Myofascial Pain
Syndrome and Trigger
Point Therapy

About Myofascial Pain and Dysfunction

The myofascia is a network of thin tough connective tissue that encases muscles and organs throughout your body, enabling soft tissues, bones, organs and neural bodies to glide freely among other structures during movement. When fascia tissue is injured or subjected to excessive force loads, it can become dense and develop sticky adhesions or trigger points that cause pain and inhibit fluid movement.

At NYDNRehab, myofascial release techniques and trigger point dry needling team up with diagnostic ultrasound and advanced regenerative technologies to promote healthy fascia and restore pain-free movement.

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Dr. Lev Kalika
Dr. Lev Kalika

Clinical director & DC RMSK

About Myofascial Pain Specialist Dr. Lev Kalika

Dr. Kalika’s path to expertise in treating myofascial disorders began in 1998, when he moved to Prague to be mentored by two of the world’s foremost pioneers in human movement science: prof Vladimir Janda MD PhD, and prof Karel Lewit MD PhD, the inventor of dry needling.

Dr. Kalika later went on to become an expert in diagnostic musculoskeletal ultrasound. He began to use ultrasound imaging to guide dry needling procedures, and he has published multiple scientific papers on the topic. He is considered one of the world’s top experts in ultrasound guided procedures.

Dr. Kalika’s extensive work with patients has led him to pursue the latest techniques for optimizing patient outcomes. He is certified in the Stecco Method of fascial manipulation therapy, with many years of experience in the approach, enabling him to better address the fascial component of myofascial pain syndrome.

Dr. Kalika uses diagnostic ultrasonography to clearly visualize the structural components that contribute to myofascial pain. In his 25 years of experience in treating patients with myofascial pain syndrome, he discovered that trigger points are only an expression of a greater underlying musculoskeletal condition.

Dr. Kalika uses ultrasound guided dry needling to relieve trigger points, a procedure for which he has published research and gained widespread recognition. Dry needling procedures and trigger point injections performed “blind” without ultrasound imaging only treat the symptoms, without resolving the underlying cause of trigger points.

NYDNRehab is Manhattan’s Premier Clinic for Myofascial Pain and Dysfunction

NYDNRehab is Manhattan’s Premier Clinic for Myofascial Pain and Dysfunction

The role and function of myofascial tissue has only recently gained widespread attention from researchers, and many practitioners have a poor understanding of how fascia tissue integrates with other structures to optimize human movement.

Dr. Kalika got a head start on fascial treatment, thanks to his mentorship from early pioneers. While other practitioners are only now learning about fascia, Dr. Kalika has had several years of hands-on experience to fine-tune his own unique approach to myofascial treatment.

Oftentimes, fascia adhesions and trigger points need to be addressed before beginning physical therapy, to ensure optimal results. Diagnostic ultrasound imaging gives us a clear real-time picture of how fascia interacts with other structures, enabling us to identify adhesions and trigger points that cannot be palpated from the skin’s surface.

Our personalized one-on-one approach to patient care, along with our proprietary treatment protocols, make NYDNRehab the clinic of choice for myofascial pain treatment and trigger point therapy in NYC.


Fibromyalgia Symptoms
and Causes

  • Localized muscle pain and stiffness
  • Muscle weakness
  • Trigger points that cause pain
  • Postural and structural abnormalities
  • Overuse from sports or exercise
  • Occupational trauma or overuse
  • Poor nutrition and inadequate hydration
  • Being sedentary and out of shape

For Effective and Lasting Myofascial Treatment, Accurate Diagnosis is Key

Diagnosis of myofascial densifications, adhesions and trigger points requires an in-depth knowledge of fascia and the underlying process of fascia densification. Many practitioners lack the education or experience to properly interpret fascia densification from a clinical perspective, and misdiagnosis is common.

Myofascial pain syndrome is often misdiagnosed as fibromyalgia, but the two conditions have distinct characteristics. Myofascial pain is localized in specific muscles, while fibromyalgia pain is widespread throughout the body. Trigger points are not a feature of fibromyalgia, although fibromyalgia patients may also have myofascial pain syndrome, making it critical to differentiate between the two.

At NYDNRehab, we use the highest resolution ultrasonography equipment to view the fascia and its interactions with other structures in real time. Ultrasound imaging gives us a clear picture of trigger points and adhesions that interfere with movement. Our research-grade equipment also gives us capabilities for sonoelastography, to detect and measure fascia densifications.

Diagnosing Lymphedema

Cutting-Edge Myofascia and Trigger Point
Treatment Approaches

In recent years, mainstream fascia manipulation techniques performed by untrained practitioners have become a sort of fad that promises — but fails to deliver — a cure-all remedy for musculoskeletal pain.

When performed by a trained professional who understands the fundamental properties of fascia and the role it plays in human movement, fascia manipulation therapy is an evidence-based and reliable methodology that restores the integrity of fascia tissue.

Myofascial treatment approaches at NYDNRehab include:

Stecco Fascia Manipulation Therapy

The Stecco Method of fascia manipulation is one of the most effective methods for treating fascia tissue, with the aim of reversing fascia densifications and restoring the ability of fascia layers to glide among muscles, nerves and other structures.

We combine Stecco therapy with other therapies and regenerative technologies that enhance the effects of fascia manipulation by regenerating tissues at the cellular level and stimulating the body’s own reparative mechanisms.

