Chronic Overuse / Regenerative Medicine

Effective regenerative treatment for runners is one of the key directions in modern medicine science. Physical therapists today are developing new and modernizing the known ones ways of regenerative medicine. Among others, Extracorporeal Shockwave Therapy (ESWT) and Extracorporeal Pulse Activation Technology (EPAT) are the most approved and effective non-invasive methods for runners regenerative therapy.

ESWT/EPAT provides different voltage waves, which creates pressure in the stimulated area and accelerates the metabolism. ESWT and EPAT enhances blood supply, which regenerates and recovers the area of injury. These methods have received FDA approval and are successfully practicing at Dynamic Neuromuscular Rehabilitation clinic in NYC since 2007.

Chronic inflammations in professional runners occur previously inflamed areas and can make an influence tory compounds could be a treatment of choice in healing the inflamed area.

A doctor performs ESWT/EPAT on a patient At DNR we have experience in using ESWT and EPAT for treating the following runners’ conditions:

  • Achilles tendonitis
  • Achillodynia
  • Bone non-unions
  • Bursitis (inflammation of a bursa)
  • Hallux limitus
  • Heel spurs
  • Painful trigger points
  • Patellar tendonitis
  • Plantar fasciitis
  • Rotator cuff tendonitis
  • Stress fractures
  • Stress reactions
  • Tibialis anterior syndrome
  • Various chronic enthesiopathies
  • Various sports injuries


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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