Tendon Clinic at

About Tendon Pain and Dysfunction

Tendons are made up of fibrous elastic connective tissue that is continuous with muscle tissue, connecting muscles to bones. As muscles contract, tendons pull against their bony attachments at the joint, causing the bone to rotate around the joint axis to produce movement.

During physical activity, tendons are subjected to enormous force loads that sometimes cause ruptures and overuse injuries. Tendons can be slow to heal due to their limited blood supply. If left untreated, injured tendons can degenerate over time, dramatically restricting movement.

Regenerative therapies and innovative training approaches can help to accelerate tendon healing and restore optimal function.

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Dr. Lev Kalika
Dr. Lev Kalika

Clinical director & DC RMSK

About Tendon Specialist Dr. Lev Kalika

Dr. Lev Kalika is an NYC tendon doctor with over 15 years of experience treating tendinopathies, using a combination of rehabilitative exercises and regenerative technologies. He has helped hundreds of patients to rehabilitate tendon injuries, restore functionality, and return to sports.

Dr. Kalika has devoted many years of study to mastering various evidence-based diagnostic and treatment methodologies. He is a recognized expert in diagnostic musculoskeletal ultrasonography, with multiple scientific papers to his credit. He has worked with some of the world’s best radiologists in the field of musculoskeletal ultrasonography.

“My success in treating tendon pain comes from a deep understanding of tendon pathologies, and from the ability to visualize each individual tendon. No two tendons are alike in their anatomy, biomechanics and function. Most tendons are superficial structures, and are much better visualized by high resolution ultrasonography than by Xray or MRI. A distinct advantage of diagnostic ultrasonography over MRI is the ability to visualize muscles and tendons in motion.”

The high-resolution diagnostic ultrasound equipment at NYDNRehab has capabilities for sonoelastography to test for tendon stiffness, and superior microvascular imaging (SMI) to assess inflammation and detect vascular neogenesis. These two features give us an enormous advantage when diagnosing and treating tendons, giving our patients the very best results.

Why Treatment at NYDNRehab is Better than
Conventional Tendon Physical Therapy

NYDNRehab is the clinic of choice for elite athletes suffering from tendon pain and injuries. Our innovative treatment methods and advanced technologies set our clinic apart as a world-class rehabilitation facility for athletes and non-athletes alike who want fast and effective tendon rehab. Our methodologies and technologies ensure that our patients get total and effective healing, to restore optimal performance and return to sports.

We use the most advanced technologies for thorough and accurate diagnosis. Our clinic features the highest resolution diagnostic ultrasound equipment, with capabilities for dynamic imaging during sports performance. Our advanced assessment technologies let us quantify and analyze collected data to establish a baseline and track progress.

Our personalized rehab protocols are customized to meet the unique needs of the individual patient. Whether your goal is to return to the playing field or to simply get back to normal life, NYDNRehab is the best tendon rehabilitation clinic in NYC.

We Treat All Types of Tendon Injuries

  • Tendonitis is inflammation of the tendon, often caused by overuse. Although painful, tendinitis often resolves itself after a few days, once the activity that caused it is discontinued. Unless tendonitis becomes chronic it rarely requires treatment beyond standard first aid like icing and rest.
  • Tendinosis is pain caused by micro tears of the tendon tissue, often occurring during physical activities that overload the tendon. In tendinosis, the tendon’s collagen fibers are structurally altered in response to sudden or repetitive overload. Despite structural changes, a tendon may not become painful until your body’s compensation mechanisms fail. Pain is a warning sign to stop or modify your activity and seek treatment. Ignoring tendinosis can lead to tendon rupture and degeneration.
  • Tenosynovitis is inflammation of the tendon sleeve membrane. Tendons are encapsulated in sheaths that are prone to inflammation from excessive friction.
  • Tendon Ruptures can occur suddenly or progress gradually. A tendon rupture is most often a sudden and very painful event, and may require surgical repair.

Accurate Diagnosis Means Successful Tendinopathy Treatment

NYDNRehab features research-grade ultrasound equipment with the highest resolution available in New York City. Our equipment also has capabilities for sonoelastography and superb microvascular imaging (SMI), the latest advances in tendon imaging, and not possible with other radiological modalities. We are among the first sports medicine clinics to feature dynamic ultrasonography using the USONO ProbeFix device.

