my lower right back. 18 different physicians, MRIs, Ultrasounds, Xrays, Medication, nothing helps. I have no idea how I'm going to keep living my life.
Thanks for sharing. I can't tell you how many people I've seen with chronic pain that have DRAMATIC relief in pain after getting twitches from trigger point injections.
@@JeffreyPengMD Thank you for your video Jeffrey. This is amazing content, deserves a thumbs up and subscription. Would you have any recommendations on finding a good physician, given dry needling technique is so important?
Michael, were you able to get trigger point injections and find some relief? 🙏
@@reesecop Hey Teresa, thanks for your reply. I found a physio who specializes in Trigger point, but he recommended not going straight for the spot as sometimes that can cause severe flareups. We had two session so far and have done surrounding muscle groups up to 1/2 inch away. I feel about 25% better. Next week we're gonna try for the trigger point, fingers crossed.
Thank you for your msg, and if you are going through anything similar wishing you all the best as well.
@@BboyFever Did you go through the trigger point directly? If yes, how did it went? Trying to solve lower back pain I've had for 2 years now. Wish you all the best!
I just had my first dry needling. Your message helped me get there. Thank you 🙏
Wonderful! Good luck!
How was it Jennifer? Painful? Did it relieve the pain from the trigger points?
Fantastic video! Thank you! Saving to watch again later and subscribed! Side note, do you speak on a Bible teaching on you tube? I listen to several videos and your voice sounds just like one of the narrators. 😊
Excellent case study. This is very common mistake doctors make in chronic pain with the lower gluteus maximus trigger points over the ischial tuberosity being mistaken for proximal hamstring problems. As an osteopathic physician treating chronic pain for over 20 years the two most common misdiagnosis for chronic pain are hypermobility and chronic trigger points. He doesn't excellent job of explaining this point of medical students not being given any information about this super important topic for chronic pain.
I have suffer with myofacial pain for 15 years. Took one year to diagnose after repeated visits to specialists including psychology classes where they teach you to try and live with your pain. In my 15 years with this problem I've notice that stress significantly increases pain and also my food triggers: like chocolate, grains, wheat, and nuts. When I consume those triggers, pain almost becomes intolerable. No medication really reliefs it but it does put me to sleep so it kind of works but then that only helps at bedtime. I use an aggressive foam roller with nodules on it and sometimes I roll on a softball when trigger points are deep in the muscle. I will say this, my trigger points have moved all over my body but sometimes doctors have a hard time accepting my issues with pain. But in those 15 years trigger points have subsided for months but then they come back with a furry. I will show this video to my pain management doctor and tell him about the dextrose 10cc maybe this will calm down my fibro. I'm a 63 yr old male. Thanks again Doc
I wish i could have watched this 10 years ago before having both legs amputa... Just kidding, the leading case study here was exactly what i went through, 3 years of various military physios and doctors for accute hip/glute pain, until finally one tried 'this new thing called' dry needling. One great big jolt, some worried looks and some stretching and the following day i was back to sprinting my way outa the gates with tears of relief. I did a lot of weighted runs prior to the injury which is where i imagine the cause can be attributed - a great video, and this website is really useful also. Many thanks 🙏👌
This causes unbelievable pain and suffering. After 4 years, I'm at the point of disability from severe global pelvic pain. Just had an evalluation with a sports rehab PT which is probably who i should have seen in the first place since my pain began after becoming a marathon runner. I've also started seeing a myofascial release therapist. Praying they can reverse this and help me. I've spent around $30,000 at this point and had 2 unnecessary pelvic surgeries. Smh
Thanks so much
Yep! I had been trying to get to the cause of my pain for 20years. I lost count of the amount of specialists appointment, MRI's, X-ray, Ultrasounds, and all sorts of appointment from physio, myotherapy, injections etc etc etc but to no avail. I would've spent about 10K over those years trying to figure out what the issue was. I ended up finding out the issue myself. Turns out its MPS Myofascial pain syndrome. So now to continue forking out more money now to get the ACTUAL issue resolved - fingers crossed!! 🤨
This information identified what I am probably experiencing currently in my elbows, arms, and neck. My massage therapist uncovered incredible amount of "tightness", and "knots" in my shoulder, neck, back with referred pain. I started to feel exaggerated amount of pain soon after Covid in October and now suffering what is called Long Covid with slow recovery. I am curious about your treatment of needling and how to get a consultation/ visit with you. Fascinating! Thank you.
