Ultrasound Guided Injection Therapies for Fascia, Muscles and Nerves

Physically active people are well aware of the role of muscle in human movement, and the majority of physical training is geared toward increasing muscle size, strength and power. What is poorly understood is that muscle does not act alone in force production – it works in concert with fascia and the nervous system to guide, control and distribute forces. Without fascia, the human body would not be able to operate with the skill and precision needed for optimal motor control.

The close link between muscle and fascia is often overlooked in conventional physical therapy. Yet injuries often affect both muscle and fascial tissues, and their associated nerves. Treating injured muscles and joints while neglecting fascia is only partial treatment, leaving the patient with unresolved issues that continue to cause pain and dysfunction.

Injection therapies and orthobiologic procedures are opening new frontiers in rehabilitative medicine, with promising advancements on the horizon. At NYDNRehab, we are embracing the latest injection therapies and orthobiologic solutions to accelerate injury healing and restore functional movement.

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Dr. Kalika and Dr. Brosgol are Pioneers in Advanced Injury Rehab

Dr. Lev Kalika
Dr. Lev Kalika

Clinical director & DC RMSK

Dr. Lev Kalika, DC clinical director of NYDNRehab, is an internationally recognized expert in diagnostic and musculoskeletal ultrasound imaging, with multiple research papers to his credit. Dr. Kalika has studied with some of the world’s most prestigious experts in diagnostic, fascia, and nerve ultrasonography, and has presented his research at multiple international professional conferences.

Dr. Kalika is an active member of the American Institute of Ultrasound in Medicine (AIUM), and has developed his own unique approach to Dynamic Functional and Fascial Ultrasonography.

Dr. Yuri Brosgol

Orthobiologic specialist

Dr. Yuri Brosgol, MD is a neurologist with 20+ years of experience in treating pediatric and adult myofascial pain. When emerging research on the critical role of fascia in human mobility captured Dr. Brosgol’s interest, he pursued training in orthobiologics and fascial release techniques. Dr. Brosgol learned fascial hydro release techniques directly from Dr. Carla Stecco, the world’s leading specialist in fascial science.

Dr. Brosgol has become a leader in the use of orthobiologic solutions to treat muscles, fascia and nerves, paving the way for transformative advancements in rehabilitative medicine.

Together, Dr. Kalika and Dr. Brosgol are combining their skills to revolutionize the way musculoskeletal pain and injuries are treated. Dr. Kalika’s successful track record of rehabilitating musculoskeletal injuries combined with Dr. Brosgol’s expertise in treating myofascial pain makes NYDNRehab the clinic of choice for injury rehab in NYC.

The Synergistic Relationship Between Muscles, Fascia and Nerves

Muscle fibers contract (shorten) in response to neural signaling from the brain to the motor unit – a segment of muscle tissue defined by one motor neuron and the muscle fibers it innervates. When the brain sends a message to the motor neuron, all of its associated fibers contract simultaneously – a phenomenon called the “all or nothing” principle of muscle contraction.

The number of muscle fibers per motor unit varies widely throughout the body, depending on their purpose and location. Generally speaking, small motor units responsible for precise, controlled movements such as those of the eye and hand muscles, may have only 10–100 muscle fibers per motor unit. By contrast, larger muscles like the quadriceps or glutes may have thousands of muscle fibers per motor unit, capable of generating powerful forces, but with less precision.

Muscles and nerves do not act alone. Muscle actions are controlled and guided with the help of fascia, a complex web of thin, tough connective tissue that surrounds and connects muscles, engulfs the visceral organs, and holds the body’s structures in place during dynamic movement. Fascia is strong and elastic, able to stretch and contract as the body moves, providing elastic tension that complements muscle action.

Fascia itself is densely embedded with sensory nerve endings, including proprioceptors, nociceptors, and mechanoreceptors – neural bodies that send feedback to the brain about the body’s position in space, as well as sensations of pain and pressure. Fascia is estimated to have over 250 million nerve endings, making it a major pain generator when injured. Fascia, muscles and nerves act synergistically to inform the brain of the body’s state at any given time.

Fascia is made up of collagen fibers, lubricated by hyaluronic acid – a slippery gel-like substance able to attract 100X its mass in water. In addition to its elastic and neural properties, facia provides a slippery surface that allows nerves and blood vessels to glide freely among larger structures while allowing larger structures to move in harmony, without friction.

