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.

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Dry Needling Therapy

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
Dry Needling vs Acupuncture

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.

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. Mikhail Bernshteyn MD (Internist)
Dr. Christina Pekar DC
Dr. Michelle Agyakwah DC
Mariam Kodsy Physical Therapist

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 NYDNRehab 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 Rewards


Is Dry Needling Safe?

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.

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

Research at NYDNRehab

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. 12th World Congress of the International Society of Physical and Rehabilitation Medicine (ISPRM 2018), At Paris, France. MULTILEVEL EVALUATION OF MOTION AND POSTURE PATTERNS IN LOWER EXTREMITY AND SPINE USING DYNAMIC ULTRASOUND.
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.
[R.Ya. Abdullaev, R.V. Bubnov, V.I. Tsymbalyuk, O.I. Grechanyk, L. Kalika, Z. Pilecki], Fact, 2017.pp. 150-163 Book chapter: “Novel approaches of physical therapy and pain management.” in Ultrasound of the spine, peripheral nerves and for pain management

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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