Ultrasound Guided 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.

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.

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 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.

Dr. Lev Kalika, clinical director of NYDNRehab in Midtown Manhattan, learned ultrasound guided dry needling directly from Dr. Karel Lewitt 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.