Ultrasound Guided Dry Needling

About Dry Needling

As people increasingly embrace exercise and physical activity as part of a healthy lifestyle, the need for therapies that address overuse and injury is on the rise. Simultaneously, the field of rehabilitative physical therapy is expanding to embrace new technologies and innovative therapies that are often overlooked or ignored by traditional medicine.

One treatment that is growing in popularity to address muscle pain and dysfunction is ultrasound guided dry needling. The treatment targets active myofascial trigger points, sensitive knots of muscle tissue that are essentially mini muscle spasms. Trigger points tend to arise around injured tissue, and are thought to play a significant role in many types of pain syndromes, including neck and back pain, TMJ, fibromyalgia, and other musculoskeletal disorders.

Lev Kalika DC, RMSK Myofascial pain specialist in Manhattan

Dr. Lev Kalika is revolutionizing dry needling by using ultrasound guidance to make the procedure ultra-precise and comprehensive. When used in conjunction with other technologies such as ESWT and EMTT, ultrasound guided dry needling renders ultimate results.

Dr.Kalika learned dry needling from its inventor, Dr.Karel Lewit MD, when working with him in Prague’s Motol Hospital.

Acupuncture and Dry Needling Specialist

Tatyana Kapustina has been practicing traditional Chinese medicine for over 15 years. She holds a Master’s degree in Acupuncture from the Pacific College of Oriental Medicine.

Ms. Kapustina learned dry needling procedures from Dr. Jan Dommerholt, founder and CEO of Bethesda Physiocare, who was the first physical therapist in the United States to teach trigger point dry needling and injection techniques to health care providers.

Dr. Kalika further joined forces with Dr. Rostyslav Bubnov, a double board certified specialist in regional anaesthesia and pain management. Dr. Bubnov is a world-renowned pioneer in his approach to ultrasound guided dry needling.

Kalika and Kapustina both studied under Dr. Bubnov to bring his methodology to NYC.

Conventional or “blind” dry needling lacks specificity, and usually requires multiple sessions. With ultrasound guidance, the procedure precisely targets trigger points, eliminating any guesswork.

Dr.Kalika believes that, when performed under ultrasound guidance, dry needling is in itself a diagnostic tool, as it rarely requires more than three needle insertions to learn whether the procedure will be effective or not.

Dr. Kalika has conducted multiple research studies on ultrasound guided dry needling, and has contributed his expertise to multiple publications, He is recognized as an international expert in integrative rehabilitation, sports medicine, myofascial pain and ultrasound guided dry needling.

The Ultrasound Guided Dry Needling Procedure

Ultrasound guided dry needling is performed by two clinicians working together. A manual exam is first conducted to map out the area where suspected trigger points are likely to hide.

Common locations of trigger points are regions with:

Reduced joint mobility
Failed load transfer
Fascial adhesions
Joint hypermobility

Shear wave sonoelastography is then used to image changes in tissue elasticity in those regions. Once the zone is narrowed down, grey-scale high resolution ultrasonography is used to locate hidden trigger points. Once located, a needle is inserted into the trigger point by the second practitioner, under ultrasound guidance.

After the needles are withdrawn, we use sonoelastography to check the location for changes in tissue elasticity. We may augment dry needling with other technologies to stimulate a regenerative effect, or use manual fascial release to enhance healing.

What to Expect After Treatment with Dry Needling

The patient may experience some soreness for the next 24 hours, and we recommend that they refrain from sports or excessive walking. Once the soreness wears off, the patient often feels improvement of their original complaint.

If trigger points are chronic, they are likely to reappear in a different location and will need to be dry needled again. Since it is impossible to perform dry needling on both the front and back sides of the body in a single session, multiple sessions may be necessary. However, on average we do not need to perform more than three treatments, and two is often enough. In extreme chronic cases, 3-5 treatments may be necessary.

Results of Ultrasound Guided Dry Needling

Patients often wonder if ultrasound guided dry needling replaces physical therapy, and if it should precede or follow physical therapy.

