About Back Pain

Back pain is a common complaint among adults around the world, and it accounts for the majority of doctor visits in the United States. Yet most back pain is non-specific in nature, meaning that no specific mechanical or pathological cause can be identified. There is a growing consensus that back pain is multifactorial, meaning that each case of back pain may have more than a single cause. For that reason, accurate diagnosis is key to effective back pain treatment.

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Dr. Lev Kalika
Clinical director & DC RMSK

About Back Pain Specialist Dr. Lev Kalika

Dr. Lev Kalika, clinical director of NYDNRehab, is the author of multiple medical publications and research, and an international expert in the fields of rehabilitative sonography, ultrasound guided dry needling and sports medicine. Dr. Kalika works with athletes, runners, dancers and mainstream clients to relieve pain, rehabilitate injuries, enhance performance and minimize the risk of injuries. His clinic features some of the most technologically advanced equipment in the world, rarely found in a private clinic.


Why Physical Therapy Alone May Not Resolve Your Condition

Physical therapy is a valuable and effective approach to resolving musculoskeletal pain and dysfunction, but in many cases, physical therapy does not provide a stand-alone solution. Prior to beginning physical therapy, patients often need to address underlying issues that contribute to their pain and disability.

Unfortunately, mainstream physical therapy clinics are often not adequately equipped or experienced to identify and treat complications that undermine the effectiveness of physical therapy. They often rely on one-size-fits-all treatment protocols that overlook the unique characteristics of the individual condition, opting to treat the symptoms and not the patient.

Issues that should be addressed prior to beginning physical therapy include:

  • Scar tissue and fascia adhesions
  • Neurogenic inflammation
  • Joint edema
  • Inflamed soft tissues
  • Myofascial trigger points
  • Compressed or entrapped nerves
  • Tendons that have degenerated and lost their elastic properties
  • Compensation patterns developed post-injury
Block PT

Holistic Non-Invasive Diagnosis and Regenerative Therapy

Identifying and treating underlying issues prior to beginning physical therapy is key to getting fast and effective results. Failure to do so can completely undermine your treatment protocol, and in some cases, your condition may even worsen.

At NYDNRehab, we use a broad range of advanced technologies and innovative therapeutic approaches to resolve issues that can potentially undermine the success of physical therapy.

Our talented staff is certified in a diverse array of treatment methodologies, rarely found in run-of-the-mill physical therapy clinics. Our one-on-one sessions are personalized, based on the patient’s unique diagnostic profile.

Obstacles to physical therapy success include:

  • Scar tissue and fascia adhesions
  • Neurogenic inflammation
  • Joint edema
  • Inflamed soft tissues
  • Myofascial trigger points
  • Compressed or entrapped nerves
  • Tendons that have degenerated and lost their elastic properties
  • Compensation patterns developed post-injury

Why Back Pain Physical Therapy at NYDNRehab is Better than Conventional Back Pain Treatment

The human body is made up of interconnected structures designed to work together in coordinated patterns to produce movement. Because the spine is involved in every aspect of human movement, back pain often originates from weakness, tightness or imbalances of muscles and connective tissues located far from the locus of pain.

Conventional medicine often focuses on pain management, treating generalized back pain with opioids, steroid injections and anti inflammatory medications without addressing its underlying causes. This often leads to recurring episodes of back pain that are never fully resolved, causing chronic pain and disability.

Why Back Pain Physical Therapy
Excessive use of MRI and surgical

Excessive use of MRI and surgical interventions have proven to be no more effective than conservative care for improving patient outcomes, and excessive use of prescription pain medications appears to be fueling the current global opioid epidemic.

Many people stop moving when they are in pain, but with back pain, active treatments are more likely to be successful than passive treatments. Any back pain treatment should involve active care, where the patient is an active participant in their recovery. Active care includes exercise, modifying thoughts and beliefs about back pain, and learning more about behaviors that cause back pain.

Types of Back Pain

Non-specific back pain
Non-specific back pain

Has no identifiable root. The patient experiences pain, yet no mechanical cause can be determined by medical practitioners.

Myo-fascial back pain
Myo-fascial back pain

Has its origins in the fascia, the thin tough sheath of connective tissue that encases and compartmentalizes muscles. Myofascial pain often stems from trigger points, tiny knots in fascia that sensitize nerves in local muscles or connective tissue.

Mechanical back pain
Mechanical back pain

Originates from excessive stress on muscles surrounding the vertebral column. Mechanical pain is often caused by daily habits such as poor posture, poorly-designed workstation ergonomics, or faulty lifting techniques.

Nociplastic back pain
Nociplastic back pain

Arises from heightened activation of peripheral sensory nerves, despite no clear evidence of tissue damage.