When fascia is injured, it can become dense and sticky, losing its elastic and slippery properties and adhering to other structures. Nerves and blood vessels can become entrapped in densified fascia, causing pain and restricting movement. Muscle action can be impaired, disrupting motor unit recruitment patterns and reducing movement efficiency.

The Myofascia and Biotensegrity

The myofascial system includes muscle and fascia, and their associated neural bodies. During physical activity, muscles and fascia work together to provide tensile integrity – aka biotensegrity – a state of elastic tension that guides and controls movement, holds organs and other structures in place, and mediates outside forces. When muscles, fascia or both are damaged, biotensegrity is compromised and mobility is impaired.

Restoring biotensegrity is a key factor in injury rehabilitation. It is not enough for injured muscles tissues to heal and pain to subside. Restoring the elastic and slippery properties of fascia is a critical step in injury rehab that should be addressed early on, before physical therapy begins. Unless the damaged fascial layers are treated and restored, mobility will continue to be impaired, increasing the risk of future injuries.

At NYDNRehab, we pre-treat injured tissues before beginning physical therapy. Our end goal is to fully restore functional mobility, and that cannot be achieved without addressing biotensegrity. Starting physical therapy prematurely can result in further tissue damage, and it can reinforce inefficient motor patterns that undermine physical performance.

Advanced Therapy at NYDNRehab Means Faster Healing and Superior Results

Mainstream physical rehab typically relies on standardized treatment protocols and estimated recovery timelines that treat all injuries alike. Treatment is often focused on the locus of pain, with little regard for adjacent and distal structures that may also be affected. Failure to consider the full spectrum of potential damage can leave you with lingering issues that manifest later on, impairing your performance and increasing your risk of injury.

Our holistic and integrative approach to injury rehab sets NYDNRehab apart from mainstream clinics. We treat the whole patient, not just your symptoms. We never take a one-size-fits-all approach to physical rehab. Our one-on-one sessions ensure that you get the full attention of your therapist, so we can fine-tune your rehab program as you heal.

Your personalized treatment protocol includes multiple phases:

  1. Thorough diagnosis on your first visit that includes a review of health history, clinical exam, functional evaluations, and a comprehensive exam using high-resolution ultrasonography.
  2. Pretreatment of injured tissues and fascia using manual and regenerative therapies, and orthobiologic injections, to accelerate tissue repair at the cellular level.
  3. Progressive physical therapy that begins with gentle movement and progresses to more challenging exercises aimed at restoring and exceeding pre-injury performance levels.
  4. Our PRP is highly concentrated, with at least 10 billion platelets per sample.
  5. Neuromuscular feedback training, to restore signaling pathways between the body and the brain. Neuromuscular training eliminates inefficient compensation habits and optimizes coordinated muscle recruitment patterns. This step is often missing in conventional therapy, leaving a critical gap that sets you up for re-injury.

We closely monitor your progress to ensure that your personalized protocol is delivering its intended results. Followup ultrasound sessions and ongoing evaluations confirm your healing journey, from the early stages of injury to full recovery. We only release you when we are satisfied that you can safely return to your sport or physical activity with confidence.

Dynamic Ultrasound Imaging Ensures Accurate Diagnosis

At NYDNRehab, we understand that every patient has a unique anatomy, and every injury has unique characteristics. Almost all injuries involve multiple tissue types affecting bones ligaments, tendons, muscles, fascia, nerves and blood vessels. Our holistic approach ensures that nothing goes undetected.

Unless your clinician is able to visualize your injured tissues and explore their impact on other structures, diagnosis is a guessing game at best. We use the highest-resolution diagnostic ultrasound to dynamically visualize your injury in real time.

Ultrasound imaging has several advantages over MRI:

  • Your ultrasound exam takes place on your first visit, in the comfort of our clinic – no delayed appointments to a special lab, and no wait time for results!
  • Ultrasound lets us visualize the body’s structures in motion, to see how your injury impacts other body parts.
  • Unlike MRI that takes static images of a limited area, ultrasound lets us visualize long bodies like muscles, nerves and bones, along their entire path.
  • Ultrasound is completely safe for most patients, with no exposure to harmful radiation.
  • Our advanced ultrasound unit equips us with capabilities for sonoelastography, to test the elasticity of tendons and fascia, and superb microvascular imaging, to detect early signs of tissue healing.
  • Dr. Kalika is one of the world’s top experts in diagnostic ultrasound, ensuring that your diagnosis is thorough and accurate.

