About Musculoskeletal Ultrasonography

Most people are familiar with ultrasound imaging as a safe and convenient tool for viewing babies in the womb, but ultrasonography has much broader applications for human health. When used for diagnosis and treatment of musculoskeletal injuries and disorders, high resolution musculoskeletal ultrasound (MSUS) imaging is a game-changer for restoring pain-free movement.

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Dr. Lev Kalika
Dr. Lev Kalika

Clinical director & DC RMSK

About Dr. Lev Kalika,
International Expert in MSUS

NYDNRehab clinical director Dr. Lev Kalika is an internationally recognized expert in diagnostic and musculoskeletal ultrasound imaging, with multiple research papers to his credit. Dr. Kalika has studied with some of the world’s most prestigious experts in diagnostic ultrasonography, and has attended multiple international conferences on the topic.

Ultrasound imaging has multiple advantages over other imaging tools like MRI, Xray and CT scan:

  • Ultrasound equipment is portable and takes up minimal space.
  • Ultrasound imaging is significantly less expensive than other imaging modalities.
  • Ultrasound allows us to visualize images in real time, with the patient in motion.
  • During ultrasound imaging, the patient becomes a stakeholder in the diagnostic process, giving us valuable feedback.
  • Ultrasound allows us to travel the entire length of structures like nerves, muscles and tendons.
  • Ultrasound lets us compare damaged tissues with healthy tissues on the uninjured side of the patient’s body, for more accurate diagnosis.
  • Our high-resolution Aplio unit has capabilities for superb microvascular imaging (SMI) to detect early signs of healing, and sonoelastography to measure tissue stiffness. These tools are invaluable for tracking progress and confirming the effectiveness of treatment.
  • Ultrasound imaging provides precise guidance for needling procedures.
    Our equipment has the highest resolution available in NYC, for clarity in diagnosing nerve, muscle and tendon injuries.

As a New York ultrasound practitioner, Dr. Kalika is an active member of the American Institute of Ultrasound in Medicine (AIUM), and is currently developing his own unique approach to Dynamic Functional Ultrasonography.

Lev Kalika Technology

Why NYDNRehab is a Leader in Diagnosis and Treatment of Injuries, Movement Disorders and Pain Syndromes

Modern technology has opened the doors to countless new approaches for diagnosing and rehabilitating injuries, pain syndromes, and movement disorders. However, most physical therapy clinics still rely on symptoms-based diagnosis, one-size-fits-all recovery timelines, and cookie-cutter treatment methods that often miss the mark, prolonging pain and suffering without resolving the underlying causes of pain and dysfunction.

At NYDNRehab, we believe that what cannot be measured cannot be successfully treated. In order to precisely diagnose and treat your condition, our clinic features some of the most advanced technologies in the world.

A quick and accurate diagnosis means your treatment protocol can be precisely tailored to your needs. Our growing collection of high-tech tools lets us monitor your progress based on hard data, and adjust your treatment as needed.

Our personalized one-on-one approach means that you will receive the very best care for your condition. Our goal is to get to the root of your problem as quickly as possible, and set you on the road to recovery, so you can get back to doing the things you love.

Why NYDNRehab is a Leader in Diagnosis and Treatment of Injuries
Diagnostic Ultrasonography

Diagnostic Ultrasonography

Accurate diagnosis is key to successful treatment. Symptoms play an important role, but being able to visualize your body’s structures in real time, with your feedback, gives us a “look under the hood,” to see what’s really going on.

Many conditions share the same symptoms, and a symptoms-based diagnosis can lead to the wrong treatment, prolonging your pain and costing you time and money.

Our New Aplio i800 ultrasound equipment renders the highest resolution images possible, giving us a crystal-clear look at your soft tissues, nerves, bones and joints.

Unlike static images taken by Xray or MRI, diagnostic ultrasound lets us visualize structures beneath the skin’s surface, with the patient in motion.
Ultrasound lets us travel the length of long structures like nerves, bones and muscles, to identify anomalies and pinpoint the scope and extent of damaged tissues. It also allows us to quickly compare damaged tissues to healthy tissues on the patient’s uninjured side, to optimize diagnostic results.

Once we diagnose your condition, we can get right to work on your treatment plan — no need to wait to get images back from the lab!

In addition to its imaging capabilities, our research-grade high-resolution Aplio i800 equips us innovative tools not available on lower quality ultrasound equipment


Sonoelastography enables us to evaluate the elasticity of muscles, ligaments and tendons. Tissue stiffness is a mechanical property that indicates the overall health of soft tissues. Therapists have traditionally relied on manual palpation to detect damage to soft tissues, but even the most skilled therapist can only guess at the extent of damage.

Sonoelastography provides us with quantitative data that we can use to establish a baseline and track tissue healing throughout the rehabilitation process.

Sonoelastography lets us see beyond gray-scale images to:

  • Visualize myofascial trigger points

  • Detect thickening or fibrosis of the fascia

  • Monitor pre- and post-treatment elasticity for physical therapy, dry needling, injection procedures, shockwave therapy, and more.

Superb Microvascular Imaging

Superb Microvascular Imaging (SMI) lets us detect early microvascular flow in very small vascular structures. Structures like ligaments, tendons and fascia have limited vascularity, and are therefore slow to heal. Our regenerative technologies are designed to stimulate cellular repair and enhance blood flow to damaged tissues. SMI lets us detect early signs that our treatment plan is working, and SMI gives us a tool for monitoring all stages of the healing process.

Sports Medicine Ultrasound for Peak Athletic Performance

Sports Medicine Ultrasound for Peak
Athletic Performance

In addition to its important role as a diagnostic tool, high-resolution ultrasonography provides us with a training tool for restoring neuromuscular pathways and re-establishing optimal muscle firing patterns.

Injuries from trauma and overuse can lead to compensation patterns that serve to unload damaged tissues as they heal. Once established, those patterns are difficult to correct without specific motor feedback training. Ultrasound lets the patient visualize the muscles during movement, to retrain the brain to activate specific muscles in a coordinated sequence.

Ultrasound-guided feedback retraining helps athletes to restore optimal muscle firing patterns, to ensure peak athletic performance and dramatically reduce the risk of re-injury.


Get the Best Diagnostic and
Musculoskeletal Ultrasound in NYC

Injury rehabilitation takes time, and at NYDNRehab, we believe that time should not be wasted on misdiagnosis and ineffective treatment methods based on diagnostic guesswork. Our cutting-edge ultrasonography equipment and tools take the guesswork out of diagnosis, allowing us to design a personalized treatment plan that accelerates your recovery. Contact NYDNRehab today, and see why we are Manhattan’s ultrasound provider of choice in NYC.


Clinical Case Studies

Case Study: Joint Hypermobility Syndrome

Our patient is a tall, slender 36 year-old female complaining of joint pain throughout her body, with her right (dominant) elbow causing the worst pain, and significantly interfering with her job and recreational activities.

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Case Study: Lateral Epicondylitis

Our patient is a 56 year-old male jeweler who came to us with lateral elbow pain. The patient is a very athletic tennis player who works out at the gym on a regular basis.

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Dr.Kalika just coauthored in a new medical textbook, which is going to be published later this year in one of the worlds leading medical publication Springer-Verlag.


Сurrently Dr.Kalika is enrolled in Post Graduate University Degree of Expert in MusculoSkeletal Ultrasound By Barcelona University


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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