Truth! I've been suffering with this for about 6 years. When I go in for dry needling, some of the therapist aren't as experienced. I know that if I don't get the twitch, I will be hurting pretty much the next day. It's a total waste of money. If I get the twitch. I can have relief for a varied amount of time. Right now, relief is for about 2 weeks. I'm hoping that I will be able to find a good therapist that gets the twitch every time. Then, I will be able to have a longer time of relief.
Thanks for sharing. This has been my experience exactly. Must get that twitch!
Well let's see where do I begin. I suffer from myofascial pain and myofascial knots. These came about in 2018-2019 from a cervical fusion.c3, c4 c5 Warning never get a cervical fusion if you don't have to the doctors do not explain everything in detail and what are the side effects are. The fusion caused my lower disk to bulge they won't go in and do anything about it they feel that it will be a ripple effect down my spine. The upper cervical vertebrae a whole lot of pressure. The upper and lower vertebrae is will suffer the most after you have a fusion done it puts too much tension and pressure on the areas. As I mentioned I quickly developed myofascial not in my official pain syndrome from this and also fibromyalgia. I have been getting on the average 20 trigger point injections throughout. The length of my cervical spine on both sides into the upper traps. It helps but it's more or less a Band-Aid. Every 3 months I have to go back. My neck is so tight. It feels like rubber bands are snapping to the point where you cannot simply turn your head left or right. Myofascist knots are almost impossible to break. I'll explain this to you the best that I can. Our bodies are covered with myofascial tissue think of it like that white skin over a chicken breast. It allows our muscles to slide and move throughout our body. When you get a knot in the myofascial tissue what happens is the blood flow and oxygen is decreased. And it forms a knot in the tissue from that point on it forms a knot and the muscle. I bet no one ever told you that these can spread. Well they can. They can get so tight they can pull you out of alignment. The reason they spread is because they pull from all different directions causing more tightness and pressure in a different area to the point where another not knot starts to form. And wham another myofascist knott. I remember the first started on just the right side of my neck. Then eventually down to my trap area upper back. Next thing I knew there were forming on the left side of my neck, and down my traps . Some of the knots are so hard. The dr told me they feel like a bone . Tell me so-called help I have found is trigger point injections. Heat works the best for me, stretching your muscles that are affected by this. . Nothing else seemed to help no acupuncture no dry needling. No tens unit, no chiropractor
Dr. Peng, do you have any leads for a good sports medicine doctor in the Fort Lauderdale, Florida area. I am looking for one that has experience with trigger points and knows how to do trigger point injections. I have a chronic issue that does not respond to myofascial massage or any other kind of massage.
Thank you. Just thank you. Dr. Peng. More doctors need to watch this video. Can you touch on referred lower back pain and trigger point in the groin? Thanks again
You can use this to help identify trigger point locations: ua-cam.com/video/_x4TMjLK82Y/v-deo.html
How is trigger point injection different from a nerve block? Sounds similar...pls explain. Thanks...I JUST BECAME A FOLLOWER!!! Love your channel!!🎉
I had similar problems with my shoulders and arms. Many of the symptoms that you described, loss of range of motion, considerable referred pain throughout my arms, elbows and even my shoulder blade area. This gradually grew worse over the course of a year and my doctor refered me to a Physical Therapist but after 10 visits had no relief. While at the PT she mentioned that my muscles were very tight. I realized I needed a PT that specialized in just that, tight muscles. I then went to a rolfer and after 10 sessions was almost pain free. Rolfers specialize in deep massage work on the Myofascial tissues. I still go a couple of times a year just to maintain the status quo. I tell people about my experiences every chance I can because Doctors don't seem know very much about Myofascial problems or Rolfers.
This is my first time hearing about Rolfers!
What is rolfer?
Look it up you'll find plenty of info on the net.@@hermantugimin1285
I was in pain for over 30 yrs with my back and also having back surgery, till i found trigger shots 🙌
Get it my back every 6 months. And had 3 sessions to my shoulder that surgeon wanted to do rotator cuff surgery, completely healed now.
Woah, amazing!
