Modal Pain Management · Dr. Alex Movshis, MD
After Trigger Point Injections: What Not to Do, Soreness, and Side Effects
Questions or problems, any hour: (646) 290-6660. Emergency: call 911 or go to the nearest emergency room.
Full guide:modalpain.com/aftercare/
trigger-point-injections/
At a glance
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Right after the injections
- The muscles may feel numb or loose for a few hours while the numbing medicine works.
- Go back to your normal day. Drive if you feel normal.
- Start the gentle stretches we showed you today, within comfort.
- Keep taking your usual medicines, including any blood thinner, on the plan we made with you.
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The first 1 to 3 days
- Soreness in the injected muscles often starts within a few hours and usually fades within 3 days.
- Heat or ice, whichever feels better. Neither has been shown to work better.
- Acetaminophen (Tylenol) or your usual over-the-counter pain reliever is fine if you need it.
- Ordinary activity is fine. Let the soreness guide when you go back to hard workouts.
- If your injections included a steroid and you have diabetes, check your blood sugar more often for the next day or two.
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The weeks after
- Stretch the treated muscles every day and keep up your physical therapy or home exercise program.
- Notice what you can now do that you could not before. That is how we judge the injections.
- Pain no better than before the injections after 2 weeks? Book an earlier follow-up rather than waiting.
Call 911 or go to the nearest emergency room for
- Chest pain, pain that is sharper when you breathe in, or shortness of breath in the hours or days after injections near the upper back, shoulder blade, chest wall or base of the neck
- New weakness or numbness in the legs, or new loss of bladder or bowel control, after injections in the back
- Ringing in the ears, a metallic taste, numb lips, confusion, or a seizure
- Trouble breathing, swelling of the lips or throat, or hives spreading over the body
Call us at (646) 290-6660, day or night, for
- Redness, warmth, swelling or drainage at an injection site, or a fever
- Soreness that is getting worse after 3 days instead of better
- A bruise that keeps growing
- Any question about your blood thinner plan
The knot in your upper back that has been pulling your shoulder toward your ear for months finally let go on the table, with a twitch you could feel. Tomorrow the muscle may ache more than it did before the injection. That is expected, and what you do over the next few days matters more than how you rest.
These are the instructions Dr. Alex Movshis gives after trigger point injections at Modal Pain Management. If yours were done elsewhere, most of this still applies, but follow your own physician’s discharge instructions where they differ.
What not to do, and what the evidence actually says
Search for this and you will find long lists: no exercise for 48 hours, no heat, no massage, no alcohol. None of these come from a study of trigger point injections. Here is what is supported.
Do not rest the muscle completely. The physicians who described trigger points recommended stretching the muscle after it was injected (Simons 1999). The trials did the same: in a randomized trial of 102 patients, injections plus stretching and ultrasound plus stretching both did better than stretching alone after treatment, although by 3 months the stretching-only group was doing at least as well (Esenyel 2000). In another trial, both groups were given home stretching exercises, and both improved at 4 and 12 weeks (Ay 2010). Start the stretches we showed you on the first day, gently, and do them daily.
Do not ignore chest symptoms. When injections are given near the upper back, shoulder blades, chest wall or base of the neck, the lung lies close under the muscle. A collapsed lung (pneumothorax) after a trigger point injection is known only from case reports (Ahiskalioglu 2016). In one, caused by a piece of broken needle left behind, upper back pain that was sharper on breathing in began about 2.5 hours after the injections, followed by shortness of breath, and an over-the-counter pain reliever only partly dulled it (Reindorf 2025). Chest pain, pain on breathing in, or shortness of breath in the hours or days after these injections means you should call 911 or go to the nearest emergency room.
Do not stop or change a blood thinner on your own. The multisociety guideline places trigger point injections in the low bleeding-risk group, where stopping a blood thinner is often not needed, and treats people with a higher bleeding risk more cautiously (Narouze 2018). We make the plan with you before the procedure.
Heat or ice, a hot shower, a massage, a glass of wine: none have been tested after trigger point injections. Use what feels good. In a study of needling soreness, a cold spray followed by stretching reduced soreness only immediately, with no difference 6 hours later (Martín-Pintado Zugasti 2014).
Soreness: how much, and how long
It is common. Our injections contain 0.25% bupivacaine or 0.2% ropivacaine, sometimes with a small dose of steroid. In the classic trial of upper back trigger points, which used dilute lidocaine, soreness appeared 2 to 8 hours after the procedure in 42% of injected patients, against all of the patients treated with a dry needle, whose soreness was also worse and lasted longer (Hong 1994). Rates with bupivacaine or ropivacaine have not been measured the same way. Studies of needling soreness find it usually lasts less than 72 hours (Martín-Pintado-Zugasti 2018).
Part of the soreness is the needle passing through a tight muscle. Part may be the numbing medicine itself. In laboratory studies, all local anesthetics damage some muscle fibers, bupivacaine more than the others, and the fibers regenerate over 3 to 4 weeks. It rarely causes a noticeable problem in people (Zink 2004).