In some cases, ultrasound guided dry needling is all you need to resolve your issue. In other cases, you may need it prior to physical therapy, to make it possible for the physical therapist to release your muscles. Deep and/or chronic trigger points may be impossible to release manually. In certain cases it is better to perform dry needling after regenerative treatment or physical therapy.

Our decisions on when to perform dry needling are based on the individual patient’s diagnosis and imaging results. We recommend a comprehensive consultation prior to the procedure, since every case is unique. Dr. Kalika will perform a meticulous examination and propose the optimal protocol for your treatment.

Dry Needling Therapy

During trigger point dry needling, a thin needle is injected into an active trigger point to elicit a relaxation response. The procedure is called “dry” because there is no medication injected by the needle. Since trigger points are like minuscule muscle cramps that tend to appear where connective tissue meets nerves and muscle, the needle has the effect of releasing the cramp, eliminating pain and taking pressure off of surrounding muscle, connective and nervous tissue.

When done blindly, dry needling can be a hit-or-miss proposition, falling short of penetrating the trigger point itself. At NYDNR, our dry needling technique is guided by high resolution ultrasound, enabling us to accurately place the needle into the targeted muscle knot without unnecessary multiple attempts.

Dry Needling vs Acupuncture

Both dry needling and acupuncture penetrate the skin with thin needles to provide pain relief. However, that is where the similarities end. Acupuncture is an ancient technique designed to balance and restore healing energy, or chi, to treat a variety of medical conditions. Although the underlying mechanisms of the treatment are not fully understood, acupuncture is recognized as a pain relief treatment by the Western medical community and is highly regulated.

Dry needling is a fairly recent therapy developed by Dr. Karel Lewit of Prague’s famous School of Rehabilitation, along with colleagues Janet Travell and David Simons. The treatment specifically targets myofascial pain brought on by a number of issues, including:

Physical trauma
Muscle ischemia (reduced oxygen flow to muscle tissue)
Compression or entrapment of nerve roots
Muscle overuse
Physical and mental fatigue
Psychological trauma
Metabolic disorders

Unlike acupuncture, dry needling is based on knowledge of anatomy and physiology. When the needle penetrates a trigger point, it invokes a localized twitch response in the muscle tissue that ultimately releases the knot and restores normal function.

Ultrasound Guided Dry Needling vs Trigger Point Injections

Trigger point injections deliver pain medication into a trigger point, but the procedure has several drawbacks, and extremely low efficacy.

The first drawback is the pain medication itself. The science tells that no medication can eliminate or reduce trigger points. The mechanism of pain injections is similar to that of dry needling. It comes from the needle piercing the trigger point, not from the medication.

The second drawback is that trigger point injections are performed blind, meaning they can only be used to target superficial trigger points that can be palpated from the skin’s surface. However, most active trigger points are located deep in the tissues, close to joints or inside the muscle belly next to nerves or arteries.

Deep trigger points cannot be injected blind, based on palpation alone. We use ultrasound guidance to visualize trigger points, for accurate targeting that eliminates them for good.

Advantages of Ultrasound Guided Dry Needling (UGDN) at NYDNRehab

Ultrasound guided procedures at NYDNR use the most advanced ultrasonography equipment, enhanced with sonoelastography, rarely available in private clinics.

High resolution ultrasonography is the method of choice for UGDN procedures, able to detect deep trigger points that cannot be manually palpated.

UGDN is highly effective, requiring only 1-3 applications, versus blind dry needling that requires multiple repetitions.

Blind dry needling cannot access deep trigger points, and lacks precision and specificity.

We are able to combine UGDN with focused and radial shockwaves, for optimal results.

UGDN can eliminate the symptomatic phase of physical therapy, moving the patient directly from symptoms to correction, and reducing care by 4-8 weeks.

UGDN is an evidence based treatment approach with a high degree of efficacy.

Dr.Kalika is an internationally recognized expert in UGDN, with multiple scientific publications to his credit.

