Dr. Lev Kalika is clinical director of NYDNRehab, located in Manhattan. Lev Kalika is the author of multiple medical publications and research, and an international expert in the field 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.
Nowadays there is significant increase in the amount of patients with neck pain. Clinical experience and scientific data shows that this recent increase is due to excessive usage of hand held devices, computers, excessive sitting and increased amounts of stress.
Many patients complain of the pain in the shoulder area where in fact what they are experiencing is lower neck pain. Muscles and joints of the lower neck are also known to refer pain into mid back or between the shoulder blades. Myofascial involvement occasionally may refer pain into the arm, elbow or even as far as the hand. The herniated disc in the cervical spine which compresses the nerve root will produce pain, numbness and tingling down the arm and into the hand. Although disc bulges, protrusions and herniations in the cervical spine are not uncommon, majority of people suffer from myofascial pain when it comes to the neck pain. The most consisted characteristic of the myofascial pain in the neck is that of the pain changing location.
Bringing together the reported data from different studies, we can claim that pain in the neck has increased by 10.4% and 21.3% in the past five years. Prevalence in general population is higher in women compered to man, however a high peak of this type of pain is observed in sitting-workers of both genders.
The cervical spine consists of seven vertebras interconnected by the discs, spinal joins and the ligaments. The top of the cervical spine is connected to the cranium (head) through intricate anatomically designed cranio-cervical junction. The muscle of the neck connect many anatomical areas together. In order to fulfill many different neuromuscular functions for mobility, stability and connection of the central nervous system to the neck the muscular and fascial system are anatomically very complex in this area of the body. The neck muscles serve as connectors for integration of very precise mobility necessary not only for movement but for integration of: vision, hearing, balance and breathing.
Reasons for neck pain may vary from many disorders of different tissues within shoulder girdle and cervical spine. Here are some of the causes:
The protruded, bulged or herniated disc in the cervical spine are not uncommon however most of them go away with proper conservative care in a relatively short time. Surgery is rarely necessary. However when its warranted the healing is much faster and reoperations are very rare.
Neck arthritis is not uncommon. It causes limitation in the movement of the neck and pain. However in the hands of experienced physical therapist or a chiropractor the pain can be eliminated and enough of the lost movement can be restored in order for the symptoms to subside.
The cervico-cranial syndrome is characterized by the neck pain at the junction with the skull, headaches, occasional dizziness and blurry vision. Sometimes patient may have concomitant pain in the jaw. Depending on the symptom presentation this syndrome may be called as orofacial pain or TMJ (temporo-mandibular joint) pain syndrome. Irregardless of the name the etiology of this syndrome is within the musculoskeletal system and not the problem in the mouth or the nervous system.
Pain in the cervical spine may be a symptom of more serious problems like degenerative disc disease, herniated disc, or a pinched nerve. Cervical facet joints are rare source of pain. Most of the pain experienced in the cervical spine outside disc disease is of myofascial character. In the absence of perpetuating factors myofascial pain responds well to variety of different manual therapies in combination with rehabilitative exercises , acupuncture and extracorporeal shockwave therapy.
Preventive treatment for reducing the risks of this type of pain should include ergonomic work space arrangement, gentle stretching, postural exercises, Pilates specific neck and breathing exercises.
Neck pain treatment should address all functionally interrelated body segments such as: whole upper extremity, shoulder girdle, rib cage, cervical spine, and even skull and TMJ. Movement dysfunction in any above described areas could affect biomechanics of the cervical spine through kinetic interlinking of muscular chains. Sitting postures, lifting, prehension, breathing as well as ergonomic conditions must be examined and addressed. The use of hand held devises must be minimized for the time of symptom duration because hand held devices perpetuate abnormal movement stereotypes affecting the upper quarter. Patient is recommended to take short breaks with performance of brief remedial postural exercises for reduction of strain to the neck imposed by desk and computer work.
At Dr. Kalika’s clinic neck pain treatment is conducted by a combination of DNS (dynamic neuromuscular stabilization) therapy, clinical Pilates, variety of manual myofascial and neuromuscular methods, acupuncture, extracorporeal shockwave therapy which concurrently address all interrelated tissues as well as motor control of the upper quarter of the human body. Home exercise program based on movement impairment examination is also very effective component of successful and long lasting relief.
and a faulty diagnosis can make treatment a total waste of time.
Failure to accurately diagnose a condition in its early stages can lead
to chronic problems and sometimes devastating results.
Diagnostic musculoskeletal sonography (MSUS) provides the perfect tool for the rehab practitioner. Yet many doctors and physical therapists have no experience with MSUS, are unaware of its advantages, and have no idea how to use it as a diagnostic tool.
Below is a prime example of how ultrasound can take the guesswork out of diagnosis.Successful Treatment
A bad physical therapy experience is one of the primary causes of unnecessary surgery.
We have equipped our clinic with the latest research-grade technology to arrive at objective and accurate diagnoses, and to objectively measure our patients’ progress.
Most importantly, we are the only facility in the US where structural medical diagnosis is reflected in functional treatment, and vice versa.
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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