Achilles Tendinopathy

About Achilles Tendinopathy

Your Achilles tendon is arguably the most important tendon in your body, enabling you to walk, run, jump and play sports by linking your foot actions to the muscles of your lower extremities. One of the most important properties of the Achilles tendon is its elasticity, enabling the tendon to stretch like a rubber band, releasing elastic energy as it recoils to its original length.

Repetitive overuse without adequate recovery can cause the fibers of the Achilles tendon to lose their elastic properties, reducing performance and causing pain. Due to low vascularity, tendons are slow to heal, and many athletes ignore Achilles pain until it begins to hurt their performance. But neglecting Achilles dysfunction can cause further deterioration of the Achilles tendon and lead to long-term disability.

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Dr. Lev Kalika
Dr. Lev Kalika

Clinical director & DC RMSK

About Tendon Specialist Dr. Lev Kalika

NYDNRehab clinical director Dr. Lev Kalika has devoted his life’s work to finding innovative ways to treat and rehabilitate athletic injuries, pain syndromes and movement disorders. His expertise in diagnostic ultrasonography, shockwave therapy and dry needling is chronicled in multiple research articles he co-authored.

Tendinopathies are common among athletes and physically active people, and they can be difficult to treat. Dr. Kalika uses high resolution diagnostic ultrasonography to identify the scope and severity of tendinopathies, along with sonoelastography to assess tendon stiffness at baseline, and throughout the course of treatment.

Dr, Kalika’s expertise is trusted by competitive runners, elite athletes, and physically active people in NYC and beyond.

NYDNRehab is a Leader in Achilles Tendon Physical Therapy

NYDNRehab is a Leader in Achilles Tendon Physical Therapy

A healthy Achilles tendon is dense and stiff, with the capacity to withstand large force loads. In general, the stiffer the tendon, the greater its capacity to forcefully recoil and release elastic energy, contributing significantly to force production. But over time, repetitive overuse can cause the tendon fibers to break down, reducing their elasticity and function.

Low vascularity limits the flow of nutrients to Achilles tendon fibers, making them slow to heal. Regenerative therapies give us the ability to jump-start the tendon healing process by triggering your body’s own reparative mechanisms. When coupled with other proven treatment approaches, regenerative Achilles tendon physical therapy can be a game-changer for restoring tendon function.

Advanced Diagnostics are Key to Successful Achilles Tendinitis Treatment

Achilles tendon injuries can range from mild tendinitis marked by pain and inflammation, to full-blown acute ruptures that can be crippling. Getting a quick and accurate diagnosis is the first step to developing an effective treatment protocol

At NYDNRehab, we use the most advanced high-resolution diagnostic ultrasound available to visualize the damaged tissues in real time, with the patient in motion. Once we identify the type and extent of damage, we dive deeper to create a baseline profile for Achilles tendonitis physical therapy.

Your baseline assessment may include:

  • Sonoelastography, a unique technology that enables us to measure tendon stiffness.

  • Force plate jump testing to evaluate elastic recoil and force production.

  • Kineo Intelligent Load system to measure eccentric tendon strength.

  • Platform perturbation on C.A.R.E.N, our computer assisted rehab environment, to assess tendon landing on an unstable surface.

  • Tendon tolerance testing, to assess load tolerance for training and rehab.

  • Superior microvascular imaging (SMI), to detect healing activity at the capillary level and monitor the healing process.

Our thorough and accurate diagnosis of your Achilles tendon ensures that our treatment protocol is effective, and that no time is wasted on ineffective treatment methods. Our goal for Achilles tendon physical therapy is to restore full function in the shortest time possible, so you can get back quickly to your sport or activity.

Advanced Diagnostics are Key to Successful Achilles Tendinitis Treatment

Regenerative Achilles Tendon Physiotherapy

Once we accurately diagnose your Achilles tendinopathy, we design a personalized treatment plan to meet your unique needs. Your treatment protocol may begin with one or more of our regenerative therapies, to jump-start the healing process.

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.

Extracorporeal Magnetic Transduction Therapy (EMTT)

EMTT is a 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 tendon tissues.

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 penetrates tendon fibers with electromagnetic fields, to reactivate the electrochemical function of tendon cells and cell membranes. HEIT generates a magnetic field 600 times stronger than the field of a normal magnet, to restore electromagnetic homeostasis in tendon cells.

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.

INDIBA CT9 Radiofrequency Device

Ultrasound Guided Injection Therapies

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 tendon 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 tendon fibers. PRP can help to jump-start healing in old or chronic tendon 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 tendon tissue, stimulating the body’s own natural healing mechanisms, to encourage growth of new healthy tendon fibers.