Thank you for this video. I think I have had this for many years. I'm 38 and I've had it since my early 20s. The pain is always there, but it's been nearly unbearable over the past few months, especially when I'm driving. I've been to massagers, chiropractors and physiotherapists, and I massage the area myself and do the exercises prescribed by the physiotherapists. But whatever I do, I feel like I'm fighting against something pressing on my upper back muscles. It doesn't cause numbness or tingling, and it doesn't restrict movement, it's just a constant pain in one specific place.
Also, since I was a child I've had a pulling sensation in the nerves or muscles around my right ear, which in the past few years has caused involuntary facial twitches. I suspect that the two problems are related, since they are both on the righthand side, and they both seem to be aggravated at the same time, namely by driving, travelling in a vehicle, or carrying anything on my back, shoulders or in my right hand for an extended period. However, every doctor and physiotherapist I've spoken to dismisses this idea. I'm wondering if anybody else has similar symptoms, or if it's likely that the cause of the pain in the face and upper back could be caused by the same thing.
I don't have the same pain but I do have refer pain to my knee from sitting at my desk from work for 15 years. Started in my early 30s. After watching this, I did seek out a PT for dry needling. I had to go to 5 providers to find one that worked for me. You do have to find someone who is not dismissive and willing to look for twitches. He is right, once I feel the twitch, the pain is gone immediately. I finally have some relief. It's worth a try if dry needling is allow in your state. I also did a lot of research on my own by using a foam roller to find my trigger points and sharing this with my provider. Also watched a lot of youtube videos to diagnose myself. It's very difficult to find a good provider that knows what they are doing but you just have to persevere. Good luck.
I had the lower back pain from the age of 12, was not able to sit for over 20 mins. When I was in school, I was the only student who got the permission to squat on my chair - that was the only way to reduce the pain.
For over 15 years, I didn’t even know what the name is for this type of pain, I just know that for the last 15 years, there was no one day I was pain free.
I had a sensory deprivation experience last year and that was the first time after 15 years I recall what a “pain free” body could feel like (but only lasted for 10 mins”, then all pain comes back.
The moment I learned that there is a term “myofascial pain” was the moment that I found the key to science, literature, and truth to recovery.
Thank you so much Doc for your video!!
Wow, thanks for sharing your experiences. I'm glad you found this useful!
Where were you when I was suffering with neck shoulder and arm pain? After 3 years I was discharged from the military. And after another 3 years of work it finally relaxed and the pain stopped.
100% agree with this. I suffered sciatic pain in my glute, radiating down the outside of my calf. This resulted in pain sitting, standing and sleeping. Stretching and massage over years could not rectify the issue. One session of dry needling into the glute trigger points removed 95% of the pain. Today I’ve been researching due to headaches I’ve been suffering every other week, for 48-72 hours at a time and it would appear it’s radiating from the upper trap region. I’m about to book another needling session to address the issue, as stretching and theragun treatment is not sufficient. Highly recommend needling to anyone with trigger points.
100%. Thanks for sharing
That's awesome I need to try this, is this the same as acupuncture?
Practising physiotherapy since 12 years and your research enlighted a lot...thanks a lot sir...ur intention to help people with your research is outstanding and you deserve a salute...thanks to u again...
Thanks for your kind words and for commenting!
I feel like you're telling my story of dealing with chronic neck pain this past year. My Dr says today, let's try trigger shots since nothing else has worked. 🤞🤞 hopefully this it 🙌🏼
Good luck! Thanks for sharing your experience. Try to get those twitches!
Day 3- completely pain free🙌🏼 headache-gone, neck pain-gone, but was still a little tight yesterday. Today is better! I had developed tennis elbow on right-side as well during the past few months.. woke up the next day after getting the trigger shots in my neck.. elbow pain- GONE 🙌🏼 💯 I feel normal again after a year of pain🤗
Amazing!!
@@tomsale5142 my doctor thought it was from arthritis at 1st, so he gave me 2 different injections in my neck - epidural and a blocker. No relief. So that's why he said 🤔I think it's muscle tension.. tried the trigger shots last week 🙌🏼.. but I do feel everything tightening up again, so I may need it a few times 🤷🏼♀️. Just glad we figured out what works.
Still doing good?
Hi its a dry needling only or you inject something for trigger point,trp using kindly guide
Thank You, Doctor: I have SAME thing it seems and am scheduled for MRI. I usually am only given one or two trigger points and suspect I simply need more. Also took two kinds of medications, yet they are not providing relief. THANK YOU for info, Doctor.
Need to get those twitch responses!
