Extracorporeal Shock Wave Therapy


Shockwave therapy begins with a tissue scan using the highest resolution ultrasound equipment. Once we identify the area of concern, we map the focal region, including target size and depth. Next, we mark the area to be treated and set our transducer at the appropriate depth. Diagnostic ultrasound lets us visualize any changes occurring in the tissues over time, to monitor the healing process. Our approach guarantees precision in targeting and treating the affected area. Dr.Kalika has over 17 years of experience in ultrasound guided procedures. He has been an active member of the International Society of Medical Shockwave Therapy (ISMST) since 2007, and has treated over 3000 patients using ESWT. Our clinic features the only shockwave machine that combines focused, defocused and radial shock waves.

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Dr. Lev Kalika

Clinical director & DC RMSK

About Shockwave Therapy Specialist
Dr. Lev Kalika

Dr. Kalika has devoted his life’s work to revolutionizing the way musculoskeletal pain syndromes and movement disorders are diagnosed and treated. In addition to years of training and experience in extracorporeal shockwave therapy (ESWT), Dr. Kalika is recognized as an international expert in musculoskeletal ultrasonography, and has published multiple scientific papers on its use in rehabilitative medicine.

The clinic at NYDNRehab features the most advanced shockwave equipment available, enabling us to effectively target different types of tissues by adjusting the frequency, intensity, breadth and depth of tissue-specific shockwaves. Our use of ultrasound imaging to guide shockwave procedures ensures that the shockwaves hit their mark, to produce optimal results.

Dr. Kalika is an esteemed member of the International Society for Medical Shockwave Treatment (SMST). His 20+ years of experience and expertise in ESWT and diagnostic ultrasound imaging make NYDNRehab the clinic of choice for extracorporeal shockwave therapy in NYC.

Our Awards

Extracorporeal Shockwave Therapy (ESWT), Extracorporeal Pulse Activation Technology (EPAT) and Defocused Shockwave are the most advanced and highly effective non-invasive treatment technologies approved by the FDA for orthopedic musculoskeletal disorders.

At NYDNRehab, we use three different shockwave machines for focused, defocused, linear and radial shockwave treatment. Each type of shockwave has its own advantage over the others, to address different types of tissues. Most pathologies involve multiple tissue types, and they are all connected. With multiple options for treatment, we are able to vary the depth and width of penetration, zoom in to focus on specific tissues, and zoom out to cover larger areas.

This proprietary technology is based on a unique set of sound waves that stimulate the metabolism, enhance blood circulation and accelerate the healing process. After treatment, damaged cells gradually regenerate and damaged tissues eventually heal. These non-invasive outpatient procedures represent breakthrough regenerative treatment options for a broad range of musculoskeletal conditions.

Having performed thousands of procedures over the years, Dr.Kalika’s experience has shown that successful outcomes of shockwave therapy lie in precise ultrasound guidance and the combination of different types of shockwaves for optimal energy deliverance to different types of tissues.

Some facts about shock wave therapy

While there is no perfect regenerative modality, research shows ESWT to be the leading regenerative treatment, surpassing injections of stem cells and platelet-rich plasma (PRP).

  • Shock wave therapy is completely non-invasive, with no known side effects.

  • ESWT is the best treatment modality for tendon injuries.

  • ESWT is second only to ultrasound guided dry needling for treating myofascial pain and releasing myofascial trigger points.

The advent of new technologies over the past several years has opened a vast range of possibilities for therapeutic, non-invasive and non-pharmacological methods to help patients manage pain and heal damaged tissues.

One promising new therapy that is getting the attention of the medical community is extracorporeal magnetic transduction therapy (EMTT), a non-invasive treatment technology that uses electromagnetic fields to reduce pain and stimulate cellular neogenesis in targeted tissues.

NYDNRehab is pleased to offer this groundbreaking new technology to our patients to treat a variety of conditions, including joint and muscle disorders, bone fractures, athletic injuries and chronic pain conditions.


Most pathologies involve more than one
type of tissue. Tissues affected in a single
treatment area may include:

  • Fascia

  • Muscles

  • Tendons

  • Ligaments

  • Bones

  • Nerves

  • Blood vessels

Combining different types of shockwaves under ultrasound guidance is one of the most effective ways to treat musculoskeletal pathologies. However, it requires an experienced practitioner who is able to use diagnostic ultrasonography to assess damaged tissues, determine the appropriate focus and depth, and select the appropriate type and energy of shockwaves.

Tissue assessment is based entirely on grayscale ultrasound images that may include elastography and microvascular imaging, requiring advanced expertise to identify various structures and determine the most effective treatment, for targeted intervention.

YOUR BODY’S Ability to heal is greater than anyone has permitted you to believe.

Advantages of Shockwave Therapy with Ultrasound Guidance

When performed under ultrasound guidance, shockwave therapy (SWT) is 70% more effective Zu than SWT performed without the advantage of ultrasound imaging.