ProbeFix attaches directly to the athlete, allowing us to visualize damaged tissues during sport-specific actions. ProbeFix renders accurate real-time images of the body’s structures in motion, and can even be synced with motion capture cameras to produce 3D images of muscles, fascia, bones and joints during physical activity. This game-changing technology gives us a huge advantage for diagnosing tendon injuries and restoring optimal biomechanics during sports activities.

NYDNRehab is the only clinic in New York with a fully equipped motion and gait analysis laboratory. Our motion and gait analysis technology and proprietary software lets us measure and quantify muscle and tendon function in real time.

At NYDNRehab, we are dedicated to rehabilitating your injury, not just treating your symptoms. To accurately diagnose and treat your tendinopathy, we conduct a comprehensive evaluation consisting of:
  • Thorough health history
  • Review of physical activity at onset of pain
  • Manual physical exam
  • Artificial intelligence strength and range of motion assessment
  • High resolution ultrasonography and elastography to pinpoint the root cause of inflammation, injury and pain
  • Surface electromyography
  • High-tech gait, running and motion analysis

For sport-specific injuries, we use the latest technologies to analyze movement mechanics and identify motor deficiencies. By eliminating movement and training errors, patients and athletes are able to dramatically improve their performance while reducing their risk of injury.

Advantages of Diagnostic Ultrasonography over MRI

Patients with tendon injuries are often referred for MRI, but MRI falls far short of ultrasound imaging when it comes to tendon rehabilitation.

Advantages of ultrasound imaging over MRI include:

  • Much higher resolution
  • On-site imaging and interpretation – no waiting for lab results
  • Capabilities for dynamic assessment in real time
  • Ability to visualize fascia adhesions related to tendon degeneration
  • Capabilities for superior microvascular imaging (SMI) to assess the inflammatory component
  • Capabilities for sonoelastography to assess tendon stiffness
  • Ability to track patient progress via dynamic imaging during treatment

Running Diagnostics

Our state-of-the-art running analysis lab enables us to identify biomechanical and neuromuscular deficiencies that are invisible to the naked eye, and to distinguish between injuries and compensation strategies.

Gait analysis enables us to:

  • Measure and quantify functional limitations, impaired movement and disability
  • Identify movement deviations that are undetectable during the clinical examination
  • Distinguish compensation patterns from their root cause, so that treatment interventions target the injury and not the symptoms

Data from gait analysis equips us to design effective treatment strategies that address the source of tendinopathy, retraining the athlete to run more efficiently, prolong their running career, and prevent future injuries.


Jumping Diagnostics

Sports that require jumping like basketball, tennis, volleyball and dance place huge demands on the athlete’s body. From preparation to landing, jumps impose enormous forces on the athlete’s muscles, joints and connective tissues. Poor mechanics not only reduces the level of performance, but mechanical deficiencies can lead to debilitating and career-ending injuries. Excessive and damaging forces often stem from poor muscle coordination, improper motor control and muscle imbalances. At NYDNRehab, we use the most advanced real-time force plate technology and 3D video analysis to evaluate the athlete in motion. Our ProFix dynamic device enables us to collect high-quality ultrasound images in real time during dynamic exercise.

Jumping diagnostics evaluates:

  • Ground reaction forces
  • Joint angles
  • Compensation patterns
  • Coordination of muscle firing patterns

Real-time force plate analysis enables the athlete to see where their mechanical deficiencies lie, so they can focus on correcting them. The therapist analyzes the data to create a rehab training protocol, to strengthen weak muscles, improve motor coordination and refine the athlete’s jumping technique.

We Use High-Tech Equipment for Optimal Results

The clinic at NYDNRehab features an impressive array of technologies and therapies to treat tendinopathies. Our personalized approach lets us customize your treatment plan to ensure your tendon tissues are fully rehabilitated.

As part of your progressive tendon rehabilitation, we correct mechanical deficiencies and restore coordinated messaging between your brain and muscles. Our end goal is to restore functional levels of pre-injury performance.

