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:
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.
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:
Dry needling is often used in conjunction with other treatment methods, including extracorporeal shock wave therapy, manual therapies and physical therapy.
Research at NYDNRehab
and a faulty diagnosis can make treatment a total waste of time.
Failure to accurately diagnose a condition in its early stages can lead
to chronic problems and sometimes devastating results.
Diagnostic musculoskeletal sonography (MSUS) provides the perfect tool for the rehab practitioner. Yet many doctors and physical therapists have no experience with MSUS, are unaware of its advantages, and have no idea how to use it as a diagnostic tool.
Below is a prime example of how ultrasound can take the guesswork out of diagnosis.Successful Treatment
A bad physical therapy experience is one of the primary causes of unnecessary surgery.
We have equipped our clinic with the latest research-grade technology to arrive at objective and accurate diagnoses, and to objectively measure our patients’ progress.
Most importantly, we are the only facility in the US where structural medical diagnosis is reflected in functional treatment, and vice versa.
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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