Neck Pain

About Neck Pain

We often refer to life’’s challenges as “a pain in the neck,” and for good reason. Neck pain can be a nagging annoyance that interferes with your ability to focus mentally and perform physically. Neck pain can stem from a number of causes, and treating the symptoms alone is not enough. You need to find and treat the source of your neck pain if you want to get rid of it for good.

Resolving neck pain requires a holistic approach that takes into consideration the entire functional chain of structures and tissues that govern neck alignment. Modern medicine’s reductionist approach aims to treat the locus of pain, when in fact the neck is dependent on multiple tissues and structures for biotensegrity – the interplay of tension and alignment that provides mechanical integrity.

To eliminate neck pain, we need to consider other factors such as:

At NYDNrehab we take an integrative approach to diagnosis and treatment of neck pain. Our highly specific clinical examination of multiple anatomical areas and their functional interrelationship is backed up by high resolution diagnostic ultrasonography. Ultrasound imaging lets us look at the interplay of multiple structures in much greater detail than MRI, all in a single session.

Before we begin physical therapy to restore function, we take measures to address pain and restore structural integrity.

Our pre-PT therapies include:

  • Regenerative injections of platelet rich plasma
  • Prolotherapy
  • Interfacial plane hydrodissection
  • Extracorporeal shockwave therapy
  • Magnetic transduction therap
  • Neuromodulation
  • Ultrasound guided dry needling
  • Manual fascial manipulation

Our physical therapy plans are customized, based on the patient’s unique profile. Thanks to our extensive diagnostic toolbox, we are able to gather an enormous amount of information on your first visit, so we can get started on eliminating your neck pain right away.

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Dr. Lev Kalika

Clinical director & DC RMSK

About Neck Pain Specialist Dr. Lev Kalika

Dr. Lev Kalika’s mission is to change the way common conditions like neck pain are diagnosed and treated. The neck pain specialists at NYDNRehab leverage cutting edge technologies and innovative treatment methods that are rarely found in private PT clinics. Patients with neck pain are often subjected to unnecessary surgeries or treated with pain medications, steroid injections and muscle relaxants that fail to resolve their condition. They often go from doctor to doctor without finding lasting relief for their pain and dysfunction. The neck pain specialists at NYDNRehab go beyond treating your symptoms, pulling out all the stops to get to the true source of your neck pain and correct it for good, so you can enjoy pain-free movement again.

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

Conventional neck pain treatment focuses on the locus of pain without looking at the bigger picture. But your neck does not function independently of the rest of your body, and your pain could stem from issues anywhere along your body’s kinetic chain, from soles of your feet to the top of your head. In most cases, neck pain is only a symptom, not the cause itself. Conventional neck pain treatment often includes:
  • Corticosteroid injections to reduce inflammation
  • Cervical nerve root block injections to relieve pain
  • Muscle relaxants to relieve tension
  • Narcotic pain medications
  • Ice and/or heat therapy to reduce inflammation and ease pain
  • Surgery to remove a disc that irritates a nerve root
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Neck pain often involves muscles and fascia, with multiple interconnected pain generators. For example, multiple myofascial trigger points in the trapezius muscle can lead to abnormal tension in its deep fascia, irritating the spinal roots that pierce the fascia at that level. Because each pain generator can influence others, it is difficult to pinpoint whether the pain originates from muscle, fascia or nerves.

Some doctors attempt to diagnose cervical neck pain with MRI, but that is almost always a waste of time, except in rare cases of radicular symptoms, such as numbness and tingling in the fingers. Even then, radiating radicular pain often involves the peripheral nerves, which cannot be examined with MRI. Patients often end up going from scan to scan, and from doctor to doctor, without resolving their neck pain.