Neuropathic back pain
Neuropathic back pain

Is caused by disease or damage that affects the somatosensory nervous system.

Nociceptive back pain
Nociceptive back pain

Is the most common type of back pain. It arises from physical damage to the body due to trauma or surgery.

Symptoms, Causes and Risk Factors of Back Pain

  • Dull or achy pain in the spinal region
  • Burning pain that runs from the low back to the legs (sciatica)
  • Muscle spasms and tightness
  • Pain that gets worse after long periods of sitting or standing
  • Pain and stiffness when trying to stand up straight
  • Pain when walking
  • Pain when moving from standing to sitting
  • Lifting objects with poor technique
  • Poor workspace ergonomics
  • Poor posture when sitting or standing
  • Weakened deep spinal muscles and core musculature
  • Neuromuscular dysfunction
  • Faulty gait mechanics
  • Motor deficits in the lumbopelvic region
Risk Factors
  • Sedentary lifestyle with excessive sitting
  • Smoking
  • Obesity
  • Metabolic disease
  • Physically demanding work
  • Poor sleep habits
  • Overuse from exercise or occupation

Accurate Diagnosis Means Successful Back Pain Treatment

Our initial back pain diagnosis begins with a clinical exam. Radiology rarely adds useful information unless conservative care fails to resolve back pain. In such cases, epidural steroid injections or surgery may be considered as a last resort. However, the first line of defense for back pain treatment is always conservative care, making imaging with MRI or Xray unnecessary.

Diagnostic ultrasonography can be useful for identifying soft tissue damage or inflammation, and it can be used to provide a differential diagnosis for disc bulges or spinal canal stenosis. Ultrasound can also be used to guide pain-blocking injections and dry needling procedures.

Accurate Diagnosis Means Successful Back Pain Treatment
We Use High-Tech Equipment for Optimal Results

We Use High-Tech Equipment for Optimal Results

At NYDNRehab, we go beyond treating back pain symptoms to finding the underlying causes of back pain and eliminating them. To optimize results, we use advanced technologies that are rarely found in a private clinical setting.

We approach back pain with a variety of manual and therapeutic exercise techniques, spinal stability strengthening, gait retraining, ultrasound guided dry needling and exercises to correct motor dysfunction and improve neural communication between the muscles and the central nervous system.


Regenerative Technologies for Back
Pain Physical Therapy

At NYDNRehab, we use a combination of treatment approaches for back pain, based on the specific needs of the individual patient. 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.

We combine regenerative shock wave therapy, electromagnetic transduction therapy and other regenerative approaches to relieve pain and stimulate healing. Our regenerative technologies and innovative therapeutic approaches make NYDNRehab the premier clinic for back pain treatment in New York.

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)

More Treatment Options

Acute Back Pain
Acute Back Pain
  • Over the counter NSAID’s (non-steroidal anti-inflammatory drugs) to relieve pain and inflammation
  • Acupuncture
  • Chiropractic care
  • Ultrasound guided dry needling (UGDN)
  • Epidural Steroid Injections (ESI)
Chronic Back Pain
Chronic Back Pain

Persistent back pain may require more extensive treatment, including:

  • Physical therapy
  • Chiropractic care
  • EMTT (electromagnetic transduction therapy)
  • ESWT (extracorporeal shock wave therapy)
  • Ultrasound guided dry needling (UGDN)

Preventing Back Pain

An ounce of prevention is worth a pound of cure, especially when it comes to back pain. The most important thing you can do to prevent back pain is to exercise on a regular basis and manage your weight. In addition, adopting healthy lifestyle habits like smoking cessation, a whole foods diet, getting enough sleep, managing stress and staying hydrated will help to reduce your risk of back pain.

Back pain often stems from mechanical errors during running, walking, sports and exercise. A thorough biomechanical and 3D gait analysis can help identify mechanical errors that increase your risk of back pain. Gait retraining, corrective feedback training and posture retraining can all help to protect you from back pain.

Preventing Back Pain

Get Personalized Back Pain Physical Therapy Designed Just for You

At NYDNRehab, we never take a cookie-cutter approach to patient care. The causes and symptoms of back pain can vary from one patient to the next, and each case requires a unique treatment approach. We thoroughly examine each patient and base our treatment solutions on your personal diagnosis. We provide one-on-one Physical Therapy, custom-designed for the individual patient.


Benefit from Our Innovative Non-Invasive Therapies

Back pain rarely requires surgery. Physical therapists and chiropractors are the most equipped practitioners for dealing with common back pain. At NYDNRehab, we take a multimodal modern approach to treating back pain. Our treatment protocols include corrective exercise, manual therapies, dry needling and home exercise prescription. Our back pain specialists are certified and knowledgeable in multiple different treatment approaches that can be combined to optimize the effectiveness of your treatment plan.