Extracorporeal Shockwave Therapy (ESWT)

Focused extracorporeal shockwave therapy (ESWT) uses sound wave technology to produce several regenerative and pain-mediating effects, including:

  • Neovascularization

  • Release of growth factors such as TGF-1, VEGF

  • Stimulation and proliferation of fibroblasts

  • Stimulation of mesenchymal stem cells

  • Antibacterial effects

  • Promotion of local circulation

  • Suppression of pro-inflammatory mediators

  • Direct effect on peripheral nerves

TECAR Therapy

TECAR therapy dramatically speeds up tissue healing by normalizing electrical charges within damaged cells. When combined with Stecco manipulation therapy, TECAR works to accelerate fascia healing and restore its integrity.

INDIBA Radiofrequency Therapyy

INDIBA Radiofrequency Therapy

Ultrasound Guided Dry Needling

Ultrasound Guided Dry Needling

Myofascial trigger points often contribute to fascia pain. Dry needling is an outpatient procedure where thin non-medicated needles are inserted into myofascial trigger points to evoke a twitch response that releases contractile nodes. Ultrasound guidance eliminates the need for multiple insertions, reducing pain and discomfort for the patient.

Ultrasound Guided Hydrodissection

Hydrodissection is a technique for treating peripheral nerves entrapped by densified fascia. It involves injecting a saline solution, to separate entrapped nerves from surrounding fascia and adjacent structures.

Ultrasound Guided Hydrodissection

Get the Most Advanced Myofascial Treatment in NYC

It can be tempting for clinicians to simply find pain generators, movement restrictions or weak muscles and treat them as independent entities.. But the human body is an integrated system of interrelated structures, and myofascial issues can cause altered movement patterns that create complex structural and functional problems.

Resolving myofascial pain and dysfunction requires strategically planned and multifaceted intervention by a knowledgeable practitioner. There are plenty of therapists willing to provide myofascial manipulation without fully understanding the nature and function of fascia tissue, leaving patients with unresolved issues that can cause pain, reduce mobility, and create structural and functional complications.

At NYDNRehab, we use the most advanced diagnostic ultrasound to get a full picture of your fascia and how it interacts with other structures, to provide personalized care that restores fascia integrity and eliminates trigger points.

Don’t waste your time and money on ineffective treatment approaches that target symptoms without resolving their underlying cause. Contact NYDNRehab today, and get the most advanced myofascial therapy available, so you can move freely without pain or restrictions.

Range of Available Unique Physical Therapy
Treatments at Nydnrehab

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Myofascial FAQs

Will my myofascial pain go away on its own?
In healthy active individuals, myofascial trigger points and densifications may self-resolve over time, especially with deliberate self care that includes stretching, proper hydration and a nutrient-dense diet that supports collagen synthesis and replenishes hyaluronan, a fluid composed of water molecules and hyaluronic acid that gives fascia its elastic and slippery properties. However, persistent myofascial pain that goes untreated can lead to more complex issues and reduced mobility.
Is dry needling for trigger points painful?
You may feel brief mild discomfort when the needles are inserted, but the pain from your trigger points will disappear right away. Ultrasound guidance ensures that the needle hits its mark, to eliminate the need for multiple insertions.
Will I need to have multiple therapy sessions, or is a single visit enough?
A single dry needling session may be enough to eliminate your trigger points, but you may need additional therapy sessions to restore the health and integrity of your fascia. Our goal is to get to the root cause of your problem and resolve it, so you can enjoy pain-free movement.
How does nutrition affect fascial tissue?
Fascia is made up of layers of collagen fibers, lubricated by hyaluronic acid. Nutrients that support collagen production and promote the production of hyaluronic acid help to keep fascia smooth and elastic. Water is an important component of hyaluronan, and chronic dehydration can cause fascia to become dry, dense and sticky. Foods that support collagen synthesis include bone broth, cruciferous vegetables like broccoli and cabbage, high-zinc foods like grass-fed lamb and beef, oysters, and zinc-containing foods like avocados, cacao, sunflower seeds and cashews, which help collagen to mature.
How does fascia affect my vital organs?
Fascia not only surrounds muscles, but it also engulfs the visceral organs and connects organs to muscles during movement. This component of fascia is often overlooked by fascia manipulation practitioners who do not properly understand the relationship between fascia and internal disease. Healthy fascia keeps your vital organs in their proper position, and protects them from other structures during physical activity.

Research at NYDNRehab

Efficacy of extracorporeal shock waves in the treatment of myofascial pain syndrome: a systematic review and meta-analysis of controlled clinical studies.
Constipation and gut motility is associated with posture instability: Role of muscle trigger points and potential to treat by targeted dry needling
Comparative Study of Dry Needling under Ultrasound Guidance and Extracorporeal Shock Wave Therapy for Myofascial Pain and Spasticity Management
Ultrasound Mapping of Subscapular Multifidus Muscles to Boost Efficacy of Dry Needling under Ultrasound Guidance for Myofascial Pain Ultrasound Mapping of Subscapular Multifidus Muscles to Boost Efficacy of Dry Needling under Ultrasound Guidance for Myofascial Pain

In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)


Complete tear of rectus femoris
with large hematoma (blood)


Separation of muscle ends due to tear elicited
on dynamic sonography examination

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