Electromagnetic Transduction Therapy (EMTT)

More Achilles Tendinopathy Treatment Options

Our unique advanced technologies give us an arsenal of tools for Achilles tendinopathy rehabilitation. Our state-of-the-art equipment is designed to accelerate healing, restore strength and range of motion, rehabilitate neuromuscular pathways, and optimize skills execution, so you can return to physical activity with confidence.

Blood Flow Restriction Training
Blood Flow Restriction Training (BFRT)

Rebuilding muscle strength while your Achilles tendon is still healing can be a challenge, especially if you need to return to sport in the shortest time possible. BFRT lets you increase muscle size and strength at much lower training volumes, to reduce stress on your still-healing Achilles while rapidly restoring muscle performance.

DD Robotech
DD Robotech

This cutting edge technology uses artificial intelligence (AI) to provide feedback during intense and motivating training sessions. DDR helps to strengthen muscles, enhance neuromuscular and neurocognitive performance, and fine-tune skills that demand coordination, strength, power and endurance. During a DDR training session, data is automatically generated, processed, stored, and interpreted, so we can track your progress and fine-tune your Achilles tendonitis rehab program.

Kineo Intelligent Load System
Kineo Intelligent Load System

We use the Kineo intelligent loading system to create customized training and rehabilitation programs for our patients. With Kineo, we can custom-design a personalized variable load program to restore Achilles tendon elasticity.

Proteus Motion System
Proteus Motion System

Proteus features a patented 3D multi-planar resistance arm that provides consistent resistance through the entire range of motion. Users are cued to perform movements that distribute loads evenly, enabling you to “feel” the movement. Proteus motion enhances force production and fine-tunes motor sequencing, for optimal skills retraining.

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

This multifaceted system gives us a broad range of tools for assessment, feedback and performance enhancement. Dr. Kalka has integrated his own unique selection of technologies to optimize the ways in which C.A.R.E.N helps patients to achieve their Achilles tendinopathy rehab goals.



Get State-of-the-Art Achilles Tendonitis
Treatment that Really Works!

For physically active people, Achilles tendinopathy can be a death-blow that keeps you from living your life to the fullest. Regenerative therapies and advanced technologies are game-changers for Achilles tendonitis rehab, making it possible to restore full function, even when your injury is several years old. But research-grade technologies are rarely found in run-of-the-mill physical therapy clinics.

NYDNRehab is one of the best-equipped physical therapy clinics in the world, featuring technologies that are rarely found in private clinics. We are dedicated to helping our patients eliminate pain and dysfunction in the shortest time possible, and to restoring physical performance to pre-injury levels. Contact us today, and see why NYDNRehab is the premier clinic for Achilles tendon physical therapy in NYC.

Range of Available Unique Physical Therapy
Treatments at Nydnrehab

Achilles Tendinopathy FAQs

What is the difference between Achilles tendonitis and Achilles tendinopathy?
Tendinopathy is essentially a failed healing response, where the tendon fibers become haphazardly arranged in irregular patterns. While the condition is sometimes called tendinitis, tendinopathy is the most accurate terminology. The term tendinitis implies certain biological processes and inflammatory activity that are often not present in an injured tendon.
My Achilles tendon injury stopped hurting, so why is my jump still impaired on the injured leg?
Absence of pain does not always indicate healing. The majority of the nerve endings reside on the surface of the tendon, and damaged fibers in the belly of the Achilles may not necessarily cause pain. If the fibers never healed properly, they can cause tendon dysfunction. You need to fully rehabilitate your tendon to realign its collagen fibers and restore full function.
How can physical therapy help heal my injured tendon?
Achilles tendon physical therapy uses a combination of progressive eccentric loading, stretching, and strengthening exercises to restore tendon function. Prior to beginning physical therapy, your clinician should prepare your tissues by using regenerative therapies, fascia manipulation and trigger point therapy. Failure to prepare your Achilles tissues can lead to further damage during physical therapy.
I injured my Achilles tendon 10 years ago playing college sports. Is it too late for rehabilitation?
It is never too late to rehabilitate an injured Achilles tendon. Neglecting to do so can severely reduce your mobility and stability later in life. A dysfunctional Achilles tendon often causes compensation patterns that affect other parts of your body, creating a variety of pain syndromes that impact your quality of life. A good Achilles tendon rehabilitation program should address compensation patterns in addition to healing the tendon itself.
I work in an office all day and am not very active, but my doctor said I have an Achilles tendon rupture. How could that happen?
Lack of use can cause your muscles and tendons to atrophy (shrink) and weaken, making them vulnerable to injuries during everyday activities. If you are overweight and sedentary, your chances of Achilles tendon injury are even greater. In addition, multiple common medications – including statins, steroids and metabolic regulators – can increase your risk of tendon injury. Starting a regular walking program, managing your weight and making healthy lifestyle changes can help protect your Achilles tendon from future injury.

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    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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