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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Steroid Injection-Induced Pain and Muscle Atrophy

Our patient is a 58 year-old female with complaints of persistent pain in the sacroiliac joint, with radiating pain and paresthesia to the buttock and trochanter.

learn more
Get Back Pain Treatment That Really Works!

Get Back Pain Treatment That Really Works!

Back pain can be debilitating, interfering with your ability to enjoy life to its fullest. Pain medications and surgeries often fail to get to the root cause of back pain, treating the symptoms without resolving their underlying causes. At NYDNRehab, we make it our mission to get to the source of your back pain and correct it, so you can move freely again and enjoy a full and active life.

If you suffer from chronic back pain and want to find the best back pain doctor in NYC, visit NYDNRehab in midtown Manhattan. Our back pain specialists provide individualized treatment plans to meet the unique needs of every patient. We don’t just treat back pain – we get to its source and restore healthy pain-free function, so you can enjoy the very best quality of life. Contact us today and schedule your first session, to get rid of your back pain for good.

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    Dr. Lev Kalika Clinical director & DC RMSK

    Research at NYDNRehab

    Conference: the 12th World Congress of the International Society of Physical and Rehabilitation Medicine (ISPRM 2018) At: Paris, France “DRY NEEDLING UNDER ULTRASOUND GUIDANCE DECREASE NEUROPATHIC COMPONENT AND INCREASE LEVEL OF MOTION IN PATIENT WITH LOW BACK PAIN”
    Back Pain

    This page contains novel technological non- invasive approaches for treatment of low back pain and herniated disc disorders.We have been on forefront of rehabilitation of most difficult low back and neck pain disorders with combination of our integrative hands on manual, rehabilitative and technological approaches.

    Back pain affects 90% of Americans at some point of their life and is the leading cause of visits to the doctor. Low back pain is the most prevalent cause of disability in people under age 45; $100 billion is spent annually on treatment of low back pain, with more then half of that spent on surgical treatment. Low Back Pain (LBP) has long reached epidemic proportions in the Western world. Acute LBP is one of the leading symptoms that force an individual to seek medical attention. At the same time the chronic back pain is responsible for enormous cost to health care and society.

    It has been traditionally, although incorrectly, believed that acute LBP episodes resolve themselves within a relatively short period of time. This mistaken belief has led to the symptomatic management, consisting mostly of the bed rest and pain medication, which is proven to promote chronicity. A scientific consensus gradually emerged over the past ten years that understate the role of the structural findings by MRI and/or X-RAY as being decisive in LBP diagnostics and treatment strategies. By far the most common painful locomotor (musculoskeletal) system conditions are in fact the ones called idiopathic (without an apparent cause) because no structural pathologies can be found.

    An alternative had been suggested advising encouraging LBP patients with reassurance that there is no serious life-threatening disease involved and that the only sure road to the complete recovery goes through the measured resumption of normal activities and restoring function. Implementation of this approach resulted in significant decrease in LBP chronicity and consequent disability in part by eliminating the psychological impact of pain on the nervous system.

    Restoring function has only recently become the standard in physiotherapy,chiropractic and rehabilitation medicine. However the restoration of function is mostly attempted by the practitioners through the purely mechanical means. They commonly fail to acknowledge that functional pathology is not just altered biomechanics, but rather a response of the Central Nervous System to pain and dysfunction by altering motor control residing in the brain. Therefore, it is motor control of the Central Nervous System and not the biomechanics that should be addressed when formulating the treatment of low back pain.

    It must be also realized that by no means can people complaining of back pain with non-identifiable origin be labeled malingerers, nor should their condition be identified as psychogenic. The somatic origin of their symptoms can be easily established. Clinical examination usually reveals the multitude of signs and symptoms of physical origin of pain. And here lies another problem. Because functional aberration can be objectified through the physical examination, it is routinely treated as a mechanical disorder, the approach which, as we stated above, is inadequate and leads to poor treatment outcomes.

    When treating the function it is important to realize that the mechanical change is a source of information processed through the Central Nervous System, which in turn makes the locomotor control programs react in a coordinated fashion. Even when mechanical changes are obvious and structural pathology is objectified, it is the disturbed function that should be the primary target of the treatment.

    The biggest mistake in medical approach to treatment of back pain has been isolated by science and has become common knowledge today. Since the wide availability of the MRI doctors have been over relying on radiologic findings with such diagnoses as herniated or bulging disc. This has led to many unnecessary spinal surgeries which known to have poor outcome. In fact recent survey of 800 spinal surgeons to choose most appropriate treatment for herniated and bulging disc conditions was physical therapy.

