Lower back pain

About Lower Back Pain

Pain in the lower back has become increasingly common among adults in Western civilizations as people become more sedentary and overweight. Long hours spent sitting, use of computers and mobile devices, and decreased physical activity levels are key contributing factors to lower back pain and dysfunction. Low back pain can range from mild to debilitating, and often worsens over time. LBP accounts for a rising incidence of work absenteeism, costing both employers and workers time and money.

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Dr. Lev Kalika
Dr. Lev Kalika

Clinical director & DC RMSK

About Lower Back Pain Specialist Dr. Lev Kalika

Lower back pain is often categorized as non-specific, meaning there is no apparent structural cause. Dr. Lev Kalika has spent years revolutionizing back pain treatment by introducing high resolution diagnostic ultrasonography for structural diagnosis, combined with gait and motion analysis technology to visualize and objectify functional human movement and its impact on the spine.

In addition to his academic credentials, Dr. Kalika is a Certified Biomechanist, Certified Gait Analyst, Certified Dynamic Neuromuscular Stabilization (DNS) practitioner, and is certified in Fascial Manipulation. He has spent time with Diane Lee, a leading world expert on sacroiliac joint (SIJ) dysfunction, and is certified in the Integrative System Model (ISM).

Dr. Kalika is an expert in the Stecco method of fascial manipulation, and uses high resolution ultrasonography to identify and treat densified fascia and entrapped spinal and pelvic nerves. He has over 15 years of experience in diagnostic musculoskeletal ultrasonography, and is an expert in ultrasound guided injection therapy and ultrasound guided dry needling. He is also and expert in extracorporeal shock wave therapy (ESWT).

Dr.Kalika’s expertise in lower back pain is sought by professional athletes, dancers, runners and physically active individuals across the United States.

Why Lower Back Pain Rehab at NYDNRehab is Better than Conventional Physical Therapy

Conventional treatment of low back pain often focuses on the locus of pain, ignoring the many contributing factors that can be the underlying cause. Successful treatment of low back pain addresses the cause rather than the symptoms.

To get to the root cause, two factors must be identified:

  • Motor dysfunction Because the spine is integrated into all human movement, faulty motor patterns anywhere along the kinetic chain can contribute to low back pain.
  • Pain generation Pain can be referred to the low back from multiple structures throughout the body. It can also be caused by nerves that are compressed or entrapped by other structures.

In many cases, a muscle, joint or nerve is irritated during specific movements. Since multiple structures can refer pain to the low back region, we must identify where the primary load transfer failure originates. Spinal stability has to be addressed from the perspective of dynamic stability, with the body in motion.

Conventional physical therapy often zeros in on core strengthening exercises, ignoring the many other factors that come into play during dynamic movement.

At NYDNRehab, we analyze your body in motion, to identify faulty motor patterns and compensation habits that are often at the core of lower back pain.


Accurate Diagnosis Means Successful Lower Back Pain Treatment

Comprehensive Spinal Assessment

Our diagnostic process begins with a comprehensive spinal assessment, incorporating diagnostic ultrasonography as an invaluable tool for visualizing soft tissue structures – muscles, tendons, nerves and fascia – affecting the spine. Advanced ultrasound imaging is particularly effective in examining intricate structures such as the lumbar interfascial triangle, the posterior layer of the thoracolumbar fascia (TLF), aponeurosis of the erector spinae muscles, and the medial layer of the TLF.

Ultrasound is also useful for detecting alterations in paraspinal muscle density and appearance, and helps us identify other key factors such as the infiltration of fat into muscles and the replacement of muscle fibers with fat cells. The advanced precision of diagnostic ultrasound by far exceeds that of conventional imaging methods, enabling us to detect and diagnose spinal injuries with greater accuracy and detail.

With the advent of high resolution diagnostic ultrasonography, MRI – once regarded as the “gold standard” of diagnostic imaging – has rapidly lost its utility for diagnosing low back pain. While MRI may be useful for surgical interventions, it cannot compete with ultrasound’s ability to thoroughly examine the integrity and biotensegrity of the lumbo-pelvic-hip complex.