Once the diagnostic process is complete, we create a personalized treatment protocol, designed just for you. Your early treatment may include a combination of manual, regenerative and orthobiologic injection therapies aimed at healing damaged tissues prior to physical therapy.

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Our Ultrasound Guided Orthobiologic Procedures

Orthobiologic injection therapies use natural/neutral solutions, injected with precision thanks to ultrasound guidance. The injected solutions stimulate cellular repair by either nourishing or irritating the targeted cells. Needling procedures like dry needling and PENS use filament-thin non-medicated needles to target myofascial trigger points and normalize neural activity.

For ultrasound-guided needling procedures, Dr. Kalika partners with orthobiologic specialist Dr. Brosgol to ensure that the needles hit their mark. Treatment results are dramatically enhanced when combined with focused extracorporeal shockwave therapy (fESWT), and Stecco myofascial release, both areas of expertise for Dr. Kalika.

Orthobiologic procedures available at NYDNRehab include:

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 right concentration and quality of platelets, and to and follow proper isolation techniques. When administered correctly, PRP can help to jump-start tissue healing in chronic injuries and accelerate repair in acute injuries.

Matrix PRP

For muscle 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 muscle. 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 cell migration to the treatment site.

Platelet Releasate Therapy

Platelet releasate therapy involves injecting 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 arthritic joints and helps to deactivate a variety of proteinases that typically degrade cartilage.

Prolotherapy and Prolozone

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. Prolozone takes Prolotherapy to the next level by adding a combination of procaine, anti-inflammatory medications, vitamins, and minerals, followed by a mixture of ozone/oxygen gas, injected into targeted joints or tissues. When performed under ultrasound guidance, Prolozone therapy quickly reduces pain and inflammation while jump-starting the healing process.

Hyaluronic Acid Injections

Hyaluronic acid is a natural component of fascial tissue. Its slippery gel-like properties provide lubrication that reduces friction, enabling muscles, nerves and blood vessels to glide freely among other structures without pain or restrictions. Hyaluronic acid injections can help to restore hydration to densified fascia, to revitalize its functional properties.

Interfascial Plane and Nerve Hydrodissection

Injuries often involve damaged fascial tissue that has thickened and become sticky, often adhering to other structures. In the process, nerves and blood vessels can become entrapped, causing pain and restricting mobility. 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 manipulation and shockwave therapy, to fully restore fascial integrity.

Ultrasound Guided Dry Needling

Myofascial trigger points – tiny knots of tightly contracted muscle fibers – are often a component of myofascial pain. The dry needling procedure inserts filament-thin non-medicated needles into trigger points to evoke a twitch response, relaxing contracted fibers and immediately relieving pain. Ultrasound guidance eliminates the need for multiple insertions, reducing discomfort for the patient.

Percutaneous neuromodulation (PENS)

Percutaneous neuromodulation (PENS) uses electrical stimuli to calm and desensitize hyperactivated nerves. It involves the insertion of several filament-thin needles under ultrasound guidance, advanced into muscle tissue adjacent to the targeted nerve. PENS stimulates the nerve with varying waves of low frequency electrical current to restore optimal neural messaging.

Ultrasound Guidance Makes Our Injection Therapies More Accurate and Effective

Without ultrasound imaging, therapeutic procedures are hit-or-miss, often failing to achieve their goals. Guidance by high resolution ultrasound ensures that injected solutions reach their intended tissues, without bleeding over into other structures. This means faster pain relief and accelerated healing, often with fewer treatment sessions.

During needling procedures, ultrasound guidance protects nerves and blood vessels from accidental needle penetration while ensuring that injected substances hit their target. It is important to note that only advanced high resolution ultrasound shows us minute details that cannot be seen with regular ultrasound imaging. High resolution imaging is critical for fascial and nerve injections, and for treating tendon tears.