Dry Needling Foundation

Dr. Lev Kalika, clinical director of Physical Therapy Clinic in Midtown Manhattan, learned ultrasound guided dry needling directly from Dr. Karel Lewit (the founder of the method) himself. NYDNR was the first rehabilitation clinic in the US to practice dry needling therapy.

Symptoms that dry needling may benefit include:

Pain and tenderness is the affected area
Muscle weakness and fatigue
Pain that radiates through the body when a trigger point is manipulated
Stiffness and reduced flexibility

Dry needling is often used in conjunction with other treatment methods, including extracorporeal shock wave therapy, manual therapies and physical therapy.

Our Awards

Clinical Case Studies
NYDNRehab

Chronic Right-Sided Neck Pain after Dry Needling

Our patient is a female in her 20s who came to us with severe right-sided neck pain, consequent to a dry needling session at another clinic. Her pain spanned from the upper trapezius area and down the medial scapular border.

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Ultrasound Guided Dry Needling for Vertigo Treatment in Patient with Skull Trauma

Our patient is a 30 year-old male with head trauma, suffering from persistent vertigo and neck pain. Prior attempts to resolve his condition had been unsuccessful, primarily due to misdiagnosis and ineffective treatments.

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Ultrasound Guided Dry Needling for Chemotherapy-Induced Pain and Numbness

Our patient is a 43 year-old female suffering from hand numbness and impingement of the right shoulder consequent to chemotherapy treatment for thymoma.

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Ultrasound Guided Dry Needling for Scoliosis-Related Pain and Mobility

Our patient is a 30 year-old male who had been diagnosed with Ehlers-Danlos syndrome – a condition characterized by joint hypermobility.

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Occupational Hip and Low Back Pain

Our patient was a 55 year-old male employee of the Metropolitan Transportation Authority (MTA). The patient’s job required heavy manual labor. He came to us complaining of hip and low back pain.

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Lev Kalika Clinical Director and DC, RMSK

Myofascial pain specialist in Manhattan Dr. Lev Kalika has been working to revolutionize physical medicine, rehabilitation, sports medicine and athletic performance since 1998. Having conducted multiple research studies in ultrasound guided dry needling, and contributing his expertise to multiple publications, Dr. Kalika is considered 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. The clinic features a range of technologies available only in the world’s top research labs, making them available for patient care, not just research.

Our Specialists

Dr. Yuri Brosgol MD

Dr. Michael Goynatsky DPT

Dr. Daniela Escudero DPT

Dr. Michelle Agyakwah DC

Dr. Tatyana Kapustina L. Ac.

Is Dry Needling Safe and Legal?

Ultrasound guided dry needling is an extremely effective evidence-based approach for treating myofascial pain caused by trigger points that rarely requires more then three treatments! Dry needling is perfectly safe and effective when performed under ultrasound guidance. During ultrasound guided dry needling (UGDN), painful trigger points are detected in deep layers of soft tissue using non-invasive high resolution ultrasonography. Once located, the clinician inserts a thin needle into the tissue, guiding it to the exact location of the trigger point. Once the needle penetrates the trigger point, it elicits a twitch response in the tight knotted tissue, causing it to relax and relieving pain. Dry needling is nearly painless, and the needles are “dry,” meaning they do not deliver medication to the site of the trigger point. While trigger point therapy can be performed without ultrasound guidance, it is a hit-or-miss procedure when trigger points are located in deep tissues and cannot be palpated through the skin. With ultrasound guidance, the dry needling procedure is quick and effective, since ultrasound imaging allows the clinician to precisely target each trigger point. Dry needling is legal in NYC.

