Neuromuscular Rehabilitation in New York

Physical therapy is a way of treating injuries and conditions of the neuromuscular and musculoskeletal systems. The musculoskeletal system is the body’s network of bones, ligaments, joints, and tendons that work together to provide stability, structure, and movement, while the neuromuscular system refers to the ways in which the nerves and muscles work together to achieve that movement. New York Dynamic Rehabilitation clinic (NYDNRehab), located on Manhattan’s Upper East Side, is a pioneer in specialized physical therapy, integrated physical therapy, and manual physical therapy.

Integrated physical therapy refers to a combination of conventional clinical and advanced technological treatments. A good example of the integrated physical therapy approach used at NYDNRehab is our gait analysis lab, which studies and assesses the biomechanics of an individual’s running or walking in search of abnormalities. As a patient moves along our treadmill, markers on his or her lower extremities transfer information to a sophisticated software program that is analyzed by a physician. Gait analysis analyzes muscle activity, joint angles, and the force of the body’s movement. While evaluating video of the patient’s movement we also ask them a series of questions about their running and medical history, flexibility, footwear, and training. Understanding the patient’s background is critical to a sound evaluation.

We also use manual physical therapy in the form of dynamic neuromuscular stabilization. Dr. Lev Kalika, the clinical director of NYDNRehab, was among the first to introduce this method of manual physical therapy to the United States. DNS is a specialized physical therapy that involves re-training the body in posture and motion. The patient is placed in the precise postures used by a child first learning how to crawl and walk. While he or she is in this position, a physician manipulates the spinal joints and relaxes the muscles. This activates the dormant global motor patterns in the brain that are in charge of motion and essentially re-trains the body in posture and movement.

We also use Computer-Assisted Rehabilitation Environment (C.A.R.E.N), a specialized physical therapy that until recently was only available in research universities and military hospitals, but is now available at NYDNRehab and a few other private locations. C.A.R.E.N is primarily used to treat back pain and neurological and sports disorders. Consisting of a computerized motion platform, an instrumented treadmill, and a 180-degree hemispherical screen, C.A.R.E.N creates imaginary situations and environments in which the patient is able to perform exercises not available within the narrow constraints of a clinical environment. These motivating exercises help to train the patient in balance and stability, restoring equilibrium to damaged bodies. At the same time, C.A.R.E.N provides the tools for accurately measuring the patient’s progress as the exercises progress.


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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