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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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Clinical director & DC RMSK
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Trigger points are tiny knots of muscle tissue that often form near the tendon-bone junction, causing pain and weakness. Ultrasound guided dry needling accurately targets trigger points to elicit a twitch response, instantly relieving pain and tension.
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.
Shockwaves send pulses of energy at near-supersonic speeds into damaged tissues. Shockwave therapy works by inducing micro-trauma to the tendon tissue, initiating a healing response that promotes blood vessel formation and increases blood flow for greater oxygen and nutrient delivery. ESWT has been shown to accelerate tendon healing and reduce pain.
EMTT uses electromagnetic fields to reduce pain and stimulate cellular regenesis in targeted tissues. It is often used in conjunction with ESWT to optimize cellular regenesis and speed healing.
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.
Different tendons have distinct anatomy, structure and loading mechanics. Since each tendon is designed for a unique function it must be treated independently. Science suggests that stem cell or Platelet Rich Plasma (PRP) injections can potentially be helpful, but concrete evidence is currently lacking. PRP is currently more of a fad than a science. It is a cookie cutter approach to treating all tendons without distinguishing one from another. However, we may use PRP injections under ultrasound guidance if we feel they could advance the healing process.
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.
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.
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.
Below is a prime example of how ultrasound can take the guesswork out of diagnosis.
A bad physical therapy experience is one of the primary causes of unnecessary surgery
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
