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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Lev Kalika DC, RMSK

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.

Tatyana Kapustina

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

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
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
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

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.

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 Lev Kalika

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

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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