Ultrasound Guided Injection Therapies

Injuries, pain syndromes and movement disorders all have one thing in common – they are rarely fully resolved with drugs and/or surgery. Yet most people go to conventional doctors for musculoskeletal pain, not knowing that most doctors and physical therapists have neither the training nor the tools necessary to heal damaged tissues and restore functional mobility. Instead, they focus on managing symptoms, creating life-long patients who never fully recover.

Meanwhile, integrative medicine is on the rise, offering holistic alternative solutions aimed at eradicating pain, regenerating tissues, and optimizing movement, without drugs or surgery. The surge in holistic medicine is getting a powerful boost from advancements in regenerative energy technologies and orthobiologic injections that go beyond treating symptoms, with the goal of permanently eliminating the causes of pain and dysfunction.

The combined skills and expertise of Dr. Kalika and Dr. Brosgol take regenerative injection therapy to the next level by exploiting and combining orthobiologics under the guidance of the highest resolution ultrasonography available. Our Canon Aplio i800 system visualizes the most nuanced anatomical details, ensuring precise targeting of our regenerative procedures.

When combined with our expertise in anatomy, function, and understanding of musculoskeletal pathologies, our unique integrative approach sets us apart as the clinic of choice for regenerative therapies and physical rehab in NYC.

We’re located on 25th street in Manhattan NYC. 
Open Monday-Friday, 10am-8pm.

Who are doctors Kalika and Brosgol?

What are orthobiologics and what is the science behind them?

How are candidates for orthobiologics diagnosed at NYDNRehab?

What criteria must be met for successful injection therapy outcomes?

Which orthobiologic therapies are available at NYDNRehab?

How do energy technologies enhance the effects of orthobiologics?

Do orthobiologics and energy therapies replace physical therapy?

What makes NYDNRehab the best choice for injection therapies in NYC?

Injection Therapies FAQs

Dr. Kalika and Dr. Brosgol are at the Cutting
Edge of Integrative Medicine

Dr. Lev Kalika

Clinical director & DC RMSK

Verified Expert Profiles

Dr. Lev Kalika, DC, RMSK, clinical director and founder of NYDNRehab, is an expert in integrative physical rehabilitation with over 20 years of clinical experience in diagnostic musculoskeletal ultrasonography, rehabilitative sports medicine and conservative orthopedics. He is an active member of the American Institute of Ultrasound in Medicine (AIUM), and his expertise in diagnostic ultrasonography is recognised by his peers on the world stage, where he frequently presents his own research on ultrasound-guided procedures.

Dr. Kalika is certified by the International Society for Medical Shockwave Therapy (ISMST) to perform extracorporeal shockwave therapy. He has developed his own unique approach to dynamic functional and fascial ultrasonography and has published peer-reviewed research on the topic. He works closely with Dr. Brosgol, providing ultrasound guidance during orthobiologic procedures.

About Me Case Studies

Dr. Yuri Brosgol

Orthobiologic specialist

Dr. Yuri Brosgol, MD,is a neurologist with 25+ years of experience in treating myofascial and chronic pain conditions. In addition to being a pioneer in orthobiologics and fascial release techniques, Dr. Brosgol is a functional medicine specialist, providing a holistic and nuanced approach to treating common sports injuries and chronic pain syndromes.

Together, Dr. Kalika and Dr. Brosgol are revolutionizing the way musculoskeletal pain is diagnosed and treated. The clinic at NYDNRehab features some of the most advanced technologies and therapies available for rehabilitative medicine.

Orthobiologic Injection Therapies

Orthobiologic procedures use biological substances derived from the patient’s own body (autologous), or from a matched donor, to treat damaged tissues. The injected solutions stimulate cellular repair by either nourishing or irritating the targeted cells, triggering an immune response that releases biologically active agents such as growth factors, cytokines, lysosomes, inflammatory mediators, and adhesion proteins.

Orthobiologics are primarily used to treat orthopedic injuries or degenerative conditions involving joints, tendons, ligaments, fascia, cartilage, and spinal structures. Rather than simply masking pain or surgically replacing tissues, orthobiologics contain signaling molecules that trigger the body’s own self-healing mechanisms.

Orthobiologics are not stand-alone miracle cures, and injections are not appropriate for all cases. They work best when incorporated into a personalized treatment protocol based on the individual patient’s blood work, and their metabolic and hormonal profiles. In properly selected cases, orthobiologics can accelerate healing and help patients to delay surgery or avoid it altogether. Best results come from a carefully planned protocol that includes energy therapies and physical rehabilitation.

