1000 Section - Trigger point injections: An alternative approach to cervical dystonia

Case Diagnosis: Etiology of cervical dystonia is unknown however the consequences of involuntary muscle contractions can cause twisting, repetitive movements, and abnormal posturing. These symptoms can be debilitating and can lead to pain, contractures, and social isolation. In this case series, we demonstrate that utilizing trigger point injections and manual therapy, individuals with cervical dystonia were able to improve symptoms.

Case Description: Case 1:  49 year male with history of cervical dystonia. He received 200 units of botulinum toxin to the splenius capitis and trapezius. Patient demonstrated trigger points in a similar distribution therefore it trigger points were attempted, providing reduction of symptom for approximately 8 weeks.

Case 2:  17 year old female with a severe traumatic brain injury presented with right gaze preference and dystonic movements. Botulinum toxin however, due to  toxin needs in extremities, trigger points to the bilateral cervical paraspinals, sternocleidomastoids, trapezius were attempted. This provided neck greater range of motion and reduced dystonic movements.

Discussions: Cervical dystonia interferes with the ability to perform activities of daily living therefore treatment is warranted. Case one, patient was successful with botulinum toxin however the financial burden was unsustainable therefore an alternative treatment was attempted. Utilizing trigger point injections and providing manual therapy, patient was able to discontinue toxin use. In Case two, botulinum toxin was an option for treatment however, limitation to amount of toxin leads to difficult discussions on muscle selection. Trigger point injections reduced her dystonic movements and increased neck range of motion. 

While trigger points are often utilized for pain, applying them to patients who experience cervical dystonia provides an alternative more economical option that has been effective.

Conclusions: Among individuals who experience cervical dystonia where access to botulinum toxin is not feasible, trigger point injections may be an alternative treatment to address their symptoms. Further research is needed.