Accurate Diagnosis Means Successful Lower Back Pain Treatment

The chiropractic and physical therapy professionals at NYDNRehab are experts in diagnostic musculoskeletal ultrasonography, a safe imaging technique that is much more useful than MRI for diagnosing low back pain:

  • Much higher resolution
  • Ability to view anatomical structures in motion
  • Ability to measure tissue elasticity with elastography
  • Repeatable analysis for monitoring treatment progress
  • Precise guidance for injection therapies
We use high resolution diagnostic ultrasonography to:
  • Screen for disc pathology
  • Detect spinal stenosis
  • Identify facet joint disorders
  • Expose lumbodorsal fascia alterations
  • Diagnose and retrain core musculature
  • Diagnose cluneal nerve impingement
  • Diagnose LBP-related hip and pelvic floor dysfunction
In addition to ultrasonography, our clinic features a fully equipped motion and gait analysis laboratory. We are the only private clinic in NYC to offer state-of-the-art 3D gait analysis. Deficient gait mechanics can alter pelvic alignment, which is often a primary cause of LBP.

Symptoms, Causes and Risk Factors of Lower Back Pain


  • Persistent dull achy pain
  • Pain that travels down the buttocks and legs
  • Pain that feels worse after extensive sitting
  • Pain that gets better after position change
  • Pain in the morning that improves with movement
  • Muscle spasms in the low back
  • Reduced mobility


  • Trauma from accidents, sports or exercise
  • Herniated disc or degenerative disc disease
  • Facet joint dysfunction
  • Dysfunctional sacroiliac (SI) joint
  • Spinal stenosis or osteoarthritis
  • Muscle weakness and imbalances
  • Overuse from exercise or occupation

Risk Factors

  • Sedentary lifestyle and excessive sitting
  • Being out of shape and/or overweight
  • Poor lifting technique
  • Bad postural habits
  • Deficits in walking or running gait
  • Age-related wear and tear
  • Weak core and pelvic muscles

Low Back Pain Treatment in NYC at NYDNRehab

At NYDNRehab, we take a comprehensive and individualized approach to lower back pain rehab. We combine the most advanced, scientifically proven low back treatment methods with our experience and expertise, to get superior results that eliminate pain and restore healthy functional movement.

Our treatment methods include:

  • Physical therapy
  • Chiropractic care
  • Ultrasound guided dry needling
  • Dynamic neuromuscular stabilization (DNS)
  • McKenzie therapy
  • Anatomy in motion (AIM)
  • ESWT
  • EMTT
  • Neuromodulation
  • Integrated systems model (ISM)
  • Clinical Pilates
  • Postural restoration and recalibration methods
  • Stecco fascial manipulation
  • Myofascial release
  • Acupuncture
  • Ultrasound guided injection therapies

We personalize our treatment plans based on your individual needs and the specifics of your condition. Our goal is to alleviate your pain and identify and treat its source, so you can get back to fluid pain-free movement.


Our Regenerative Therapies are Game-
Changers for Low Back Pain

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)

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.

Extracorporeal Pulse Activation Technology (EPAT)


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.

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.

Best Treatment Options

Acute lower back pain

Trauma from sports, exercise or accidents, or sudden pain from lifting or occupational demands, can cause sudden-onset low back pain.

Best treatment options include:
  • Ultrasound guided dry needling
  • Epidural steroid injections
  • Ultrasound guided injection therapies
  • Neuromodulation
  • ESWT
  • EMTT

Chronic lower back pain

Ongoing chronic low back pain is not normal and should be treated by a chiropractor, physical therapist or chronic back pain doctor. Chronic LBP often arises from poor, inadequate or untimely treatment, erroneous patient beliefs and coping strategies, emotional stress, and inaccurate diagnosis that focuses on the symptoms and not the underlying cause.

Best treatment options for chronic LBP include:
  • Physical therapy
  • Chiropractic care
  • Acupuncture
  • Ultrasound guided dry needling

Preventing Lower Back Pain

Staying physically active is one of the best ways to prevent lower back pain. Walking is particularly beneficial, as the gait cycle recruits all the muscles and joints in th