Ultrasound guidance lets us:

  • Precisely focus on lesions and select the appropriate shockwave intensity. This can only be done if we know the depth of the lesion and the stage of tendinosis.

  • Identify nerve entrapments or bony impingements as primary targets, making tendinosis treatment secondary.

  • Visualize and quantify inflammation surrounding the tendon via microvascular imaging.

  • Assess the tendon via sonoelastography, to locate areas of low elasticity.

To get highly effective results, shockwave therapy should be performed by a clinician with experience and expertise in diagnostic ultrasonography.

Advantages of Shockwave Therapy with Ultrasound Guidance

Combined Regenerative Technologies
Bring Fast Therapeutic Results

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)

Focused Ultrasound-Guided Shockwave Therapy

Prior to your first shockwave treatment, we do a diagnostic ultrasound scan. Ultrasound imaging lets us identify the precise area of concern, and helps us to gauge the size and depth of the targeted tissues. We then mark the area to be treated and set our equipment for the appropriate depth, ensuring that the focused shockwaves render the greatest benefit.

Ultrasound guidance enables us to:

  • Precisely locate the affected tendon or soft tissue

  • Identify the most affected part of the tissue

  • Measure the desired depth of penetration

  • Measure tissue density using sonoelastography, to select the most effective type of shockwave and the pulse frequency

  • Classify the state of the tissue before and after treatment

Ultrasound guidance ensures that the focused shockwaves precisely reach the intended site of treatment. Diagnostic ultrasound also allows us to visualize any changes in the treated tissues, to help track the healing process. Ultrasound guided shock wave therapy is the gold standard for shockwave treatment.

 Focused Ultrasound-Guided Shockwave Therapy

Radial vs Focused Shockwave

ESWT can be administered using radial (pressure ), or focused (sound) shockwaves. Our choice is determined based on the specific needs of the patient.

Radial vs Focused Shockwave

Focused shock wave therapy uses a cylindrical coil to generate electromagnetic waves. It penetrates deeper tissues, causing tissue membranes to vibrate and create pressure waves in their surrounding fluids without losing energy. Focused shock wave is used to target a smaller focal area. Ultrasonography is often used in conjunction with focused shock wave therapy to accurately visualize deep tissues.

Focused shock waves are most often used for:

  • Acute athletic injuries

  • Bone fractures

  • Shin splints

  • Groin pain

  • Achilles tendon pain

  • Medial and posterior tibial pain

  • Ankle sprains

  • Wound healing

Radial shock wave therapy is the most commonly used form of ESWT. It is used for a larger treatment area at a more superficial level. It transmits kinetic energy to targeted tissues, creating a radial wave. Radial shock waves emit their greatest energy at the skin’s surface, and lose power as their energy penetrates deeper tissues.

Radial shock waves are most often used for

  • Superficial tendinopathy

  • Superficial trigger points

  • Myofascial pain

  • Plantar Fasciitis

  • Fascial adhesions

Radial shock wave therapy is also effective for managing spasticity in conditions such as stroke, cerebral palsy, multiple sclerosis, dystonia and writer’s cramp.

Radial and focused shockwaves are often used in combination to treat acute and repetitive overuse injuries in athletes.

The Underlying Science of Shock Wave Therapy

While it may seem counterintuitive, a small amount of damage needs to be done to the body to prompt it to repair itself. Shock wave therapy creates tiny ruptures in the capillaries that feed injured tissues. This prompts the body to start producing new blood vessels to replace the damaged ones. The tiny new blood vessels increase the blood supply to the injured area, increasing the flow of oxygen and nutrients necessary for healing.

Increased nutrient-dense blood flow is necessary for neovascularization to occur, to start and maintain the repair process of damaged tissue. The application of acoustic waves creates capillary micro-ruptures in tendon and bone and significantly increases the expression of growth indicators such as the eNOS, VEGF, PCNA and BMP. These processes stimulate the growth and remodeling of new arterioles. The new blood vessels enhance the tissue’s blood supply and oxygenation, resulting in accelerated healing of muscles, tendons and bones.

Sufficient amounts of collagen are also necessary for tissue repair. Shockwave therapy hastens procollagen synthesis. The newly created collagen fibers are forced into a longitudinal structure, making tendon fibers denser and stiffer.

Trigger points are the principal cause of pain in the back, neck, shoulder and limbs. They are palpable nodules in taut bands of muscle fibers that have extremely contracted sarcomeres. The dysfunctional sarcomeres contract so tightly that they begin to cut off their own blood supply. This causes the build-up of waste products which in turn, irritates the sensory nerve endings, causing even more contraction. This vicious cycle is referred to as a metabolic crisis. Although the precise medical effects of acoustic wave therapy are still unclear, it can be assumed that the delivered acoustic energy unblocks the calcium pump, thus reversing the metabolic crisis and releasing the trigger points.