The safety and efficacy of ultrasound guidance for needling procedures is backed by the latest research:

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A 2018 study of injections into the pes anserine bursa – a fluid-filled sac located at the inner knee – affirmed that performing the procedure under ultrasound guidance resulted in superior patient outcomes in terms of pain relief and enhanced mobility.
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A 2025 study compared needle placement based on palpation (aka “blind” needling) versus placement under ultrasound guidance. The ultrasound-guided procedure was associated with significantly greater accuracy and safety, achieving 100% accuracy in reaching the targeted tissues, compared to 40% with the palpation-guided procedure. Moreover, sensitive structures were pierced in 38% of blind procedures, compared to only 4% with ultrasound guidance.
3
Another 2025 study compared the efficacy and safety of ultrasound guided needling to non-guided procedures. The authors concluded that ultrasound guidance enhances treatment accuracy, reduces adverse events, and improves clinical outcomes.
4
A new 2025 study by Dr. Kalika and his colleague, Dr. Bubnov, highlights the distinctive role of ultrasound imaging in distinguishing intricate nerve patterns and accurately diagnosing specific changes within the brachial plexus, noting that ultrasound is a highly informative and indispensable tool in injury assessment and management.
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Regenerative Technologies Enhance Injection Therapy Results

Regenerative technologies deliver natural energy waves – sound, radiofrequency, electric, and magnetic – to the injured area to stimulate and activate the body’s own innate healing mechanisms. These therapies are extracorporeal, meaning they are applied through the skin, without penetration.

When used in conjunction with injection therapies, regenerative technologies enhance and accelerate the healing effects of orthobiologics.

Focused Extracorporeal Shock Wave Therapy (ESWT)

Focused ESWT is an evidence-based technology that uses high frequency sound waves to stimulate the body’s own reparative mechanisms. ESWT helps to relieve pain and inflammation in damaged tissues, paving the way for injection precision. Wave frequency, intensity and depth can be adjusted to meet the specific demands of different tissue types.

Myofascial Acoustic Compression Therapy (MyACT)

MyACT is a new type of focused shockwave technology that allows for deeper compression of the focused waves. Its higher frequency transforms the mechanical energy of shockwaves into biochemical signals that attract growth factors and stem cells to the treatment site.

Extracorporeal Magnetic Transduction Therapy (EMTT)

EMTT transmits high energy magnetic pulses to targeted tissues that synchronize with the body’s own magnetic fields, triggering a regenerative response. EMTT waves can penetrate deep tissues to target difficult-to-reach tendons, muscles, bones and nerves. EMTT’s strong magnetic fields help to enhance cellular processes such as osteoblast activity and collagen synthesis.

Tecar Therapy

Transfer of Energy Capacitive and Resistive (TECAR) therapy uses radiofrequency waves to deliver electromagnetic energy to damaged tissues, stimulating cellular repair, enhancing blood flow, and reducing inflammation. TECAR operates in two modes – capacitive mode targets superficial tissues like muscles that are closer to the skin, while resistive mode penetrates deeper to reach fascia, tendons, ligaments and bones. The success of regenerative and orthobiologic therapies requires extensive skills and knowledge on the part of the practitioner. Dr. Kalika’s expertise in human anatomy coupled with 20+ years of clinical experience have prepared him for these remarkable new approaches to integrative healing. His ongoing commitment to patient care and continuing education have placed him at the cutting edge of advanced healing methodologies.

The success of regenerative and orthobiologic therapies requires extensive skills and knowledge on the part of the practitioner. Dr. Kalika’s expertise in human anatomy coupled with 20+ years of clinical experience have prepared him for these remarkable new approaches to integrative healing. His ongoing commitment to patient care and continuing education have placed him at the cutting edge of advanced healing methodologies.

Physical Therapy is the Final Step in Injury Rehab

Physical therapy is an important final step on your healing journey, but it should not be started prematurely. For physical therapy to provide effective and lasting results, we must first address structural issues and restore biotensegrity to the body’s systems. Advanced orthobiologic injection therapies play a critical role in injury rehab that cannot be filled by physical therapy alone. By the same token, injection therapies alone are not enough to complete your injury rehabilitation.

Once your pretreatment is complete, we can begin a customized physical therapy program with your specific goals in mind. Whether you want to return to sport as quickly as possible and perform at your peak, or you simply want to get back to your daily routine without pain or limitations, our personalized one-on-one approach ensures that your physical therapy prepares you for whatever lies ahead.

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NYDNRehab is Your Clinic of Choice in NYC for
Orthobiologic Procedures

Muscles, fascia and nerves work interdependently to keep you on the move, and when one malfunctions, it affects the others. Healing damaged tissues and restoring biotensegrity are foundational to successful rehabilitation. Yet the vast majority of physical therapy clinics are poorly equipped in terms of knowledge, experience and technology.