Hi Dr Jeffrey! Love watching all of your video. They are very informative and useful for improving my daily orthopedic practice. I have a few questions regarding to your trigger point needling technique. What is your recommended needle size? and do you injected local anesthesia in a fanning posture or directly on the trigger point then do a few dry needling afterwards. Thankyou for your response!
I use a 27g 2 inch needle for most muscles. I tend to administer more local where there are the most twitches. But you don't have to use a lot, 0.1 or 0.2 cc. Just takes the edge off / reduces some soreness afterwards. Getting the twitches is the most important thing.
@@JeffreyPengMD thankyou for sharing your technique sir!! much appreciated
Ty for this video I have this same problem. I'm going to get needling tomorrow
Good luck!!
27:51 Does acupuncture have possible benefits? Thinking back to mentions of dry needles, refered pain, trigger points?
Hey doc,
I have two questions. You mentioned doing the injections once a week. Is there an advantage to doing them at closer intervals intervals vs every six weeks? That’s all my provider will do so I’m trying to understand the difference in treatment protocol.
Second question is why do injection help but regular massage and direct pressure to the trp site really irritates/aggravates the contraction cascade. I’m trying to improve my situation as quickly as possible but am having trouble understanding why some things work and some things really seem to cause regression. Is the trp just too sensitive or does direct pressure hit the wrong muscle group and cause worsening symptoms?
I am not looking for medical advice. Just education as this field is extremely limited in evidence-based practice. Any clarification will be helpful.
Thank you :)
I Found out found I have myofascial pain syndrome I get radiating pain sitting for to long is awful. I got From Really High Volume training at the Gym Which I used to do along side powerlifting. Had for 6 years now. Really Helpful Video I can relate to the exsample person you used.
Thanks for commenting!
Hello. I broke my back in 2006 while AD military, I’ve suffered chronic pain since. I have L4/5, S1 fusion and SCS implant. I got to injections, steroid injections, ablations…….nothing worked. I am a big believer in chiropractic care, I’ve done acupuncture, myofascial massage, recently started cupping and dry needling. But, I continue to suffer pain almost daily. Why do some people get complete relief after so few needling treatments? I feel like I need it for the rest of my life.
Is the remedy you’re suggesting regular dry needling, or trigger point injections with anesthetic/corticosteroid? For rhomboid/trap pain 2.5 years
Thank you for your thorough lecture. I am rehab doctor from South Korea, and your lecture was really helpful. Are there any tips to avoid injury to peroneal nerve and sural nerve while injecting into peroneal and solues m without ultrasound?
Greetings! Thanks for your comment. Stay away from the fibular head to avoid the common peroneal nerve. If you use a 27g needle, the chances of directly piercing a nerve is exceedingly low. You can try to approach the soleus from the medial aspect to avoid the sural nerve.
@@JeffreyPengMD Great!! Thanks a lot :)
If there are any other physicians or specialists that watch this video, I just want to say the medical community in the US is doing a horrible job of diagnosis this condition. I was a Physician Assistant trained in the USA for over 20 years and I don't even recall learning about this condition. I have now suffered for over 7 years with chronic pain. I did have some trauma to the my left arm after a vaccine related injury in 2015 and some of the issues with MPS are multifaceted, like poor posture and sedentary after being diagnosed with auto-immune disorders. But I have to say after watching 2 of Dr. Peng's video I feel like crying because he just explained everything I have been experiencing for 7 years and the unilateral pain, weakness, spasm, neuropathy (with normal MRI's and seeing specialists) is so frustrating. Then being told I have Fibromyalgia after I repeatedly told every single provider and specialist my pain was unilateral and progressively worsening. I was worked up for MS. I would have so appreciated the proper the diagnosis 7 years ago because my condition has progressively worsened and now exercise is difficult and the number of TP's I have has just gotten worse over time to the point where I know have them on the Left lower gluteal/back/leg. Basically my entire left side is affected and I am in constant pain. I read someone else post that it is a miserable way to live in Chronic pain. I refuse to take drugs, even OTC, I wish this would show all the doctors we are not drug seekers. All I wanted was a proper diagnosis and relief of the pain WITHOUT drugs (NSAIDS, muscle relaxers, anti-depressants) no thank you! I take vitamins, magnesium and I do alot of the holistic modalities. The only thing I haven't tried is the TP injections or dry needling. Thank goodness for doctors like Dr. Peng who legit care about patients and their weird symptoms that don't show up on a diagnostic test or they can't explain. I am so tired of doctors telling patients it's all in their heads. That is why I am no longer a PA. I lost faith in the system that was supposed to help people. Now I am worried about trying to find someone with experience and knowledge like Dr. Peng who can do the TP injections right. I would rather not risk a chance of someone doing them wrong and causing more damage. It's just a sad state of affairs, some many people are out there suffering in chronic pain, feeling miserable, poor quality of life and doctors just telling them it's in their heads or to just to go to Physical Therapy, Chiro, or get a massage. I have done all of this and I am still in pain. The saddest part is after 7 plus years of pain I had to figure out I have MPS on my own.