Evidence-Based Use Cases for
Orthobiologics

The use of orthobiologics is supported by a growing body of research, and its use cases continue to expand as patients experience positive outcomes. However, orthobiologics do not present an all-encompassing solution for musculoskeletal complaints, and consumers should be wary of clinics that promote them as a quick fix for pain and dysfunction.

The strongest clinical use cases for orthobiologics include:

Osteoarthritis of the knee, hip, shoulder, ankle, wrist, and foot
Tendinopathies affecting the lateral and medial epicondyle (tennis and golfer’s elbow)
Tendinopathies of the patella, Achilles, rotator cuff and gluteal tendons
Partial tendon and ligament tears of the rotator cuff, ulnar collateral ligament (UCL), and chronic ankle ligament injuries
Plantar fasciitis
Meniscal tears – especially degenerative tears in older patients
Low back pain from facet or sacroiliac joints
Chronic ligament sprains (e.g., chronic ankle instability)
Cartilage erosion or defects
Trochanteric bursitis and gluteal pain syndrome
Labral tears of the hip and shoulder

The list of use cases continues to grow, but it is important to emphasize that orthobiologics do not provide a stand-alone solution. For effective and lasting results, injections should be used in conjunction with energy therapies and physical rehabilitation, and treatment should be personalized to match the patient’s unique pathology and medical profile.

Diagnosing Candidates for Orthobiologic Therapies

At NYDNRehab, not every patient who comes through our doors is a viable candidate for orthobiologics. We do not have a preset formula for screening patients or delivering injections – our diagnosis is based not only on a structural diagnosis, but on a clinical correlation with the patient’s condition, their health status, and their blood, metabolic and hormonal profiles.

Our treatment decisions are based on our findings from a multi-tissue, multi-joint examination of the entire kinetic chain using high-resolution diagnostic ultrasound, recognizing that most musculoskeletal pathologies originate from structures outside the locus of pain. Diagnostic ultrasonography exceeds the limitations of MRI, giving us the ability to visualize multiple tissues, joints, nerves, and blood vessels in a single session, in real time.

In general, a good candidate for orthobiologics meets most of the following criteria:

The condition is mild-to-moderate, with enough healthy tissue to work with.
Healthy tissues in younger patients respond better to orthobiologic-generated growth factors, although older patients may benefit on a case-by-case basis.
Patients with metabolic comorbidities are generally less responsive to injections.
Chronic injuries lasting more than 3-6 months will benefit more than acute injuries.
The patient’s pathology should be well-defined.
The affected tissues should not be severely atrophied or unstable.
The patient’s expectations should be realistic, knowing that healing takes time, and more than one injection may be necessary.

In most cases, orthobiologics are contraindicated for:

Patients at end-stage “bone-on-bone” osteoarthritis.
Severely obese patients.
Young, active patients with complete full-thickness tendon ruptures.
Patients with a history of ongoing corticosteroid and/or NSAID use.
Patients with active rheumatoid or psoriatic arthritis.
Patients with an active infection or malignancy.
Heavy smokers.

With orthobiologics, careful screening is key to successful results, sparing disqualified patients from disappointing outcomes that fail to resolve their condition.

Criteria for Successful Outcomes

While the early use of orthobiologics was somewhat hit-or-miss, today’s procedures have become more refined and targeted, thanks to multiple high-level studies and professional registries that define the criteria for highly successful outcomes.

Factors that determine successful outcomes include:

Appropriate patient selection based on biologic markers, lifestyle factors. and NSAID/cortisone use that interferes with the inflammatory healing response.
Appropriate disease pathology, based on severity, chronicity, and complexity.
High quality and concentration of the selected orthobiologic.
Injection accuracy – blind injections miss the target 30–60% of the time, and they can accidentally penetrate nerves and blood vessels. Guidance with high resolution ultrasound dramatically improves precision.
Appropriate pre- and post-injection protocols, including energy therapies and physical rehabilitation.

At NYDNRehab, our holistic approach means our injection procedures are not just intratendinous or intra-articulate – we inject the entire kinetic chain, ensuring optimal fascial and ligament tensegrity, proper force transfer, and restoration of fascial and nerve gliding. We look at the whole person and the entire kinetic chain, paying special attention to the interactions of ligaments, nerves and fascia during movement. Each injection is personalized, based on these factors.