To be effective, injection therapies must precisely target tissues with the appropriate types and concentrations of injected solutions. “Blind” injections have a high potential of missing the targeted tissues altogether, and there is an elevated risk of penetrating other structures, like nerves and blood vessels.

At NYDNRehab, we guide our orthobiologic procedures with high resolution ultrasound, to ensure that the injected solution hits its mark without damaging other structures. The combined experience and expertise of doctors Kalika and Brosgol, along with our broad range of available therapies, make NYDNRehab the premier clinic for orthobiologic injection therapy and injury rehab in NYC.

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    FAQs: Orthobiologics for Muscle, Fascia and Nerves

    What are orthobiologic injections?
    Orthobiologics involve injecting naturally occurring substances into injured tissues to stimulate cellular repair. When used to treat muscles, fascia, and nerves, orthobiologics help to reduce inflammation, alleviate pain, and accelerate healing by attracting growth factors, cytokines, and stem cells to the treatment site..
    How do orthobiologics help to restore biotensegrity?
    Biotensegrity relies on a constant, balanced tension generated from the myofascial system. Injuries typically affect both muscles and fascia, which in turn can affect the neural bodies that serve them. Orthobiologics help restore biotensegrity by:
    • Alleviating pain and inflammation
    • Accelerating tissue healing
    • Restoring fascia’s slippery and elastic properties
    • Liberating entrapped nerves from densified fascial layers
    Support from regenerative technologies, manual fascial release, and physical therapy help to enhance the effects of orthobiologics and optimize biotensegrity.
    Do orthobiologic procedures pose any risks?
    In addition to common side effects like mild pain and swelling at the injection site that go away after a day or two, there are some greater risks, especially when needling procedures are performed blind. Penetration of nerves and blood vessels, risk of infection, and failure to deliver the solution with precision can cause complications and prolong the healing process. PRP solutions that don’t have a high enough concentration of platelets can be completely ineffective, costing the patient time and money, without satisfactory results.
    How soon can I expect to see results?
    Acute muscle injuries can take 2-6 weeks to heal after injection therapy, and chronic conditions can take up to 2-3 months. Fascia can take from 2-6 weeks, depending on the location and severity of damage. Nerve hydrodissection can bring results in just a few days. You may need up to three treatment sessions, depending on the specific characteristics of your tissue damage.
    Who can benefit from orthobiologic procedures?
    Orthobiologic injection therapy can dramatically improve your results from physical rehab. Good candidates include:
    • Athletes who want to quickly return to sport at pre-injury performance levels
    • Patients with moderate injuries or chronic pain who were not helped by rest or physical therapy
    • Patients looking for non-surgical options for injury rehab
    Injection therapies may not be appropriate or effective for patients with severe structural damage or advanced tissue degeneration. Certain drugs like blood thinners can elevate the risks of injection therapies.

    Latest Research & Evidence

    Article

    2025

    Ultrasound-Guided vs Non-Guided Pharmacopuncture for Cervical Myofascial Pain Syndrome: A Multi-Center Prospective Comparative Study Protocol.

    • Kim Kwangho
    Learn More

    Article

    2025

    Ultrasound-Guided vs Non-Guided Pharmacopuncture for Cervical Myofascial Pain Syndrome: A Multi-Center Prospective Comparative Study Protocol.

    • Kim Kwangho
    Learn More

    Article

    2019

    Accuracy and efficacy of ultrasound‐guided pes anserinus bursa injection.

    • Lee Jong H.
    • Jae U. Lee
    • Seung W. Yoo
    Learn More

    Article

    2025

    Anatomical study of ultrasound vs landmark guidance for needle placement in the obliquus capitis inferior.

    • Anatomical study of ultrasound vs landmark guidance for needle placement in the obliquus capitis inferior.
    Learn More

    Lev Kalika Research at NYDNRehab

    Article

    2025

    P199 Chemotherapy Induced Plexopathy: Role of Ultrasound in Multidisciplinary Management Strategy.

    • Lev Kalika
    • Bubnov Rostyslav
    Learn More
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    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)

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    Complete tear of rectus femoris
    with large hematoma (blood)

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    Separation of muscle ends due to tear elicited
    on dynamic sonography examination

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