Your tendinopathy therapy may include:


Load Management

Conventional treatment for tendinopathy focuses on rest and stretching exercises, but current research indicates that tendons heal and regain function more quickly when treated with progressive weight loading therapy. For athletes looking to return to sport, load management using advanced technologies is a true game changer.

Eccentric strengthening

Muscles and tendons generate force in two phases. In the concentric (shortening) phase, the muscle fibers generate torque that exceeds the force of gravity. In the eccentric (lengthening) phase, the generated force is slightly less than the force of gravity. Current research suggests that eccentric tendon loading is the most effective treatment for relieving pain and restoring tendon function.

Blood Flow Restriction Training

BFR makes it possible to rehabilitate the tendon using much lighter loads by occluding the blood vessels to elicit a regenerative response in tendon tissue. BFR helps prevent tissue atrophy after an injury while protecting damaged joints and healing tissues from excessive overload.

Kineo Intelligent Load

Kineo uses artificial intelligence to test and retrain muscles, providing real-time feedback that restores the brain-body neuromuscular connection after injury. Neuro-motor retraining is a critical but often neglected part of rehab that can make the difference between reduced performance and reinjury, and successful return to play.

C.A.R.E.N (Computer Assisted Rehabilitation Environment)

C.A.R.E.N immerses patients in a virtual reality environment while their motion is captured by 12 infrared cameras that provide 360º real-time feedback. Used for both diagnosis and treatment, C.A.R.E.N provides precise therapeutic strategies based on muscle activation patterns, eliminating human error.

Biofeedback Motor Control Training

This groundbreaking approach for patients with lower extremity tendinopathy uses force plate technology to measure the direction and magnitude of ground reaction forces during movement. Muscle activity in the area of injury is carefully evaluated, and adjustments are made to improve function and eliminate errors in movement.

Our Regenerative Therapies Accelerate
Tendon Healing

The human body has its own innate healing mechanisms, but it sometimes needs a nudge to accelerate the healing process. Regenerative technologies help to jump-start healing by stimulating tissue repair at the cellular level. Our outpatient regenerative therapies expedite recovery with minimal discomfort for the patient.

Focused Extracorporeal Shock Wave Therapy (ESWT)

Focused ESWT is used as a regenerative treatment for damaged tendon, muscle and bone tissue. This technology produces high frequency sound waves to stimulate the body’s own reparative mechanisms. It is especially effective for chronic degenerative tendon disorders and myofascial pain syndrome.

Extracorporeal Magnetic Transduction Therapy (EMTT)

EMTT is a fairly new technology that transmits high energy magnetic pulses to targeted tissues. The magnetic waves synchronize with the body’s own magnetic fields, causing a disturbance that triggers a regenerative response. EMTT waves can penetrate deep tissues up to 18 cm beneath the skin’s surface, to target difficult-to-reach tendons, muscles, bones and nerves.

Extracorporeal Pulse Activation Technology (EPAT)

Extracorporeal Pulse Activation Technology (EPAT)

EPAT, also known as defocused shock wave therapy, uses acoustic pressure waves to enhance blood circulation to targeted tissues. This speeds up the delivery of oxygen and nutrients to damaged tissues and stimulates cellular metabolism, to accelerate the healing process.

High Energy Inductive Therapy (HEIT)

HEIT uses electromagnetic fields to penetrate cells, tissues, organs and bones, to reactivate the electrochemical function of cells and cell membranes. HEIT generates a magnetic field 600 times stronger than the field of a normal magnet, to stimulate healing of nerves, muscles and blood vessels.


Ultrasound Guided Injection

Injection therapies use natural/neutral solutions that stimulate cellular repair by either nourishing or irritating the targeted cells. Guidance by ultrasound ensures that the injected substances hit their mark, for maximum effectiveness.

Platelet Rich Plasma (PRP)

PRP therapy uses a sample of the patient’s own whole blood, which is spun in a centrifuge to extract a high concentration of platelets. When injected into damaged tissues, PRP initiates tissue repair by releasing biologically active factors such as growth factors, cytokines, lysosomes and adhesion proteins. The injected solution stimulates the synthesis of new connective tissues and blood vessels. PRP can help to jump-start healing in chronic injuries and accelerate repair in acute injuries.