Wow, what a story! Thanks for sharing your experience. The silver lining is that trigger points and injection technique is starting to be discussed more within the sports medicine community at large conferences such as the American Medical Society for Sports Medicine (a significant amount of credit goes to Dr Navid Mahooti who is near Boston).
Dry needling works, same issue as above on my RT shoulder and neck.
My physical therapist suggested DN to give it a try.
Thank you...doc I have an experience of patient 26 female who has dizness, headache..for 2 years her quality of life decrease she is been to neurologist., different physiotherapy clinics...has been treated as BPPV...no change...when I get to see her she mentioned that her dizness increases when she chew meat....I asses her SCM her headache and dizness dramatically decrease ..all I did was release of trigger points release of SCM .I'm physical therapy
Amazing! Thanks for sharing
Wow, your video is so informative! I think I have myofascia pain in my shoulder/upper back/neck. Iv had the pain for 2 years now. I believe the cause is repetitive motions over the years ( i do housekeeping / cleaning for work ) i got put to physio for a year which made no difference, I got put on different pill like naproxen, pregabalins, high strength co codomols from the doctors, Nothing helped . I seen about 3 physios who all just gave me exercises to try which none helped. I seen a chiropractor who didn't find anything nor really tried. I then seen another chiropractor who iv had 6 sessions with for realignment and getting things moving but still no difference. She's now started me on dry needling , I felt a big difference after 1 session so I'm hoping by the end of the 6 sessions I will be more pain free. Is dry needling the same as trigger point injections?
Thanks for your video x
Dry needling is very similar to trigger point injections. The key is technique and to make sure you get muscle twitch responses.
I’m 53 and had a 2-level ACDF surgery last November but still suffer from shoulder joints pain after surgery. I was prescribed dry needling, but I had much more pain than prior to my surgery for up to 1 week after the dry needling session. Do you know why?
Has this been found useful for fibromyalgia? Unfortunately, my whole body is tense 24/7. I just did 1st dry needling treatment in mid back & they didn't explain it at all. I found this very informative. So, thank you for that.
I hope they can cover multiple problem areas for me in the future.
Your chart at the end, was a great addition too. Ty
Possibly! Fibromyalgia is incredibly complicated and difficult to treat. My intuition is that for some reason, some people are more predisposed to forming trigger points. Left untreated, which most are, this leads to a whole body response to pain that affects both mental and physical health. Going after the trigger points with needling (this may take MANY sessions) will potentially treat the root cause and hopefully all the other symptoms improve as the pain generators are resolved. Definitely something to discuss with your healthcare providers. Good luck!
You're welcome! You may find this useful as well: ua-cam.com/video/_x4TMjLK82Y/v-deo.html
Please go get your Vitamin D levels checked ASAP.
What's called " fibromylgia" is many times a vitamin D deficiency . We are told normal is 35 but really that is still very low and problematic . Optimal range of vitamin D in the blood is 80-100.Vitamin D deficiency can mimic almost every "disease" in the book.
Thanks a lot for sharing these stories! This sounds very similar to own story.
I wonder about a couple of things. Why don't you start out with dry needling? And if that has no effect you go wet needling. What are the long term outcomes? Clearly, if someone has been injected with a local anesthetic, you would expect an immediate relief. Are their symptoms also significantly improved three months after?