For diagnosing neck pain, ultrasound is a superior imaging modality because most cervical pain is neuro myofascial in nature, and we need to image peripheral nerves, brachial plexus nerves, shoulder nerves, as well as trigger points in the neck and thoracic spine. We also need to examine fascia. Ultrasound is the only modality that allows us to examine all of those areas in a single exam while viewing the structures in motion — something that cannot be done with Xray or MRI. At NYDNRehab, we use the highest resolution ultrasound imaging to view the structures of your neck, shoulders and upper spine in real time. Your ultrasound exam takes place right in our clinic, so there’s no wait time for lab results. Treatment often commences on the same day as your ultrasound session.

When diagnosing your condition, we look at the whole person, not just the part that hurts. Only after we learn more about your activities, lifestyle, health history and other factors do we begin our diagnostic process. You may undergo ultrasound imaging, postural evaluation, gait analysis and other assessments until we pinpoint exactly what is going on. Once we get to the source of your problem, we design a custom treatment plan especially for you, based on your unique patient profile.

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.

Symptoms and Causes of Neck Pain


  • Stiff and sore neck muscles
  • Sharp pain in the neck
  • Tenderness in the neck region
  • Pain that radiates to the shoulder and arm
  • Tingling, numbness and weakness in the arm
  • Difficulty gripping objects
  • Headaches and migraines


  • Athletic injuries and trauma
  • Awkward sleeping position
  • Poor posture
  • Texting and computer use
  • Whiplash
  • Herniated or degenerative disc
  • Osteoarthritis and spinal stenosis

Risk Factors

  • Advanced age
  • Poor sleep habits
  • Excessive use of mobile devices
  • Poor sitting posture
  • Sedentary lifestyle
  • Overuse from sports and exercise
  • High-risk sports and activities
Awkward sleeping position that places short-term pressure on muscles and nerves, causing a “stiff” neck
Athletic injuries including falls, collisions and other trauma occurring while the body is in motion at rapid velocities
Postural misalignment caused by poor postural habits or physical overuse from work or sports. Poor posture anywhere along the kinetic chain, especially the upper body, can lead to neck pain.
Prolonged poor neck position from texting, talking on the phone, using a computer or other activities that put the head in a forward position
Whiplash caused from rapid deceleration or collision in a moving vehicle
Herniated disc, where a disc becomes compressed between two vertebrae
Degenerative disc disease, due to wear and tear over time
Osteoarthritis due to eroding cartilage and inflammation
Spinal stenosis, where degeneration leads to a narrowing of the spinal canal

Accurate Neck Diagnosis Means Successful Treatment

Because neck pain can originate from a number of different causes, accurate diagnosis of your condition is critical. Once the source of pain is identified, a treatment plan can be put in place to resolve it.

To diagnose your neck pain, your therapist will conduct a thorough exam that may include some or all
of the following:

Ultrasound Imaging is Foundational to Full Recovery from Neck 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.

Stecco Fascial Manipulation for Neck Pain

Fascia is a network of connective tissue that provides tensegrity — tensile integrity that mediates intrinsic and extrinsic forces and holds the body’s structures and organs in place as you move. Healthy fascia tissue is smooth, slippery and elastic, enabling muscles, nerves and blood vessels to glide without friction. Fascia’s gliding properties are due to high concentrations of hyaluronan, an important polysaccharide that acts as a lubricant.

When damaged due to injury or lifestyle factors, fascia can become densified, making it thick and sticky, and reducing its elastic properties. Sticky fascia can adhere to other structures, entrapping nerves and blood vessels, and disrupting coordinated muscle actions. It can also develop tears that cause pain, because fascia is densely embedded with proprioceptive nerve endings.

Stecco fascia manipulation is an evidence-based methodology for treating densified fascia. Stecco’s deep friction technique heats up fascia tissue and stimulates mechanical action by producing mechanical contact stress, fragmenting densified hyaluronic chains and triggering the production of new hyaluronic acid molecules. Densified or torn fascia in the neck area can be a key driver of chronic neck pain. When combined with other treatment modalities like shockwave therapy and ultrasound guided dry needling, Stecco fascial manipulation can play a major role in eliminating chronic neck pain.


Our Regenerative Therapies are Game-
Changers for Neck 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.


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

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.

