Ultrasound-Guided Neurofascial Release & Regeneration

The technique of injecting to separate the fascial layers and stimulate repair at tissue level under ultrasound guidance

Chronic pain, such as pain in the neck, the upper back and the shoulder, pain in the lower back, or pain from Office Syndrome / Myofascial Pain Syndrome (MPS), usually arises from an abnormality of the fascia and weakness of the structural tissue, which is why ordinary treatment often does not give a full result.

Ultrasound-Guided Neurofascial Release & Regeneration is the advanced injection technique that PYONG Rehabilitation Clinic has brought into use, combining 2 important techniques:

1. Hydrodissection – injection to separate the fascial layers
2. Prolotherapy – injection to stimulate the repair of tissue

Both techniques aim at correcting the root cause of the structural problem, and are carried out by a specialist physician in rehabilitation medicine under ultrasound guidance, for the greatest precision and safety.

Combining the two techniques allows the doctor to choose the method of treatment suited to each individual patient, whether the problem comes from:

• Weakness of the tissue → corrected with Prolotherapy
• Fascia constricting or a nerve being compressed → corrected with Hydrodissection

Why treatment at PYONG Rehabilitation

• Ultrasound-Guided Neurofascial Release & Regeneration is a technique particular to PYONG Rehabilitation Clinic, combining Hydrodissection + Prolotherapy for the highest effectiveness in treatment
• The Ultrasound-Guided technique is used at every step to increase the precision of the treatment
• Hydrodissection + Prolotherapy are combined according to the pathology of each individual patient, the treatment being designed by a specialist physician in rehabilitation medicine
• Every step is supervised by a highly experienced specialist physician in rehabilitation medicine
• There is a team of physiotherapists and supporting programmes, such as AP-PRP, Dry Needling, Shockwave, Laser, to help reinforce the result of Ultrasound-Guided Neurofascial Release & Regeneration so that it is as effective as possible
• Located at Gaysorn Village, Floor L (BTS Chidlom), convenient to reach

Hydrodissection – injection to separate the fascial layers

The principle and the mechanism

Ultrasound Guided Interfascial Hydrodissection is the technique of injecting a fluid (Normal Saline, possibly mixed with a small quantity of local anaesthetic, steroid, or a lubricating substance) into the space between the layers of tissue, particularly the Fascial Plane, or around a nerve (Perineural Injection).

The pressure of the fluid helps:

• Separate or strip away adhering fascia (Adhesion)
• Reduce the compression of a nerve (Nerve Entrapment)
• Increase the movement of the muscle and the fascia

Suited to these symptoms and conditions

• Chronic lower back pain
• Osteoarthritis at an early to middle stage
• Tendon inflammation/degeneration (Tendinopathy), such as Tennis elbow, Golfer's elbow, Patellar tendinopathy, Achilles tendinopathy
• Joint instability, such as the shoulder, the knee, the ankle
• Fibromyalgia in some cases
• Degenerative disc disease
• Office Syndrome / Myofascial Pain Syndrome

Application to Office Syndrome

Hydrodissection injected around a Trigger Point or a nerve that is compressed helps:

• Reduce the compression of the nerve → reducing pain or numbness
• Release the fascia and the muscle → increasing the range of movement
• Reduce local inflammation → washing out the inflammatory mediators around the area

The result expected

• Reducing local pain and referred pain (Referred Pain)increasing the flexibility of the muscle and the joint
• Reducing numbness or abnormal sensation

Prolotherapy – injection to stimulate the repair of tissue

The principle and the mechanism

Prolotherapy is the injection of a substance stimulating the repair of tissue, such as dextrose at a concentration of 12.5–25%, into the point where the tissue is weak, such as the ligaments or the tendons.

The solution injected stimulates Controlled Local Inflammation, which makes the body:

• Release Growth Factors
• Build new collagen
• Rearrange the fibres of the tissue
  → making the tendon or the tissue stronger and more stable

Suited to these symptoms and conditions

• Nerve entrapment syndromes, such as Carpal Tunnel, Cubital Tunnel, Piriformis Syndrome, Meralgia Paresthetica
• Fascial adhesions after surgery or injury (Post-traumatic/Post-surgical adhesions)
• Myofascial Pain Syndrome / Office Syndrome with thickened fascia or a nerve that is disturbed
• Scar pain

Application to Office Syndrome

Prolotherapy is injected around the Trigger Point, such as in the fascial layer, around the joint, or around the tendon, in order to reduce the tightness and stimulate the working of the muscle in that area.

The result expected

• Reducing chronic pain related to the instability of the tissue
• Reducing the risk of MPS arising from weakness or injury

Combining Hydrodissection and Prolotherapy

• Hydrodissection aims at correcting the physical problem directly at the fascia and the nerve, using the pressure of fluid to release the adhesion or the compression. It suits cases where fascia constricting or compressing a nerve is suspected to be the main cause.
• Prolotherapy aims at correcting the problem of the strength and the stability of the connective tissue (tendons, joints), by stimulating the body to repair itself. It suits cases where Myofascial Pain Syndrome has its cause or a contributing factor in the weakness or chronic injury of these structures.

Working together, the two techniques cover both the release of tightness and the reinforcement of the stability of the structure, so that the result of the treatment is on target and lasting.

The result of the treatment

• The symptoms improve immediately after the procedure
• There is no pain during it
• The movement and the flexibility of the muscle improve
• Numbness or referred pain decreases
• It may have to be repeated every 2–6 weeks according to the symptoms

Advice: Ultrasound-Guided Neurofascial Release & Regeneration usually gives the best result when done together with:

• Dry Needling
• High Power Laser / Focused Shockwave
• PMS (Peripheral Magnetic Stimulation)
• Stretching and strengthening the muscle
• Postural Correction
• When repeated according to the plan, the result lasts longer

Safety and points to be careful of

• It should be done by a specialist physician in rehabilitation medicine
• It must always be done under ultrasound for precision
• There may be slight side effects, such as soreness or bruising, which resolve by themselves within a few days
• A detailed assessment should be made before it is done, particularly for those with an underlying condition

The cost

The service starts at 22,500 baht per session.
The doctor will assess first in order to choose the most suitable approach, and may advise repeating it every 2–6 weeks according to the symptoms.

FAQ

1. Is it painful?
   Not very painful; only tightness or slight pressure is felt during the injection.
2. How many sessions before a result is seen?
   Some improve immediately after the first session, but most are advised to repeat it every 2–6 weeks for a lasting result.
3. Are there side effects?
   There may be slight soreness or bruising, which resolves by itself within a few days.
4. Is it suited to Office Syndrome?
   Very well suited, particularly where there is adhering fascia, a compressed nerve, or weakened structure together.
5. Is recovery time or time off work needed?
   Not necessary; you can return to work as normal straight after it.