Proliferation Therapy, aka Prolotherapy

Prolotherapy uses a biologically neutral solution, often containing dextrose, saline or lidocaine. The solution irritates the affected connective tissue, stimulating the body’s own natural healing mechanisms to encourage growth of new normal ligament or tendon fibers.


Platelet Rich Plasma (PRP)

Myofascial trigger points often contribute to tendon pain and dysfunction. The dry needling procedure uses filament-then non-medicated needles, inserted into trigger points to evoke a twitch response, releasing the trigger point and immediately relieving pain. Ultrasound guidance eliminates the need for multiple insertions, reducing pain and discomfort for the patient.

Our Innovative Approach to Tendon

Recent evidence-based methodologies have dramatically changed the way tendinopathies are treated and rehabilitated. At NYDNRehab, we steer clear of invasive surgeries and pharmacological approaches. Our innovative and non-invasive therapies work with the body’s own self-healing mechanisms to optimize treatment outcomes and restore pain-free functional movement.

The tendon clinic at NYDNRehab was created to successfully treat and prevent tendon injuries. Our personalized approach to patient care ensures you get the best one-on-one Physical Therapy, custom-designed for your unique profile. Our expertise in tendon rehab combined with our advanced technologies and methodologies make the tendon clinic at NYDNRehab your top choice for tendinitis treatment in NYC.

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Tendon Injury FAQs

What are the main causes of tendon injuries?

Most tendon injuries result from repetitive overuse, from sports, exercise or occupation. Failure to allow time for full recovery post-exercise can increase your risk of tendon injuries. Tendons may also sustain damage from acute trauma.

How do I know if my tendon injury is serious?

If you have chronic pain that never goes away or has gotten worse, it’s a good idea to see a tendon specialist. Failure to treat a ruptured tendon could result in degeneration of the tendon tissue that reduces performance and causes undesirable compensation patterns.

Is there any hope for rehabbing old tendon injuries?

Tendon injuries that were never properly rehabilitated can cause additional problems anywhere along the kinetic chain. Regenerative therapies have the potential to stimulate tissue healing, even when the injury is several years old.

How do you diagnose tendon injuries?

At NYDNRehab, we use the most advanced, highest resolution ultrasound imaging available. Ultrasound lets us visualize the tendon in real time, with the patient in motion. Compared to Xray or MRI, ultrasound gives us crystal clear images that help us locate and identify the exact site of tendon injury.

What methods do you use to treat tendon injuries?

At NYDNRehab, we have a broad range of methodologies for tendon injury treatment. Your protocol may include eccentric loading, blood flow restriction training, ultrasound guided dry needling, regenerative injection therapies, shock wave therapy, neuromotor feedback training, and more.

Can I return to sports after a tendon rupture?

Prior to getting back on the playing field, you should make sure your tendon is completely healed. At NYDNRehab, we work with our athletes to ensure the tendon is completely rehabilitated. We also address compensation patterns developed as a result of your injury, and reestablish optimal muscle firing patterns to reduce your risk of re-injury.

How do you treat a detached tendon?

When a tendon tears away from the bone, it must be surgically re-attached, followed by intensive physical therapy to restore its mechanical properties and strength. The clinic at NYDNRehab features some of the most advanced technologies available for rehabilitating tendon injuries.

My tendon stops hurting once I warm up. Is it OK to run?

Absence of pain is not always an indicator that the tendon is functioning properly. If the pain returns once you cool down, it may indicate more serious damage. Running on a ruptured tendon can make it worse. Best to see a specialist.

Why do tendon injuries take so long to heal?

While tendons are extensions of muscles, their tissues become increasingly collagenous as they approach the bone. The denser tissue has lower vascularity, meaning the supply of blood and nutrients is diminished. Regenerative therapy can help increase circulation in the tendon and jump-start the healing process.

How can you tell if my tendon treatment protocol is working?

We use high-resolution ultrasound technology to assess your progress, with the help of superb microvascular imaging (SMI) and sonoelastography. SMI lets us detect the faintest activity in micro vessels , which indicates that healing is taking place. Sonoeslastography lets us test the elastic properties of your tendon, to confirm improved function.


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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