Great question. In my opinion, wet needling or dry needling doesn't matter. You gotta get the twitches. Doesn't matter what you inject (saline, lidocaine, botox, etc etc), what really matters is the physical disruption of the dysfunctional muscle unit. In my experience, if we get all the trigger points, symptoms are gone for 6-12 months. They can recur so it's important to keep stretching and treating the area for maintenance.
hello doctor, thank you so much you have specifically explain my problem for almost four years, i have visited over 17 doctors here in Nigeria but no any effective result really lost hope think what am experiencing will never be heal. mine is the pain from shoulder blead then to neck then to head mostly right site my arm. please what should i do first thank you so much,
Wow! I'm glad this helped explain things for your condition. Unfortunately I cannot give medical advice over the internet. Please seek the advice of your trusted health care provider. Best of luck!
ua-cam.com/video/y9RcwV1oXu0/v-deo.html
Dr.Peng I also wanted to ask what depth are you going with that syringe when you fan around that area in and out technique / dry needling. Thanks
As deep as it takes to get the twitches! Knowing anatomy is key.
@@JeffreyPengMD great info thanks Dr. Peng
I had dry needling in my neck,back, shoulders and pecks and it works great. my only problem is that now my nervous system is extremely sensitive for some reason. even just moving my tongue around in my mouth feels like nails on a chalkboard.
how do u do ur trigger point injections? dry, steriods, botox, etc...
16:31 ATP? inflammation? starved muscles?
17:44 ?? Neuropathy due to diabetes or trigger points or both? How to distinguish cause?
What you injecting trp session, its only dry needling or injectioning
hey Dr Jeffrey, whats the best book you would recommend on this topic?
The Trigger Point Manual by Travell and Simons
Hello dr. I am from bangladesh. I am suffering since 3 years. I have gone through more than 20 doctors and took acupuncture, prolo therapy, shock wave and all but nothing worked. I have too many trigger point on my back muscle. Can you please tell me what is a trigger point injection. Is it just the needle or you push some medicine in it? Please let me know. My quality of life gas been decreased just for this issue. Please let me know doctor
How do you know if to do trigger point injections or PRP or a different treatment
Depends on the indication! PRP has not been studied for the use of myofascial trigger points. I often use trigger point injections to treat the muscles that are often involved (usually due to compensation) in osteoarthritis as well as tendinopathies.
i was in an MVA accident 4 yrs ago at 16, had a fractured pelvis in 6 spots & broken ankles. permanent l3 nerve damage, & a torn right hip labrum. i had arthroscopic surgery which seemed to help but later on i developed chronic si joint/ low back pain. I’ve gotten so many tpi/cortisone shots… i was diagnosed with myofascial syndrome.
i was an athlete prior to all this, could this have any affect on why I’ve developed so many trigger points going from workouts to bedridden, or would it simply be from the trauma? definitely trying the dry needling out next, thanks for this video
Thanks for sharing your story. Trauma is the most common cause of myofascial trigger points. But it sounds like you have multiple other issues that could be causing chronic pain so it becomes hard to pinpoint. Difficult situation. Please continue to work with your healthcare providers, good luck!
@@JeffreyPengMD much appreciated, thanks!!
Hello doc
In regards to dry needling, do you think ultrasound guidance would provide additional benefit?
IMO, the benefit of ultrasound when it comes to needling is to avoid blood vessels and nerves. Otherwise, it's hard to "feel" the muscle twitch and respond to treatment. It's as much art and technique as it is science.
I have mftp...and the doctor told me it is because of h.pylori infection..
Is there relationship between h.pylori and mftp.?DESPITE I DONT HAVE ANY GIT SYPTOMS
Hi, Could major hemo therapy infusion help in miofascial pain? Thank you!
I'm not sure what that is! Can you elaborate?
If there is a leakage of acetylcholine at the neuromuscular junction, a concentration at the synaptic cleft AND an inhibition of acetylcholinesterase from a low ph and cgrp at the active trigger point wouldn't or is there any medication that promotes, reactivates or agonizes or reuptakes acetylcholinesterase?
That's a complicated question! The problem is the pathophysiology of trigger points is still not well understood so clinicians are still looking for other types of medications that can potentially help.
@@JeffreyPengMD
www.ncbi.nlm.nih.gov/pmc/articles/PMC10179372/
A New Unified Theory of Trigger Point Formation: Failure of Pre- and Post-Synaptic Feedback Control Mechanisms
Robert D Gerwin. Int J Mol Sci. 2023.
