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Myofascial pain syndrome originates in the fascia, the thin layer of connective tissue that encases and separates muscles and muscle fibers, enabling them to function independently. In the trunk and limbs, deep fascia separates groups of muscles into well-defined spaces called compartments. Fascial tissue has large numbers of collagen fibers and nerves that make it very sensitive. When stressed, fascia causes muscle tissue to tighten up, restricting movement and causing pain. Stressed and overworked fascia can form tight knots, called myofascial trigger points.
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At NYDNRehab, we use a combination of therapies and technologies to treat myofascial pain syndrome. Our therapeutic treatment options include:
Myofascial massage techniques. Ultrasound guided dry needling to release trigger points. Radial, focused and defocused shock wave therapy (ESWT). Electromagnetic transduction therapy (EMTT). Cupping therapy.
We select the most effective combination of treatment modalities, based on the unique condition of each individual patient.
Unlike acupuncture which seeks to restore energy balance in the body, dry needling is aimed specifically at trigger points, inducing a local twitch response that causes tissue spasms to release and relax.
Cupping creates negative pressure, the opposite of massage, to improve circulation, relieve pain and relax tense muscles.
This non-invasive treatment uses sonic waves to break up scar tissue and stimulate cell metabolism. Shock wave therapy has been proven effective in treating myofascial trigger points.
A massage therapist specially trained in trigger point pressure release technique can successfully help relieve trigger point pain.
Sometimes, due to injury or overuse, small areas of fascia can cramp or spasm, creating a tight painful knot that can often be seen beneath the skin’s surface. Those knots, referred to as myofascial trigger points, often appear in areas where connective tissue meets bones, nerves and muscle, often on the limbs and back.
Being out of shape
Muscle imbalances
Joint disorders
Nutritional deficiencies
Poor posture
Unequal leg length
Poor sleep hygiene
Trigger points can be painful when pressure is applied, causing muscle fibers to shorten. They can also cause referred pain, meaning a trigger point in one muscle can create pain in another area of the body. Trigger points can reduce muscle function, causing pain, stiffness and tension, and interfering with physical performance.
Trigger point therapy is aimed at releasing taut myofascial tissue, thereby relieving local muscle pain and referred pain. Trigger point therapy has been proven effective in treating a number of conditions, including:
Trigger point massage therapy is the most common approach to releasing trigger points. A trigger point massage therapist is trained to locate and identify trigger points, and apply appropriate massage techniques.
Trigger point therapy can be non-invasive in nature if the trigger points are located directly beneath the skin and can be palpated. In such cases, treatment may be as simple as placing pressure on the knot and/or massaging it until it releases. Deep trigger points are located in deep tissues and cannot be seen or palpated from the skin’s surface. In such instances, accurate diagnosis is key, to confirm that a trigger point exists and to identify its location. For deep trigger points, dry needling is used to stimulate a twitch response by inserting a needle into the trigger point, causing it to release.
When performed “blind,” dry needling can be a hit-or-miss proposition that increases your risk of pain and infection. However, when performed under high resolution ultrasound guidance, dry needling trigger point therapy can be a quick, painless and accurate procedure that yields rapid pain relief.
At NYDNR, our goal is to relieve pain and restore function, so you can enjoy the very best quality of life.
Dr. Lev Kalika has been working to revolutionize physical medicine, rehabilitation, sports medicine and athletic performance since 1998, with multiple research studies to his credit. In particular, Dr. Kalika has done extensive research on the use of ultrasound guided dry needling to treat pain and dysfunction caused by myofascial trigger points. Dr. Kalika is recognized as an international expert in integrative rehabilitation, sports medicine, injury prevention, athletic performance, and ultrasound guided dry needling. NYDNRehab is considered the most technologically advanced private clinic in the US. Dr.Kalika’s modern approach to the treatment of athletic injuries and myofascial trigger point pain has put him on the radar of some of the world’s top distance runners, pro athletes and professional ballet dancers.
HyunJu
YOO, PT, MPT, DPT, CPI (Licensed Physical Therapist)
Dr. Christina Pekar
DC
Dr. Michelle Agyakwah
DC
Mariam Kodsy
Physical Therapist
Dr. Kalika is currently a certified member of:
American Institute of Ultrasound Medicine
Active member of ISMST
International Society of Extra Corporeal Shockwave Therapy
Active member of GCMAS
Gait and Clinical Movement Analysis Society
Active member of NASS
North American Spine Society
Active member of IADMS
International Association of Dance Medicine and Science
Active member of Virtual Rehabilitation Society
Active member of ASRA
American Society of Regional Anesthesia and Pain Medicine
Below is a prime example of how ultrasound can take the guesswork out of diagnosis.
A bad physical therapy experience is one of the primary causes of unnecessary surgery
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
