Tendon Clinic at

About Tendon Pain and Dysfunction

Tendons connect muscles to bones, and without them movement would be impossible. Because tendons are subjected to enormous force loads, especially during sports and exercise, they often suffer ruptures and overuse injuries that cause pain and reduce performance. Tendons have a limited blood supply and are slow to heal. Regenerative therapies and innovative training techniques can 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 tendon conditions, using a combination of rehabilitation and focused and radial shockwave therapy and extracorporeal magnetic transduction therapy. He has helped over a thousand patients with different types of tendon pain.

Dr. Kalika has devoted many years of study to mastering and combining various diagnostic and treatment methodologies, based on the most advanced evidence-based technologies. He is an expert in diagnostic musculoskeletal ultrasonography, with over 15 years of experience. He acquired his expertise working with and learning from some of the worlds best radiologists in 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.”

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

Why Treatment at NYDNRehab is Better than
Conventional Tendon Physical Therapy

NYDNRehab is the number one choice of dozens of 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 rehab. Our methods and technologies ensure that our patients get total and effective healing, and that optimal performance is restored.

We use the most advanced technologies for thorough and accurate diagnosis. We conduct comprehensive assessments and collect and record quantitative data to establish a baseline and track progress. Our 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 physical therapy and rehabilitation clinic in NYC.

Types of Tendon Injuries

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.

  • Tendinosis is pain caused by micro tears of the tendon tissue, often 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.

  • 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 Tendonitis Diagnosis Means Successful

NYDNRehab features an expert class ultrasound machine with the highest resolution probe available in New York City. Dr. Kalika is also trained in sonoelastography and microvascular imaging, which are the latest advances in tendon imaging, and not possible with other radiological modalities.

In addition to our diagnostic capabilities with ultrasonography, we are the only clinic in New York with a fully equipped motion and gait analysis laboratory. Our motion and gait analysis technology 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 tendonitis or tendinosis, we conduct a comprehensive exam 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 of inflammation, injury and pain

  • Surface electromyography

  • Research-quality gait, running and motion analysis

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

Accurate Tendonitis Diagnosis Means Successful Treatment

Running Diagnostics

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

Gait analysis enables us to:

  • Ground reaction forces

  • Joint angles

  • Compensation patterns

  • Coordination of movement

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

Running Diagnostics

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.

At NYDNRehab, we use the most advanced real-time force plate technology and 3D video analysis to evaluate the athlete in motion. Excessive and damaging forces often stem from poor muscle coordination, improper motor control and muscle imbalances.

Jumping diagnostics evaluates:

  • Ground reaction forces

  • Joint angles

  • Compensation patterns

  • Coordination of movement

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

Kineo Intelligent Load
for Tendon Rehab

Tendon injuries and tendinopathies are challenging to treat because tendon tissue has low vascularity, limiting the flow of oxygen and nutrients needed to repair and regenerate cells. When left untreated, damaged tendon tissue begins to degenerate, reducing associated muscle strength and creating serious imbalances that hinder mobility.

One of the main treatment approaches for tendon rehab is eccentric loading, where emphasis is placed on the muscle lengthening phase of an exercise. The Kineo Intelligent Load system is designed to rehabilitate tendon injuries by offering a range of loading variables that can be personalized and pre-programmed, based on the patient’s unique profile. It can even simulate water training for a pain-free workout.

Kineo serves as both an assessment tool and a treatment modality. Its intelligent processing system gathers and analyzes performance data, gives real-time feedback, and renders comprehensive performance reports.

A Kineo assessment report includes charts and data that explain:

  • Isokinetic and Isometric evaluation results for open and closed kinetic chain exercises

  • Comparison of strength deficits between limbs

  • Eccentric maximal strength evaluation results

  • Power assessment results

  • Eccentric/Concentric strength ratios

The Kineo Intelligent Load system is just one of the advanced technological tools we use at NYDNRehab to accelerate the tendon healing process and restore functional pain-free movement.

We Use High-Tech Equipment for Optimal Results

The clinicians at NYDNRehab draw on an array of treatment therapies, designed especially to address the needs of the individual patient. Once the source of your tendinosis has been identified, therapy will focus on preserving and healing the tendon structure.

Our tendon specialists use the most advanced regenerative technologies and methodologies available today. During the progressive rehabilitation of your tendon, you will undergo corrective interventions for mechanical deficiencies, to restore functional pre-injury performance levels.

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
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
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 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.

Proteus Motion 3D Collinear Resistance
Proteus Motion 3D Collinear Resistance

Proteus features multi-vector collinear resistance that allows for precise muscle activation and in-depth analysis. The athlete experiences greater neuromuscular activation in every repetition, to optimize motor skills relearning. Proteus allows for error-free real-time 3D performance analytics for personalized and skill-specific retraining.

(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
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)

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.

INDIBA CT9 Radiofrequency Device

INDIBA CT9 Radiofrequency Device

Our INDIBA Tecar therapy machine converts electrical current into a stable radio frequency current of 448 kHz, designed to increase and stabilize the exchange of ions in damaged cells, evoking a regenerative response that accelerates healing. INDIBA can be used to successfully treat joint and muscle disorders, low-back pain, sports injuries, surgical incisions and various pain syndromes. Another therapeutic effect of INDIBA is extreme and prolonged cellular hyperthermia. Due to this effect, INDIBA therapy combined with manual therapy and soft tissue tissue manipulation enables instantaneous release to occur, significantly shortening the number and duration of physical therapy sessions. What is normally accomplished in two months of physical therapy can be accomplished in 3-4 sessions with INDIBA.

Ultrasound Guided Dry Needling

Myofascial trigger points often contribute to lower back pain. Dry needling is an outpatient procedure that inserts non-medicated needles into the trigger point 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.

Regenerative Ultrasound Guided Injection Therapies

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.

Focused Shockwave Therapy

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.

Electromagnetic Transduction Therapy (EMTT)

Benefit from Our Innovative Non-Invasive

Recent scientific research has led to very successful therapeutic non-invasive interventions that render optimal clinical outcomes. At NYDNRehab, we steer clear of invasive and pharmacological treatment 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.

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Get Personalized Tendon Physical Therapy,
Designed Just for You

The tendon clinic at NYDNRehab was created to help NYC”s active and athletic population, to successfully treat and prevent tendon issues. At NYDNRehab, we never take a cookie-cutter approach to patient care. Tendon issues vary from one patient to the next, each with their own causative mechanisms. We thoroughly examine each patient and base our treatment solutions on your unique diagnosis. We provide one-on-one Physical Therapy, custom-designed for the individual patient.

Get Pain-Free Tendon Treatment That
Really Works!

The expertise of the sports medicine tendon specialists at NYDNRehab, combined with the most advanced technological tools in the world, make NYDNRehab’s Tendon Clinic your top choice in NYC for tendinopathy diagnosis and treatment. If you are suffering from tendon pain, call NYDNRehab today, and begin treating your injury, not just your symptoms.

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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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