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 dysfunctionBecause the spine is integrated into all human movement, faulty motor patterns anywhere along the kinetic chain can contribute to low back pain.
  • Pain generationPain 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.

Conventional vs Holistic Therapy for Herniated Discs

Conventional medical treatment for herniated discs often involves the use of anti-inflammatory medications and epidural steroid injections (ESIs) to reduce disc inflammation. However, those measures only provide short-term relief, with the effects wearing off after several weeks. Repeated steroid injections can gradually erode the joint cartilage, causing permanent damage and worsening the patient’s condition.

By contrast, addressing disc herniation with a holistic approach can net superior results by fixing the underlying factors that caused the disc to bulge in the first place. There is a large body of research that supports conservative care over medical intervention, citing similar or superior outcomes over time.

In one study of 90 patients with lumbar disc herniation, participants were treated with acupuncture, with MRI screenings of the lumbar spine after every 12 sessions to measure disc herniation sizes. The disc reabsorption rate was 100% in the study participants, without the use of steroids or anti-inflammatories.


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.

Ultrasound Imaging is Foundational to Full Recovery from Back Pain

It is common knowledge among medical practitioners – backed by extensive scientific evidence – that most back and neck pain is NOT caused by disc herniations/protrusions. Yet conventional medical treatment zeros in on the locus of pain, often treating a bulging disc with epidural steroid injections (ESIs), with the end goal of eliminating pain, enhancing functional mobility, and shrinking the protruding disc.

However, research indicates that while ESIs may provide some short-term relief, the effect is not maintained in the long run. In fact, the disc itself is rarely the primary pain generator, and even when it is (in less than 15% of cases) treatment needs to be applied to the entire lumbo-pelvic hip complex, since back pain is multifactorial and requires a holistic approach. Spinal surgeries are even less effective, with potential horrific side effects that lead to adjacent segment disease (ASD) – a condition that arises after spinal fusion surgery where degenerative changes occur in the discs and vertebrae above and below the surgery site – leading to even more surgeries.

Back pain often stems from nerve compression due
to mechanical issues such as:

Too much sitting
Physical inactivity
Poor posture
Faulty biomechanics
Old injuries anywhere
along the kinetic chain
Densified fascia

While conventional treatment may temporarily suppress back and neck pain, the pain is likely to return when normal daily activities are resumed, or when the effects of steroids wear off. Moreover, protruding discs typically self-resolve, reabsorbing the disc in a matter of several days. When pain returns, the cycle of futile treatment resumes, until surgery becomes a last resort. Meanwhile, narcotic pain medications prescribed to treat back pain can quickly cause dependency that leads to substance abuse.

Ultrasound Imaging vs MRI for Back Pain Diagnosis

When visualized with MRI, mechanical issues rarely present themselves. You may see an image of a bulging disc, but that does not tell the full story of your back pain.

By contrast, diagnostic ultrasonography resolution is up to 100X higher than MRI for visualizing superficial connective tissues. It lets us examine the body in real time, with the patient in motion, giving us a full picture of how pain-generating nerves interact with other structures, to help us identify mechanical issues that contribute to disc herniation.

High resolution diagnostic ultrasound surpasses MRI as a diagnostic tool in multiple ways:

  • Allows for a dynamic exam that lets us view the interactions of various tissues and structures.
  • We are able to examine all the core and spinal muscles in isolation, at rest, and during movement.
  • We can examine the multifidus – a key spinal stabilizer muscle – at each spinal segment to assess size, activation, trigger points, and denervation.
  • We can visualize the facet joints and their fascial attachments in motion.
  • Dynamic ultrasound lets us view the interactions of soft tissues that provide stability, tensegrity and mobility – something we cannot do with MRI.
  • We can trace the long path of the sciatic nerve to identify nerve compression.
  • We can visualize the subgluteal region to identify or rule out piriformis syndrome.
  • We can generate images of the hip, pelvis and lumbar spine, all in a single session, with no wait time for lab results.
  • With expert-class ultrasound we can examine the spinal discs to rule out disc protrusion.
  • High resolution ultrasound provides a tool for accurately guiding needling procedures, shockwave therapy and manual interventions.
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

We Use High-Tech Equipment for Optimal Results

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.

Our technological toolbox includes:

  • 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

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.


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 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.

Get Personalized Back Pain Physical Therapy, Designed Just for You

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.

Clinical Case Studies

Case Study: Misdiagnosed Low Back Pain

Our Patient Our patient is a 33 year-old female who had been suffering from low back pain for 18 years. Three years prior to visiting our clinic, she had developed severe left-sided sciatica. An MRI revealed a spinal anomaly and the patient underwent surgery for a multi-segmental spinal fusion. While the surgery initially relieved her […]

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Case Study: Postpartum Back Pain

Our Patient Our 41 year-old female patient complained of moderate to severe low back pain. She had gone through five pregnancies – two vaginal and three by C-section. Her back pain commenced about 3 months after abdominoplasty (“tummy tuck”) surgery to correct a 6 cm diastasis recti. The surgery took place 7 months prior to […]

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Case Study: Peroneal Nerve Entrapment

Our Patient Our female patient came to us after unsuccessful treatment at another clinic. She presented with painful hip snapping, leg paresthesia (tingling/numbness), low back pain, sacroiliac(SI) joint pain, and gluteal pain. She had previously been treated with epidural steroid injections, piriformis steroid injections, and hip steroid injection, without long-term results. The Challenge Navigating the […]

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Case Study: Ultrasound Guided Dry Needling for Scoliosis-Related Pain and Mobility

Our Patient Our patient is a 30 year-old male who had been diagnosed with Ehlers-Danlos syndrome – a condition characterized by joint hypermobility. The patient’s medical history included frequent fractures and chronic pain in the lower back and buttock regions. The persistent pain was significantly impacting the patient’s daily activities and overall well-being. The patient […]

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

Our Patient Our patient was a 22 year-old male presenting with low back pain, scoliosis, and external hip and foot rotation. The Challenge The patient had previously sought orthopedic consultations and underwent MRI. The suspected diagnosis was ischio-femoral impingement, a condition associated with hamstring syndrome, to which his external hip and foot rotation were attributed. […]

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Case Study: Occupational Hip and Low Back Pain

Our Patient 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. The Challenge The patient’s job did not allow ample recovery time for standard physical therapy and injury rehabilitation to provide significant […]

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Get Pain-Free Lower Back Pain Treatment That Really Works!

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!

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    Dr. Lev Kalika
    Dr. Lev Kalika

    Clinical director & DC RMSK

    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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