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.

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.

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

All Staff »

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

Bubnov, Rostyslav, and Lev Kalika. (2019): 1921-1922. “AB0910 EFFECTIVE RESTORING MOTION AND EFFECTIVE TREATMENT OF MYOFASCIAL AND NEUROPATHIC LOW BACK PAIN BY TARGETED DRY NEEDLING USING ULTRASOUND GUIDANCE.”

Bubnov, R., and L. Kalika. (2018): e117-e118. “Multilevel evaluation of motion and posture patterns in lower extremity and spine using dynamic ultrasound.” Annals of Physical and Rehabilitation Medicine 61″

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.

Bubnov, R. V., L. Kalika, and L. Babenko. (2018): 1699-1699. “AB1199 Dynamic ultrasound for multilevel evaluation of motion and posture in lower extremity and spine.”

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 R,V, Bubnov. Pain Practice 18(S1) (2018). INTEGRATIVE LOWER EXTREMITY MOTION POSTURE ANALYSIS USING M-MODE ULTRASOUND.

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.”

[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