Abstract
The origin of the myofascial trigger point (TrP), an anomalous locus in muscle, has never been well-described. A new trigger point hypothesis (the new hypothesis) presented here addresses this lack. The new hypothesis is based on the concept that existing myoprotective feedback mechanisms that respond to muscle overactivity, low levels of adenosine triphosphate, (ATP) or a low pH, fail to protect muscle in certain circumstances, such as intense muscle activity, resulting in an abnormal accumulation of intracellular Ca2+, persistent actin-myosin cross bridging, and then activation of the nociceptive system, resulting in the formation of a trigger point. The relevant protective feedback mechanisms include pre- and postsynaptic sympathetic nervous system modulation, modulators of acetylcholine release at the neuromuscular junction, and mutations/variants or post-translational functional alterations in either of two ion channelopathies, the ryanodine receptor and the potassium-ATP ion channel, both of which exist in multiple mutation states that up- or downregulate ion channel function. The concepts that are central to the origin of at least some TrPs are the failure of protective feedback mechanisms and/or of certain ion channelopathies that are new concepts in relation to myofascial trigger points.
Unfortunately, trigger point injections didn't work for me and made the pain worse in my trap area of my upper back. A D.O. gave the injections.
I’m suffering from trigger point pain for 2.5 years in my scapula. Did 50 sessions of Physio out of which 21 sessions were of dry needling but all in vein. The problem is still as it was😢. My scapula also experiences grinding sound when I move it.
Sorry to hear that! I hope you are able to figure things out with your health care providers. Best of luck
I have same issue. Could be your posture
Good morning Dr,
If I have trigger points in my forarms do to golfers elbow and myofasciitis, will the trigger points be automatically healed if we treat the golfers elbow, or do the trigger points now become their own diagnosis that needs to be cured once the golfers elbow is healed?
That's the million dollar question. Do we treat the tendon or do we treat the muscles? I recommend treating both! I've found only treating one or the other is usually not sufficient and can cause symptoms to recur.
Untreated tendinopathy can lead to myofascial trigger points. Myofascial trigger points can also lead to tendinopathy. It really doesn't matter which came first, both need to be treated.
@@JeffreyPengMD So would the muscles be dry needled and the tendons PRP'd ? Or would it be something else?
@@gl8743 Yup
@@JeffreyPengMD Thank you!
Hi, doc Peng. How can I get PRP here in the Philippines 🇵🇭, got knee injury mcl and acl due to my conn's syndrome,
Thanks for your comment. Unfortunately I cannot give medical advice over the internet. Please seek the advice of your trusted health care provider. Best of luck!
Hello doc, what is the best way to find a provider who is competent with there dry needling / trigger point injection practice? I had dry needling done at a PT office one time and all they did was insert a needle and let it sit for 10 minutes before taking it out. I need to find someone like you!
There is currently no way to "sort by technique". The most clear cut thing to ask is if they specifically look for muscle twitches during needling.
You have to shop around. But you can always ask some eliminating questions such as. Do you use a pistoning technique, which is really what should be done. They feel around for the general area of complaint and feel for taut bands. They insert the needle in and out illiciting AS MANY TWITCHES AS POSSIBLE within reason. You can't needle a leg for an hour straight. Maybe 8 to 15 minutes per painful area.
Steer clear of estim. Steer clear of letting the muscle lay in situit
@JeffreyPengMD hello where is your practice located
Whenever I consume THC or CBD (I don't do often for obvious reasons) I get muscles contractions in my lower back and the trigger points become way more painful than usual and it takes a few days to feel better, it happened with lion's mane as well. Has anybody experienced this?.
this true. i have burning, tingling, numbness. in throat numb, tingling, chest neck burns more some tingling. best treatment for me is Valium. relaxes body somehow. 2nd best treatment steroids oral or epidural in neck. but my spine clinic just told me myofascial probably my cause now. my spine MRI good so my nerve pain coming from muscle not pressure on bulging disc on spinal cord
I had trigger short injections to fix a herniated disc but my pain got worse the doctor told me he can't so anything.. He just kept saying I'm fine but still in pain
How about Trigger Point Injections (with Lidocaine) vs Dry Needleing. What is more effective? Thank you
In my opinion, the medication doesn't matter. What matters is getting the twitches!
Thank you Dr. ❤
How do I find someone who does the correct technique in my area? I’m going on a year of severe myofascial pain.
Unfortunately there is currently no way to search for a doctor by technique. Best of luck
You just described the last 4 years of my life
You’re not alone!
