Avoid Surgery with Physical Therapy


Many people assume that once they arrive at a certain age, physical decline is inevitable, bringing with it increasing numbers of doctor visits, medications and reduced mobility. Sadly, we live in an age when we have entrusted our personal health to medical practitioners whose scope of treatment entails mostly drugs and surgery. However, a new program in the UK is helping adults with hip pain take control of their health once more and get a new lease on life.

CHAIN Physical Rehab

CHAIN, an acronym for “Cycling Against Hip Pain” is a six-week physical rehab program gaining popularity in the UK for its success in helping older adults with hip pain avoid surgery. The program’s creator, Professor Robert Middleton, proclaims the CHAIN program to be the “go-to first line of treatment for hip pain.” With over 70 percent of participants reporting reduced pain and delaying surgery, the UK’s NHS has lauded the program as money-saving, freeing up hospital beds and empowering patients to manage their own health.

CHAIN is more than just an exercise program. It is a patient education and lifestyle modification program that helps adults manage hip pain and make better daily choices for improved health. The program is based on guidelines established by NICE, the UK’s National Institute for Health and Care Excellence, for managing osteoarthritis. The guidelines call for muscle strengthening, aerobic exercise, and education as core treatments for osteoarthritis. The program’s success has prompted consideration of CHAIN treatment for additional conditions.


Physical Therapy as First Line of Treatment

Many painful joint conditions are not the result of aging, but rather stem from modern lifestyles that entail hours of sitting with little physical activity. Older adults with back, knee, hip and shoulder pain can benefit from becoming more active, and performing exercises designed specifically to relieve pain and improve function.

Benefits of physical therapy for joint pain include:
  • Improved mobility
  • Reduced risk of falls and injury
  • Increased strength
  • Greater confidence and independence
  • Reduced pain
  • Decreased depression and anxiety
  • Improved overall quality of life

Joint Pain Physical Therapy NYC

If you are suffering from joint pain in your back, hips, shoulders, knees or anywhere else in your body, don’t assume you need drugs and surgery. Our Manhattan physical therapy clinic offers the latest technologies and innovative therapies to help you relieve pain, restore function and improve health and wellbeing. The physical therapy team at NYDNR is dedicated to giving you the very best care and treatment, so you can enjoy a full and active life.


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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