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Ever enigmatic back pain has been in the past largely blamed on the discs and other pathological factors.

But with the help of new imagining technology, degenerative changes have been found from so many people living completely pain free, that it just doesn't make much sense for them to be the main villain behind pain.

While doctors agree that back pain is often muscular, in the sense that there are no major pathological factors involved, they haven't without a few exceptions embraced completely the trigger point paradigm.

One reason for this might be the use of trigger point injections for treating back pain thought to be of myofascal origin.

Injections can cause the treatment to fail by making it harder to achieve the three key factors behind effective therapy.

1. Finding the right spots, one must find the most aggravated trigger points from right muscles. It's much easier to locate the spots from you own muscles, when you have the luxury of actually being able to feel their tenderness, not so easy when you have to locate them from others. If it's entirely up to the doc to locate the spots then that can be a problem.

2. Volume, one must treat multiple muscle groups. Muscles work as a group and there will always be satellite trigger points in antagonist muscles and sometimes even in other body parts. No doc in their right mind will have the stamina or will to inject all trigger points that needs to be injected even in multiple sessions.

3. Consistency, one must treat them long enough for the trigger points to loose their tenderness, there is not much value for evaluating the effects of the therapy before this happens. This will take weeks of daily massage sessions to happen, not one session of injections or one session once per week.

Techniques and styles in applying the pressure to the trigger points makes a little difference, whether its trough injections, massage, pressure or some form of assisted stretching, what matters that its being done, and being done to the right muscles, and long enough to the trigger points to start to become less tender.