Soreness does not get sharper with a deep breath. Pain that does, or shortness of breath, is not soreness. Soreness that is still getting worse after 3 days, or comes with redness, warmth, swelling or a fever, needs a call. That pattern is not typical soreness either.
Side effects and rare complications
Most people have nothing more than soreness and perhaps a small bruise. Serious complications are rare enough to be known from case reports rather than rates:
- Collapsed lung, after injections near the chest wall (Ahiskalioglu 2016, Reindorf 2025).
- Spinal cord injury, after a blind injection into the muscles beside the spine where the mid and lower back meet (Kim 2021). That is why new leg weakness or numbness after back injections is on the emergency list.
- A reaction to the numbing medicine reaching the bloodstream, which can cause ringing in the ears, a metallic taste, numb lips, confusion or a seizure (Neal 2018).
- Infection at an injection site.
If a steroid was included. When we add a small dose of steroid, people with diabetes can see a rise in blood sugar, mostly on the first day. In a study of 51 people with type 2 diabetes given steroid injections for shoulder or back pain, fasting glucose was significantly higher on day 1 and no longer significantly raised by day 2 (Shin 2020).
How well trigger point injections work
Honestly: they can give fast relief, and the long-term evidence is limited. Relief can come right after the injection, especially when the needle produces a brief twitch in the muscle (Hong 1994). But a systematic review of 23 trials found that the effect did not depend on what was injected and was likely due to the needle or placebo (Cummings 2001), and a later review of 15 trials found no clear evidence either way for chronic pain (Scott 2009). For neck pain, a 2022 analysis found injections reduced pain more than dry needling, with low certainty (Navarro-Santana 2022). Trials followed patients for 4 to 12 weeks.
What this means for you: the injections are a way to loosen a muscle enough to stretch and strengthen it. The daily stretching and exercise are what make the gains last.
Repeat injections
There is no evidence-based number of sessions. Insurers usually allow a repeat only if the previous session helped substantially and you are in a stretching or exercise program. The Medicare policy for New York, for example, requires at least 50% relief lasting at least 6 weeks and allows no more than 3 sessions in 12 months (CMS L39662). We follow your plan’s policy.
When to go to the emergency room
Chest pain, pain on breathing in, or shortness of breath after injections near the chest wall, new weakness or numbness in the legs after back injections, or a seizure are emergencies. Call 911 or go to the nearest emergency room, and tell the team you had trigger point injections, where, and on what date.
After the result
Dr. Movshis reviews how you are doing at the follow-up visit. Good relief that lets you stretch and strengthen is the goal. No relief usually means the muscle knots are a response to pain coming from somewhere else, and the routes below are where we look next. The trigger point injection page explains who the injections are for and how they are done.
Frequently asked questions
Do not rest the muscle completely. Start gentle stretching the same day. The physicians who described trigger points recommended it (Simons 1999), stretching was part of every arm in the trials of these injections (Esenyel 2000, Ay 2010), and no study has tested rest instead. Do not ignore chest pain or shortness of breath after injections near the upper back or chest wall, because a collapsed lung, though rare, is the most important complication to recognize, and its pain can begin hours later and feel like back pain that is sharper on a deep breath (Ahiskalioglu 2016, Reindorf 2025). And do not stop or change a blood thinner on your own. Beyond that, no study has tested rest, heat or exercise rules after trigger point injections, so ordinary activity is fine.
Usually 1 to 3 days. In the classic trial, which used dilute lidocaine, soreness appeared 2 to 8 hours after the procedure in 42% of injected patients, against all of the patients treated with a dry needle, whose soreness was also worse and lasted longer (Hong 1994). Studies of needling soreness find that it usually lasts less than 72 hours (Martín-Pintado-Zugasti 2018). Soreness that is still getting worse after 3 days needs a call.
Soreness for a day or two is common, and a small bruise is possible. Numbing medicines can damage muscle fibers, bupivacaine more than others, though the fibers regenerate over 3 to 4 weeks and it rarely causes noticeable problems (Zink 2004). Rare complications reported in case reports include a collapsed lung after injections near the chest wall (Ahiskalioglu 2016), infection, and, after a blind injection into the muscles beside the spine, an injury to the spinal cord (Kim 2021).
Relief can be immediate. In the classic trial, pain improved right after the injection when the needle produced a brief twitch in the muscle (Hong 1994). How long it lasts is less certain. Trials followed patients for 4 to 12 weeks, and reviews have found that the benefit does not depend much on what is injected and may come largely from the needle itself (Cummings 2001, Scott 2009). Stretching and exercise are what make the gains last.
Yes, when you feel ready. No study has tested exercise limits after trigger point injections. Ordinary activity and stretching are encouraged from the first day. Let the soreness guide when you go back to heavy lifting or hard training, usually within a few days.