Benefit from Our Innovative Non-Invasive Therapies

Surgery for neck pain should only be considered as a last resort. Most neck pain can be resolved with non-invasive conservative treatment. Your neck pain specialist will likely incorporate a combination of approaches in your customized treatment plan.

Some of the unique neck pain treatment approaches at NYDNRehab include:


Exercises for motor control of the upper quarter of the body


Range of motion exercises


Postural correction


Ergonomic workspace correction


Individualized home exercise program


Chiropractic care



More Treatment Options

Acute Neck Pain

  • Over the counter NSAID’s (non-steroidal anti-inflammatory drugs) to reduce pain and inflammation
  • Acupuncture
  • Chiropractic care
  • Ultrasound guided dry needling (UGDN)
  • Steroid Injections

Chronic Neck Pain

  • Physical therapy
  • Chiropractic care
  • EMTT (electromagnetic transduction therapy)
  • Ultrasound guided dry needling (UGDN)

Preventing Neck Pain

Staying in shape with regular exercise is the best way to prevent neck pain. You should also be aware of your posture, especially when using a computer or mobile device. Be sure to use protective gear when playing sports or engaging in high risk activities. Good sleep hygiene, including and appropriately firm mattress and pillow can help protect your neck while you sleep.

Get Personalized Neck Pain Physical Therapy Designed Just for You

At NYDNRehab, we never take a cookie-cutter approach to patient care. The symptoms of neck pain vary from one patient to the next, each with their own causative mechanisms. We thoroughly examine each patient and base our treatment solutions on your unique diagnosis. We provide one-on-one Physical Therapy, custom-designed for the individual patient.

Range of Available Unique Physical Therapy Treatments at Nydnrehab

Clinical Case Studies

Case Study: Neck and Scapular Pain with Disc Bulges

Our Patient Our patient presented with persistent neck and interscapular pain lasting more than five years, with a history of overhead sports and a prior car accident. The patient had been unsuccessfully treated elsewhere. The Challenge Pain had begun prior to the patient’s car accident. The patient had received a brachial plexus hydrodissection, which failed […]

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Case Study: Ultrasound Guided Dry Needling for Vertigo Treatment in Patient with Skull Trauma

Our Patient Our patient is a 30 year-old male with head trauma, suffering from persistent vertigo and neck pain. Prior attempts to resolve his condition had been unsuccessful, primarily due to misdiagnosis and ineffective treatments. Apparently the musculoskeletal component of vertigo had been overlooked.   Our Diagnosis Immediately recognizing the potential link between the patient’s […]

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Case Study: Neck and Shoulder Pain Diagnosis and Treatment with Ultrasound-Guided Dry Needling

Our Patient Our patient was a 46 year-old male complaining of pain in his left shoulder and neck. During the clinical exam, it was revealed that two days prior, he had received an allergy injection in his left arm for asthma. Initial Diagnosis The initial diagnosis identified myofascial trigger points in the left rotator cuff […]

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Case Study: Patient with Facial Pain and Complex Neurological Dysfunction Successfully Treated with Alternative Therapies

Our Patient Our patient, a 28 year-old male, had been suffering for over two years with unexplained facial and upper body pain. He had seen two separate neurologists and undergone MRIs of his brain and cervical spine, with no concrete diagnosis. The patient’s symptoms included: Pains in the face, anterior neck, chest and rib cage […]

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Get Neck Pain Treatment That Really Works!

Neck pain can be relentless and debilitating, interfering with your ability to enjoy life to its fullest. Pain medications and surgeries fail to get to the root cause of neck pain, they only treat the symptoms without resolving their underlying causes.

At NYDNRehab, we make it our mission to get to the source of your pain and dysfunction and correct it, so you can move freely again and enjoy life to its fullest. Contact us today and make an appointment to get rid of your pain in the neck or good.

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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.

    Research at NYDNRehab

    Conference: EFIC Congress 2019 – Pain in Europe XIAt: Valencia, Spain
    Conference: 14th European Headache Federation CongressAt: Berlin, Germany (virtual congress), June 29 – July 02, 2020

    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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