Trigger point infiltration and botulinum toxin: medical treatments for chronic contractures
Persistent muscle contractures can become a major source of pain and functional limitation. Many people live for months or even years with a feeling of constant tension, muscle stiffness and painful “knots” that affect their daily activity, rest or ability to move normally.
When contractures become chronic and do not respond to usual measures such as physical therapy, stretching or medication, advanced medical treatments such as trigger point infiltration and botulinum toxin can help relieve pain and improve muscle function.
What are chronic muscle contractures?
A muscle contracture occurs when an area of the muscle remains contracted in a sustained manner.
In some patients, this continuous muscle tension favors the appearance of myofascial trigger points, small hyperirritable areas within the muscle capable of generating local and radiating pain.
Chronic contractures can especially affect:
- Cervical area.
- Trapezoids.
- Lumbar back.
- Gluteal region.
- Jaw.
- Shoulders.
Frequent symptoms of chronic contractures
Symptoms may vary depending on the musculature affected, but usually include:
- Sensation of muscular “knot”.
- Persistent stiffness.
- Localized pain.
- Radiating pain.
- Limitation of movement.
- Feeling of constant tension.
- Muscle fatigue.
- Worsening with stress or maintained postures.
In some cases, the pain may radiate to the arms, legs or head.
Why do some contractures not disappear?
When the muscle remains activated for a long time, changes in muscle function and pain processing can occur.
Factors favoring chronification:
- Maintained stress.
- Repetitive muscle overload.
- Poor ergonomics.
- Sedentary lifestyle.
- Postural alterations.
- Previous injuries.
- Sleep disorders.
- Associated chronic pain.
For this reason, some contractures no longer respond to conventional treatments.
What is a trigger point infiltration?
Trigger point infiltration is a medical technique aimed at treating hyperactive and painful muscle areas.
It consists of administering medication directly on the muscle trigger point to help:
- To reduce contracture.
- Reduce pain.
- Relaxing the muscle.
- Improve mobility.
- Interrupt the pain-contracture cycle.
In some cases dry needling or local anesthetics may also be used depending on the patient’s characteristics.
How is infiltration performed?
The specialist locates the tight muscle bands by physical examination and performs the infiltration on the affected area.
Many infiltrations can now be performed under ultrasound guidance to increase accuracy and safety.
It is an outpatient and minimally invasive procedure.
What is botulinum toxin?
Botulinum toxin is a medical treatment used to decrease muscle hyperactivity.
It acts by temporarily relaxing the infiltrated muscle and reducing the sustained contraction that contributes to pain.
Although popularly associated with aesthetic treatments, it has important therapeutic applications in pain medicine.
In which cases can it be used?
Botulinum toxin may be titrated in patients with:
- Chronic muscular contractures.
- Persistent myofascial pain.
- Chronic cervicalgia.
- Bruxism.
- Headaches associated with muscle tension.
- Spasticity.
- Resistant muscular overload.
The indication must be individualized according to each clinical case.
Benefits of botulinum toxin on muscle pain
Among its potential benefits are the following:
- Decrease of muscular tension.
- Pain reduction.
- Improved mobility.
- Maintained muscle relaxation.
- Reduction of functional overload.
In many patients, it significantly improves quality of life and facilitates subsequent rehabilitation.
Differences between trigger point infiltration and botulinum toxin
Although both techniques seek to reduce muscle pain, there are important differences.
| Trigger point infiltration | Botulinum toxin |
| Acts directly on the sore spot | Reduces sustained muscular hyperactivity |
| More localized focus | More prolonged muscular effect |
| May use anesthetics or anti-inflammatory drugs | Uses muscle neuromodulation |
| Indicated in punctual myofascial pain. | Useful in persistent or recurrent contractures. |
| More immediate effect | Progressive effect for days |
In some patients both techniques can be combined within a comprehensive treatment.
The importance of treating the source of the problem
Although these techniques can alleviate muscle pain, it is important to also address the factors that promote contracture:
- Stress.
- Posture.
- Work overload.
- Lack of mobility.
- Muscle weakness.
- Biomechanical problems.
For this reason, treatment is often complemented with:
- Physiotherapy.
- Therapeutic exercise.
- Postural reeducation.
- Sleep hygiene.
- Stress management.
When to consult a Pain Unit?
It is advisable to seek medical evaluation when:
- Contractures last for weeks or months.
- Pain limits daily activity.
- There are frequent relapses.
- The muscle remains continuously rigid.
- The usual treatments do not work.
A specialized assessment makes it possible to identify the origin of the muscle pain and to propose personalized treatments according to each patient.
An integrative approach to myofascial pain
We now know that chronic muscle pain does not depend solely on the affected muscle. Physical, emotional and functional factors can influence the persistence of pain.
At MIVI Salud we have specialists in pain treatment and advanced techniques oriented to the integral approach of myofascial pain and chronic muscle contractures.
Coordinator of MIVI Canarias