Today, the success of injection therapies is highly predictable for healthy patients with an accurate diagnosis, and treated with a high-quality biologic, injected under ultrasound guidance, and supported by energy therapies and targeted physical rehab.

Orthobiologics at NYDNRehab

At NYDNRehab, our personalized holistic approach means that each patient receives customized treatment, based on their unique profile. Our selection of the type of orthobiologic solution is based on multiple factors, and no two patients receive the exact same treatment.

The patient’s biologic profile, level of inflammation, location of the pathology within the kinetic chain, and the specific tissue dysfunction are all considered. We may choose to use energy technologies before or after the injection, depending on the synergistic effect we are after.

Multiple factors make orthobiologic procedures at NYDNRehab superior to those offered by other clinics:

All procedures are guided by high-resolution ultrasound imaging, ensuring that the orthobiologic solutions precisely penetrate targeted tissues.
We use the highest-resolution ultrasonography available, with capabilities for sonoelastography and superb microvascular imaging.
Our platelet-rich plasma (PRP) solutions are formulated with the highest and most efficacious concentration of platelets.
We offer multiple types of PRP, for tissue-specific results.
Our ultrasound-guided Prolotherapy injections enhance tissue regeneration.
Fascial and nerve hydrorelease procedures free up entrapped nerves and blood vessels and restore fascial gliding.

Platelet Rich Plasma
(PRP)

PRP therapy uses a sample of the patient’s own whole blood, spun in a centrifuge to extract a high concentration of platelets. When injected into damaged tissues, PRP initiates tissue repair by releasing biologically active agents such as growth factors, cytokines, lysosomes and adhesion proteins. To be effective, it is critical to use the correct concentration and quality of platelets, and to and follow proper isolation techniques. When administered correctly under ultrasound guidance, PRP can help to stimulate tissue repair in chronic injuries, and accelerate healing in acute injuries.

Matrix PRP

For tendon ruptures, Matrix takes PRP therapy to the next level by creating a collagenous bridge between the walls of the tear and the rest of the tendon. Matrix is a highly concentrated PRP, diluted and mixed with fibrinogen. At the injection site, the solution becomes a gel-like collagenous substance that adheres to the walls of the tear and fills the space between them, creating a fibrin matrix that helps to stabilize growth factors and attract stem cells to the treatment site.

Platelet Releasate Therapy

Platelet releasate therapy injects platelet releasate – a mixture of growth factors and biomolecules – into injured muscles and tendons to promote healing. Platelet releasate works by activating leukocytes and endothelial cells, and stimulating blood vessel growth, to increase the flow of oxygen, nutrients and growth factors to the damaged tissues.

Alpha-2-
Macroglobulin (A2M)

Alpha 2 macroglobulin (A2M) is a naturally occurring blood plasma protein that acts as a carrier for numerous proteins and growth factors. As a protease inhibitor, A2M reduces inflammation in osteoarthritic joints and helps to deactivate a variety of proteinases that typically degrade joint cartilage.

Prolotherapy

Prolotherapy uses a biologically neutral solution to irritate stubborn tissues, triggering the body’s innate healing mechanisms to grow new normal tendon, ligament and muscle fibers. Prolotherapy is often used for slow-to-heal tendon and ligament ruptures, where low vascularity inhibits tissue healing.

Hyaluronic Acid
Injections

Hyaluronic acid (HA) is a natural component of joint synovial fluid and fascial tissue. Its slippery gel-like properties provide lubrication that reduces friction, enabling joints, muscles and fascia to glide freely without pain. After an injury, damaged fascia can become dense and sticky, losing its gliding properties. When combined with myofascial release techniques, hyaluronic acid injections can help to rehydrate fascial tissue and revitalize its functional properties. HA also supports healing by replenishing joint synovial fluid.

Interfascial Plane and Nerve Hydrodissection

The hydrodissection procedure injects a saline solution into densified fascial layers under ultrasound guidance, separating the layers and releasing entrapped nerves and blood vessels. Hydrodissection is often used in conjunction with manual fascial release and hyaluronic acid injections, to fully restore fascial integrity.

Exosomes

Exosomes are nano-sized extracellular vesicles derived from various cells. Exosomes act as messengers that deliver proteins, miRNAs, and lipids to modulate inflammation, promote cartilage regeneration, and reduce subchondral bone loss. When injected into osteoarthritic joints, exosomes are shown to regenerate cartilage, reduce synovitis, and promote bone remodeling.