    Back Pain Is Multifactorial

    Variety of latest studies showed that patients with back pain do not fit in one category. There are multiple subgroups of patients which have low back pain. Very detailed classifications have been created based on very extensive studies of large population suffering from LBP. At Dynamic Neuromuscular Rehabilitation being participants of four World congresses of Low Back and Pelvic Pain we are quite familiar in recognizing which category and subgroup this particular patient belongs to. Our treatment protocols are not based on one modality or one method.We have professed clinical and technological diagnosis which allows us to select most appropriate integrative intervention for successful treatment. When back pain is not initially addressed with the right intervention it could become chronic and lead to serious consequences.

    How Functional Treatment Is Conducted

    The term Locomotor Dysfunction, as we have stated above, describes an abnormal condition of tissues involved in body mobility, posture and muscle balance, including muscles, joints, discs and, most importantly, neural wiring in the central motor regulation centers of the Central Nervous System. This situation can be reversed by a variety of manual techniques and remedial exercises, which affect the nervous system globally, as a whole. Manual techniques are used to treat local muscle and joint dyfsunction consist of joint and soft tissue manipulation, reflex stimulation, various muscular techniques, which release Trigger points , muscle hypertonicity (spasm) and either inhibit hypertonic muscles or facilitate (strengthen) weak muscles. Exercise program includes spinal stability (core) and postural training, body awareness exercises, sensory integration, breathing and core retraining and therapeutic exercises.Following pain reduction patients is treated with blend of specific techniques from yoga and Pilates based on individual needs.

    Rooted in Developmental Kinesiology, our therapeutic program is based on evoking the ideal movement patterns through the reflex stimulation of the motor regulation centers, and then conditioning the patients through exercise to be able to activate these patterns automatically without any conscious effort. All of the soft tissue techniques and gentle non-forceful manipulations are conducted in basic primal positions and follow the rules of Development Kinesiology.

    Our therapeutic program puts a special emphasis on the importance of deep spinal stability. Deep muscles of the spine are the first ones to be affected when motor programs become corrupted. They almost never produce pain, but their inability to properly co-contract (contract together) overloads more superficial muscles. This dysfunction overloads the spine .creates trigger points, fascial restrictions, joint subluxations and other abnormalities that ever so often result in excruciating pain so familiar to the LBP sufferers. Therefore, our primary goal in this respect is to teach our patients to feel and control these muscles in order to decrease load on the spine, reduce shearing forces and guide the body to create optimal compensation. We further aim to train our patients in how to activate these muscles (core and etc..) evoking appropriate movement patterns and eventually to condition the brain to activate the associated locomotor programs automatically without the patient voluntary control. In our experience this is the best way to release muscular tension, remove sublaxation, establish proper movement patterns, improve posture and dramatically improve and strengthen spinal stability. This approach not only alleviates suffering but also prevents relapses and recurrences which are so common with the back pain. For patients with increased work demands or athletes whether recreational or professional we progress spinal stability training into a functional training. The functional training is goal-oriented and involves various movements like: lunges, squats, pulling and twisting all of which are performed in challenging positions and are enhanced by different labile surfaces. Due to majority of jobs today requiring excessive sitting, back and pain today have intimate relationship of how patient gets into seating as well as the work place ergonomics. We have spent significant time understanding and studying seating back pain category. We have devised specific therapeutic intervention based on seating demands.

    The optimal goal of our rehabilitation programs is to optimize the function, it does not mean that we reject cooperation with the most accepted and therapeutically proven conventional methods of medical intervention which involve such procedures as epidural injections.

    It is commonly believed, even by most conservative health care practitioners, that a patient should consider epidural steroid injections only when all other options are exhausted. This belief unfortunately may backfire and harm the patient if the practitioner is biased or if he is not greatly familiar with pain management guidelines. The blind belief in the holistic approach can bring disability to the patient if the conservative care practitioner rejects the pain management treatment and has poor understanding of when and what type of pain management is best for the patient. We, in our practice, do not overestimate the power of functional approach and never ever deny the qualified patient timely referral to a pain management specialist . The functional approach that we profess is actually the best indicator of when a patient has reached the plateau and the conservative care is in need of pain management support.

    Our Specialists

    Dr. Mikhail Bernshteyn MD (Internist)
    Dr. Michael Goynatsky DPT
    Dr. Daniela Escudero DPT
    Dr. Michelle Agyakwah DC
    Dr. Tatyana Kapustina L. Ac.

    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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