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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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Clinical director & DC RMSK
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.
The motion and gait analysis lab at NYDNRehab features research-grade technology found at top research universities, and made available to patients in our private clinic. Dr. Kalika believes that what cannot be measured cannot be treated. Our gait and motion analysis goes beyond standard 3D technology, providing critical data that allows us to customize and track the progress of patient treatment.
In addition to his academic credentials, Dr.Kalika is a Certified Biomechanist, Certified Gait Analyst, and is certified in Dynamic Neuromuscular Stabilization (DNS). He has over 15 years of experience in diagnostic musculoskeletal ultrasonography, extracorporeal shock wave therapy (ESWT) and orthotic prescription. He is an expert in ultrasound guided injections and dry needling procedures.
Dr.Kalika’s expertise in lower back pain is sought by professional athletes, dancers, runners and physically active individuals across the United States.
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.
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.
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
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
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.
The advanced technologies we use for diagnosis and treatment at NYDNRehab are unsurpassed in the field of physical therapy, and rarely found in private clinics.
Our state-of-the-art gait and movement analysis lab lets us collect hard data on multiple movement parameters, to quantify individual movement patterns and measure progress.
We then apply the latest therapies and evidence-based treatment approaches to relieve your pain and dysfunction. At NYDNRehab, we never give up on our patients. We keep working until we pinpoint the underlying causes of your back pain and resolve them.
Highest resolution ultrasonography
Elastography
Superior microvascular imaging
Extracorporeal shock wave therapy (ESWT)
Electromagnetic transduction therapy (EMTT)
C.A.R.E.N (computer assisted rehab environment)
Surface electromyography (SEMG)
3D gait analysis and retraining
Biomechanical analysis and retraining
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.
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.
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
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
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 the body in ways they are intended to move. A regular walking routine can help you maintain a healthy spine while improving your cardiovascular fitness and helping to manage your weight.
Being mindful of your posture while using electronic devices and taking frequent breaks from sitting throughout the day can also help. If you play sports or are extremely active, a total body motion and gait analysis can help identify motor deficits that contribute to lower back pain.
At NYDNRehab, we never take a cookie-cutter approach to treating lower back pain. We understand that every patient and every condition is unique, and deserves personalized care and attention. Our goal is to identify the source of your pain and dysfunction and correct it, so you can once again enjoy pain-free fluid movement.
Using our superior diagnostic tools, we are able to look beneath the surface and observe your structures in motion, in real time, to discover any and all contributing factors to lower back pain. We then design a personalized treatment protocol, backed by data, to restore pain-free functional movement.
Traditional approaches to back pain treatment often involve pain medications, muscle relaxants, steroid injections, and admonishments to “take it easy.” When those methods fail to alleviate pain and dysfunction, surgery is often the next step. However, research shows that conservative care is at least as effective as surgery, without the risk and expense of unnecessary invasive procedures.
At NYDNRehab, we work with you to resolve the underlying causes of lower back pain. Our personalized one-on-one approach ensures that you get the very best treatment for your unique condition. If you are ready to eliminate lower back pain for good, schedule a consultation with our lower back pain specialists today, and get back to doing the things you love, pain-free!
Clinical director & DC RMSK
HyunJu
YOO, PT, MPT, DPT, CPI (Licensed Physical Therapist)
Dr. Christina Pekar
DC
Dr. Michelle Agyakwah
DC
Mariam Kodsy
Physical Therapist
Below is a prime example of how ultrasound can take the guesswork out of diagnosis.
A bad physical therapy experience is one of the primary causes of unnecessary surgery
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