How many get be injected i am full of active ones that have been there for 5+ yrs. Massage, pt and dry needling didnt help.
Thanks for your comment. Unfortunately I cannot give medical advice over the internet. Please seek the advice of your trusted health care provider. Best of luck!
@@JeffreyPengMD of course, no problem. I just wondered if they did 1 at a time or could do a bunch, similar to a dry needling appointment.
Is the twitch response painful for the patient?
Everyone responds to the twitch response differently. Some people tolerate it no problem. Others feel discomfort when the twitch happens
I heard that Dexamethasone can be injected according to my dermatologist who treated me for hair loss / alopecia, he said it can be used I my legs to treat pain, it’s a steroid, just wanted to know if this is true or have anyone tried dexymethasone. I’m going to start my trigger point injection with lidocaine, family doctor GP has been trained in it, this is in Vancouver BC and Richmond BC. My shoulder blade area region has myofascial pain as well as my thighs posterior, I have the TENS machine, and I used thermo gun hammer style massager and take very hot baths as well, I can’t use medical patches because I have eczema. I take pain killers extra strength over the counter, I have this pain for over 20 years because of falls from skiing and car accidents, my pain is so bad, so I have only been working part time. I wish everyone luck and thank you Dr. Jeffrey Peng for sharing this info and great video!
Steroids have been studied for trigger point injections and have been shown to NOT be helpful. But you get all the side effects of injecting steroids. Technique is all that matters with trigger point injections / needling.
@@JeffreyPengMD thank you Dr. Peng
i have this in my masseter what to do?
Thanks for your comment. Unfortunately I cannot give medical advice over the internet. Please seek the advice of your trusted health care provider. Best of luck!
Can myofascial pain syndrome be heald for ever?
Or it's still
The goal of needling is to remove the trigger points for as long as possible. I have patients who had 5+ years of pain. They are still pain free after 2 years. I know this is anecdotal. But this is incredibly difficult to study as pretty much every physician does their trigger point injection slightly differently. And most do not look for twitches.
Is the twitching breaking apart scar tissue?
Not exactly. It's a complicated biochemical pathway. Think of stretching a rubber band really tight (that's the tight muscle with muscle knots). Now when you let go, the rubber band gets restored to its normal length. That's essentially what happens when we hit a trigger point and cause a local twitch response.
@@JeffreyPengMD so is this a bigger issue than adhesions in the muscles in your opinion?
Love your videos! I have tennis elbow for both arms for 3years. I got 3 PrP injections for each size(1month apart). But I felt like the prp helped me for relief the pain for couple weeks and then it started coming back. Should I keep getting PRP or the Trp instead?
Thanks for your comment. Unfortunately I cannot give medical advice over the internet. Please seek the advice of your trusted health care provider. With that said, trigger points ALWAYS need to be on the list of causes of pain if someone is not responding as expected to treatment. Best of luck!
@@JeffreyPengMD what is in the trigger point injections? Botox?
What is trigger point injection
What are the steroid injection side effects?
You may find this helpful: ua-cam.com/video/qO6-xvWl4o4/v-deo.html
I suffer from trigger points
I hope you find the treatment you need!
Thank you. The challenge now will be to find a local doctor who uses your techniques.
Thanks for your comment!
I have started trigger points with a new Doctor. My pain Doctor was my Doctor for 16 years.
Can you explain how this new Doctor able to feel where the trigger points are needed?
I am amazed he can feel where the pain is in my back.
Always important to find great healthcare providers! Thanks for your comment
Why was this client never referred to a licensed Massage Therapist?
NSAIDs should NOT be used chronically.
One is not an elite athlete at age 16. All initially intense activities - heavy exercise - strains connective tissues, tendons, ligaments, in ways not yet adapted to. From stress fractures to persistent pains, some gradual increase rather than heavy exercise without activity buildup and slow stretching (which also necessarily must be gradually increased, especially during growth as subadult) is required.
Because modern cultures favor sedentism, children very likely experience these traumas far more than healthier active cultures.
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the pain is unbearable on top of fibromyalgia and osto now stting my carpel tunnel off down the arm going to ask for carpel tunnel surgery. and a steroid shot in back.
your practice is too far for me to visit. Do you have any colleagues in Arizona with similar technique and knowledge?
No, sorry! Your best bet may to look for your nearest academic medical center if you feel you have complicated medical issues.