ESWT and Plantar Fasciitis

ESWT and Plantar Fasciitis

New York Dynamic Neuromuscular Rehabilitation uses several modalities to diagnose plantar fasciitis, including ultrasound and clinical examination. If the case is complicated, we may even perform a thorough gait analysis using advanced technology. Shock and pressure wave therapies are very effective for treating plantar fasciitis, with studies reporting a success rate of about 92 percent. Contact us for a consultation on the benefits of ESWT for plantar fasciitis.

Clinical Case Studies

Patient with Back Pain, Scoliosis and External Foot and Hip Rotation Successfully Treated

Our patient was a 22 year-old male presenting with low back pain, scoliosis, and external hip and foot rotation.

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Occupational Hip and Low Back Pain

Our patient was a 55 year-old male employee of the Metropolitan Transportation Authority (MTA). The patient’s job required heavy manual labor. He came to us complaining of hip and low back pain.

learn more

ESWT and Chronic Inflammation

ESWT can be used to reverse chronic inflammation that occurs when the inflammatory response is not completely halted. Chronic inflammation can damage healthy areas of the body, causing chronic pain. ESWT stimulates mast cells to release pro-inflammatory compounds like cytokines and chemokines. This stimulates the regeneration of healthy cells and helps restore normal healing.

ESWT and Tendon Healing

ESWT can help the body to produce more collagen. Collagen is a protein found throughout the body that gives tendons and ligaments their structure. The collagen fibers produced by the body after shock wave therapy are forced into longitudinal structures that make tendons stiffer and denser, stopping and reversing tendon degeneration.

ESWT and Trigger Point Therapy

Radial vs Focused Shockwave

Trigger points are tightly contracted bands of muscle tissue that are the principal cause of pain in the back, neck, shoulders and limbs. Their dysfunctional sarcomeres contract so tightly that they begin to cut off their own blood supply. This causes a buildup of waste products, which in turn irritates the sensory nerve endings, causing even more pain. This vicious cycle is called a metabolic crisis.

Although the precise mechanisms of ESWT’s effect on trigger points is unclear, it is assumed that the delivered acoustic energy unblocks the calcium pump in the sarcomere, causing the trigger point to release and immediately stopping pain.

ESWT and Motor Disorders

ESWT can be successfully used to treat and manage spasticity after stroke, and in motor disorders such as cerebral palsy, multiple sclerosis, dystonia and severe writer’s cramps.

Exciting New Research Supports Shockwave
Efficacy for Pelvic and Reproductive Disorders

Our years of experience using shockwave therapy have helped hundreds of patients to successfully eliminate musculoskeletal pain and dysfunction. Today, a treasure trove of research is emerging that supports the efficacy of shockwave therapy for treating pelvic and reproductive disorders.

Recent research has found shockwave therapy to have long-term success in treating:

Pelvic disorders are common in both men and women, but patients are often reluctant to seek treatment due to embarrassment. Shockwave therapy provides a safe, non-invasive and effective solution for a broad range of pelvic and reproductive disorders, with minimal discomfort for the patient. Treatment sessions are brief, and many patients report improvement after their very first session.

Treatable Disorders

  • Osgood-Schlatter disease

  • Nonunion of a distal fibular fracture

  • 4th metatarsal stress fracture

  • Navicular stress fracture

  • Sesamoid Osteochondrosis

  • Painful Os tibiale externum

  • Apophysitis calcanei

  • Heel spurs

  • Hallux limitus

  • Hamstring disorders
  • Tendinosis of peroneal tendons, tibialis posterior

  • Various chronic enthesiopathies (painful irritation of tendon attachments due to overexertion and improper strain, or due to a degenerative process)

  • TMJ
  • Frozen shoulder
  • Bone non-unions

  • Osgood-Schlatters disease

  • Various sports injuries

  • Painful trigger points (acute and chronic painful neck, back, shoulder and etc. due to chronically shortened and thickened muscle tissue)

  • Bursitis (Bursitis is inflammation of a bursa. The major bursae are located adjacent to the tendons near the large joints, such as the shoulders, elbows, hips, and knees)

  • Many other conditions not listed above

Is Shockwave Therapy Safe?

Shockwave therapy is a noninvasive FDA-approved treatment method. When delivered by an experienced clinician, ESWT is considered safe, inexpensive, fast and effective. Shockwave therapy spares the patient from the dangers of unnecessary surgical procedures and the negative side effects of medications. ESWT is especially effective for treating injured tendon tissues in the ankles, knees, hips, shoulders, wrists and elbows. It is also used to treat bone fractures and muscle injuries, along with conditions like plantar fasciitis and carpal tunnel syndrome.

The importance of ultrasound guidance for ESWT


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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