BMAC and MFAT

BMAC (Bone Marrow Aspirate Concentrate) and MFAT (Micro-Fragmented Adipose Tissue) are orthobiologics rich in mesenchymal stem cells (MSCs), growth factors, and anti-inflammatory mediators. When injected into osteoarthritic joints, they are shown to modulate inflammation, promote cartilage repair, and delay OA progression. BMAC is harvested from iliac crest bone marrow, while MFAT is derived from adipose tissue from the thigh or abdomen.

BMAC is a more concentrated source of stem cells and growth factors than PRP and can be more regenerative for advanced knee OA. Both BMAC and MFAT deliver similar results, although BMAC is generally used for younger, bone-involved OA, while MFAT is considered a better fit for elderly patients and those with higher body weight. MFAT is often combined with PRP or BMAC to maximize the benefits of all three therapies.

Energy Technologies Support and Synergize
with Orthobiologics

Energy technologies use sound, light, radiofrequency and electromagnetic pulses to reduce pain and inflammation, and stimulate a regenerative response, By carefully selecting and combining the most appropriate therapies, we are able to harness the synergistic effects of both energy technologies and orthobiologics, for superior and enduring results. Depending on the individual patient case, energy technologies may be used before or after your injection, or both.

Extracorporeal Shockwave Therapy (ESWT)

Stimulates resident tenocytes/chondrocytes/MSCs; complements PRP/BMAC’s cytokine effect.
Promotes microvascular regeneration, opening biologic access to hypoxic tendons and their enthesis (point of attachment to bone)
Upregulates angiogenic growth factors
Induces nitric oxide and substance P modulation, to provide pain relief without blocking inflammation

Supports bone–tendon junction healing
Creates microtrauma and mechanotransduction, releasing growth factors that synergize with injected biologics.
Induces neovascularization, improving nutrient and oxygen delivery to injected tissues.
Enhances the homing and activation of stem cells through SDF-1 and VEGF pathways.
Improves extracellular matrix remodeling, preparing a scaffold for PRP/stem cell integration.

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Extracorporeal Mechanotransduction
Therapy (EMTT)

Synchronize with the body’s own magnetic fields
Helps to extend PRP’s anti-inflammatory effects, prolonging matrix remodeling and angiogenesis
Promotes remodeling of the extracellular matrix and collagen fiber reorganization
Reduces fibrotic adhesions and minimizes scarring, especially in tendons, fascia and joint capsules

Acts as a biological booster to prolong PRP regenerative effects
Promotes long-term structural repair of tendons, ligaments and joints
Enhances cell membrane permeability, improving migration, adhesion, and integration of injected PRP/stem cells.
Stimulates ion channel activity (Ca²⁺, Na⁺, K⁺), supporting regenerative signaling.
Promotes angiogenesis and microcirculation, improving survival of transplanted cells.
Reduces oxidative stress and inflammation, creating a favorable niche for stem cell activity.

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TECAR Therapy

Restores the ionic charge of damaged cells, for faster injury healing
Boosts blood flow and enhances local circulation to improve delivery of nutrients and immune cells to the treatment site
May improve PRP dispersal
Promotes fibroblast activity and collagen remodeling at PRP treatment site

Assists in eliminating fascial densifications and adhesions, and restoring tissue gliding
Increases deep tissue perfusion and oxygenation, boosting injected cell survival.
Enhances metabolic activity and waste clearance, optimizing the healing environment.
Enhances cell membrane permeability, improving migration, adhesion, and integration of injected PRP/stem cells.
Stimulates ion channel activity (Ca²⁺, Na⁺, K⁺), supporting regenerative signaling.
Promotes angiogenesis and microcirculation, improving survival of transplanted cells.
Reduces oxidative stress and inflammation, creating a favorable niche for stem cell activity.
Provides analgesia and reduction of muscle spasm, facilitating early functional rehab after injections.
Improves viscoelasticity of tissues, allowing better integration of regenerative cells.

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When delivered at the most effective levels under ultrasound guidance, ESWT + EMTT prime the microenvironment via mechanical and electromagnetic stimulation. TECAR + Laser therapy optimizes tissue metabolism, circulation, and cellular energy. Together, they extend and amplify the biological effects of PRP and stem cells, accelerating tissue integration, repair, and functional recovery.

When used post-procedure, energy therapies dramatically reduce pain and discomfort, reinforce soft tissue healing, and promote collagen fiber realignment.