Professional associations and memberships

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

American Academy

Association of Orthopedic Medicine

Active member of Interventional Orthobiologics Foundation

Certificates and Continuing Education

Research at NYDNRehab

PARAVERTEBRAL MUSCLES TRIGGER POINTS ATTACHED TO FACET JOINTS ARTHROSIS ARE PREFERRED TARGETS FOR ULTRASOUND-GUIDED INTERVENTION TO TREAT LOW BACK PAIN (2023 year). Link

BMJ PUBLISHING GROUP, BRITISH MED ASSOC HOUSE, TAVISTOCK SQUARE, LONDON WC1H 9JR, ENGLAND. JUN 2021. Link

01.04.2021 Comparative study of dry needling under ultrasound guidance and extracorporeal shock wave therapy for myofascial pain and spasticity management | Cochrane Library Link

Bubnov, Rostyslav, and Lev Kalika. (2019): 1921-1922. EFFECTIVE RESTORING MOTION AND EFFECTIVE TREATMENT OF MYOFASCIAL AND NEUROPATHIC LOW BACK PAIN BY TARGETED DRY NEEDLING USING ULTRASOUND GUIDANCE. Link

Conference paper. 12th World Congress of the International Society of Physical and Rehabilitation Medicine (ISPRM 2018), At Paris, France. DRY NEEDLING UNDER ULTRASOUND GUIDANCE DECREASE NEUROPATHIC COMPONENT AND INCREASE LEVEL OF MOTION IN PATIENT WITH LOW BACK PAIN.

Conference paper. 12th World Congress of the International Society of Physical and Rehabilitation Medicine (ISPRM 2018), At Paris, France. DRY NEEDLING TRIGGER POINTS IN RECTUS AND OBLIQUUS CAPITIS INFERIOR MUSCLES UNDER ULTRASOUND GUIDANCE IS EFFECTIVE FOR CHRONIC HEADACHE.

Conference paper. 12th World Congress of the International Society of Physical and Rehabilitation Medicine (ISPRM 2018), At Paris, France. TREATMENT OF HAND PAIN AND CARPAL TUNNEL SYNDROME USING PRECISE DRY NEEDLING UNDER ULTRASOUND GUIDANCE – RELEVANCE OF SUPINATOR SYNDROME.

Conference paper. 21st European Congress of Physical and Rehabilitation Medicine, At Vilnius, Lithuania, 1-6 May, 2018. EFFICACY OF DRY NEEDLING UNDER ULTRASOUND GUIDANCE FOR NEUROPATHIC PAIN TREATMENT.

Kalika, L and RV Bubnov. Pain Practice 18)S1) (2018). “DRY NEEDLING UNDER ULTRASOUND GUIDANCE EFFECTIVE FOR HAND PAIN AND CARPAL TUNNEL SYNDROME.”

Kalika, L and RV Bubnov. Pain Practice 18(S1) (2018). “DRY NEEDLING UNDER ULTRASOUND GUIDANCE FOR LOW BACK PAIN ALLEVIATE NEUROPATHIC COMPONENT AND INCREASE MOTION IN SPINE, PELVIS AND LOWER EXTREMITY.”

Lev Kalika (2019) “Dry needling vs acupuncture is no comparison.”

Effectiveness of targeted dry needling to treat craniofacial pain and temporomandibular disorders in patient with altered oral status Link

PRECISE DRY NEEDLING OF TRIGGER POINTS IN NECK SHOULDER AND PTERYGOID MUSCLES IS EFFECTIVE TO TREAT MIGRAINE AND HEADACHE AND RESTORE POSTURE Link

ULTRASOUND DETECTING LOCAL TWITCH RESPONSE AND NEEDLE GRASP PHENOMENA DURING DRY NEEDLING Link

Ultrasound evalution of medial knee pain patterns for targeted dry needling Link

FASCIAL ULTRASOUND THE CONTEXT FOR DRY NEEDLING TRIGGER POINTS IN TREATMENT OF MYOFASCIAL PAIN POSTURAL IMBALANCE Link

Ultrasound Mapping of Subscapular Multifidus Muscles to Boost Efficacy of Dry Needling under Ultrasound Guidance for Myofascial Pain Link

ULTRASOUND-GUIDED DRY NEEDLING CAN EFFECTIVELY MUSCLE TREMOR ASSOCIATED WITH POSTURAL IMBALANCE, MUSCLE TRIGGER POINTS – Rostyslav Bubnov, Lev Kalika, Pablo Herrero Gallego. Link