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.
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.
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.
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 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.
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.
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.
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:
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.
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 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 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.