Physical Therapy is Fundamental to Rehab Success

Some clinics may try to convince you that orthobiologics and energy technologies can replace physical therapy to resolve musculoskeletal pain and dysfunction, but nothing could be further from the truth. While regenerative therapies promote tissue healing, they do not address key factors involving neuromuscular pathways, compensation patterns, fascial restrictions, muscle imbalances and strength deficits.

To be effective, physical therapy must be personalized and targeted. Yet most physical therapists rely on generalized cookie-cutter treatment protocols that fall short of their goals, leaving patients with only moderate improvements in mobility and pain reduction. Other clinics routinely delay physical therapy until after a completed injection cycle, when certain cases call for physical prehab prior to injections.

At NYDNRehab, we sometimes precede injection therapy with targeted physical therapy to improve motor patterns and release dysfunctional tissues like densified fascia. In such cases we delay injecting the biologic solution until it is most likely to produce maximal benefits, not only for the damaged tissue but for the entire system. In other cases, we do injection therapy after prior attempts at physical therapy have failed, or to heal and fortify damaged tissues before loading them.

Many physical therapists do not know how or when to successfully progress patients from one treatment modality to the next, relying on standardized protocols that produce mediocre results. At NYDNRehab, we know exactly what therapy to use, for which tissues and conditions, and when to introduce physical therapy to get the best results for our patients.

NYDNRehab Sets a High Bar for Injection Therapies

When new medical technologies and therapies emerge, there is a high incentive for businesses to quickly adopt and market them. However, many clinicians do not possess the skillset or experience to use them appropriately or effectively, leaving patients with disappointing outcomes that fall short of the hype. Such is often the case with orthobiologics.

Orthobiologics are only maximally effective if:

They align with the patient’s pathology
They are injected with precision under ultrasound guidance
The solutions are of high quality and the right concentration
The clinician uses proper techniques
Injections are supported by energy technologies
Results are optimized with physical rehab

At NYDNRehab, our customized treatment protocols strategically combine the most advanced therapies and technologies, transforming the way musculoskeletal conditions are diagnosed, assessed and treated. We are one of the few private clinics in the USA to provide high-resolution ultrasonography, biologic injections, energy technologies, and targeted rehab under one roof.

Our holistic and multifaceted approach is backed by years of training and experience. Our customized patient-first philosophy, combined with Dr. Kalika’s expertise and successful track record, set a high bar for the appropriate use of orthobiologics, and regenerative technologies. We never promote a therapy or product unless we firmly believe it will benefit the patient in ways that accelerate healing and restore functional mobility.

If you’re ready to radically improve your mobility with the most advanced therapies in NYC, contact NYDNRehab today.

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Ultrasound Guided Injection Therapies

What are regenerative orthobiologic injections?

Orthobiologic solutions use substances derived from the patient’s own body, such as blood plasma, bone marrow or adipose tissue, The solutions are highly concentrated, and injected into damaged tissues to reduce pain and inflammation, and stimulate a regenerative healing response. Orthobiologic injections are evidence-based and considered safe for most patients when proper procedures are followed. Beware of birth-tissue “stem cell” products that don’t contain viable stem cells and are not FDA-approved for musculoskeletal use.

How many injections will I need?

The number of injections should be based on your unique condition. Steer clear of clinics that sell injection “packages.” For tendon and ligament treatment, you may need up to 2-3 injections, spaced 4-8 weeks apart. For joint osteoarthritis that responds well to the initial treatment, you may need 1-3 boosters per year.

How soon can I expect to see results?

In the first 1-4 weeks after treatment, your symptoms may temporarily worsen due to inflammation, but you should see noticeable improvement by 6-12 weeks, with peak benefits realized within 3-6 months.

How long will my results last?

For tendon conditions like tennis elbow or Achilles tendinopathy, results may last for 1-5 years, and they may be permanent if the injury is properly rehabilitated. For mild to moderate osteoarthritis, results typically last for 1-3 years, although some last for up to 5 years. For partial ligament tears, results are often permanent after sufficient physical rehab.

What features should I look for in a regenerative clinic?

Look for a clinic that does everything in-house, including high resolution ultrasonography for diagnosis and injection guidance. Transparency is key, not only in pricing, but in documenting the quality and concentration of biologic solutions. Steer clear of clinics that sell packages of multiple injections, use birth tissue derivatives instead of patient-derived substances, or promote orthobiologics as a replacement for physical rehab.