Whichever feels better. No study has compared heat and ice after trigger point injections. In a study of needling soreness, a cold spray followed by stretching reduced soreness only immediately, with no difference 6 hours later (Martín-Pintado Zugasti 2014).
There is no evidence-based number. Trials used anywhere from a single session to several weekly sessions. Insurers usually allow a repeat only if the previous session helped substantially and you are doing a stretching or exercise program. The Medicare policy for New York, for example, requires at least 50% relief lasting at least 6 weeks and allows no more than 3 sessions a year (CMS L39662). We follow your plan's policy.
References
Every figure on this page comes from the sources below. Where no study exists, the page says so and explains the reasoning instead.
- Hong CZ. Lidocaine injection versus dry needling to myofascial trigger point: the importance of the local twitch response. Am J Phys Med Rehabil. 1994. doi:10.1097/00002060-199407000-00006 · PubMed
- Cummings TM, White AR. Needling therapies in the management of myofascial trigger point pain: a systematic review. Arch Phys Med Rehabil. 2001. doi:10.1053/apmr.2001.24023 · PubMed
- Scott NA, Guo B, Barton PM, et al. Trigger point injections for chronic non-malignant musculoskeletal pain: a systematic review. Pain Med. 2009. doi:10.1111/j.1526-4637.2008.00526.x · PubMed
- Navarro-Santana MJ, Sanchez-Infante J, Gómez-Chiguano GF, et al. Dry needling versus trigger point injection for neck pain symptoms associated with myofascial trigger points: a systematic review and meta-analysis. Pain Med. 2022. doi:10.1093/pm/pnab188 · PubMed
- Esenyel M, Caglar N, Aldemir T. Treatment of myofascial pain. Am J Phys Med Rehabil. 2000. doi:10.1097/00002060-200001000-00011 · PubMed
- Ay S, Evcik D, Tur BS. Comparison of injection methods in myofascial pain syndrome: a randomized controlled trial. Clin Rheumatol. 2010. doi:10.1007/s10067-009-1307-8 · PubMed
- Martín-Pintado-Zugasti A, Mayoral del Moral O, Gerwin RD, et al. Post-needling soreness after myofascial trigger point dry needling: current status and future research. J Bodyw Mov Ther. 2018. doi:10.1016/j.jbmt.2018.01.003 · PubMed
- Martín-Pintado Zugasti A, Rodríguez-Fernández ÁL, García-Muro F, et al. Effects of spray and stretch on postneedling soreness and sensitivity after dry needling of a latent myofascial trigger point. Arch Phys Med Rehabil. 2014. doi:10.1016/j.apmr.2014.05.021 · PubMed
- Simons DG, Travell JG, Simons LS. Myofascial Pain and Dysfunction: The Trigger Point Manual, Volume 1, 2nd edition. Williams & Wilkins (textbook). 1999.
- Shin WY, An MJ, Im NG, et al. Changes in blood glucose level after steroid injection for musculoskeletal pain in patients with diabetes. Ann Rehabil Med. 2020. doi:10.5535/arm.2020.44.2.117 · PubMed
- Zink W, Graf BM. Local anesthetic myotoxicity. Reg Anesth Pain Med. 2004. doi:10.1016/j.rapm.2004.02.008 · PubMed
- Ahiskalioglu EO, Alici HA, Dostbil A, et al. Pneumothorax after trigger point injection: a case report and review of literature. J Back Musculoskelet Rehabil. 2016. doi:10.3233/BMR-160666 · PubMed
- Reindorf R, Saju J, Lee SJ, et al. Complication of trigger point injections: retained injection needle causing pneumothorax. Cureus. 2025. doi:10.7759/cureus.95679 · PubMed
- Kim JB, Chang MC. Spinal cord injury by direct damage during trigger point injection: a case report. J Int Med Res. 2021. doi:10.1177/03000605211012367 · PubMed
- Neal JM, Barrington MJ, Fettiplace MR, et al. The third American Society of Regional Anesthesia and Pain Medicine practice advisory on local anesthetic systemic toxicity: executive summary 2017. Reg Anesth Pain Med. 2018. doi:10.1097/AAP.0000000000000720 · PubMed
- Narouze S, Benzon HT, Provenzano D, et al. Interventional spine and pain procedures in patients on antiplatelet and anticoagulant medications (second edition). Reg Anesth Pain Med. 2018. doi:10.1097/AAP.0000000000000700 · PubMed
- Wellpoint Federal (Medicare Administrative Contractor). Local Coverage Determination L39662: Trigger Point Injections (TPI). CMS Medicare Coverage Database. 2026. Source
These are general instructions after a trigger point injections. If the instructions you were given at discharge differ, follow the ones you were given, because they account for your medications and your procedure. For anything you are unsure about, call (646) 290-6660. See the trigger point injections page for how the procedure works and who it helps, or the aftercare instructions for other procedures.