SCIATICA SPECIALIST

ABOUT SCIATIC NERVE PAIN

The sciatic nerve is the largest nerve in the human body, with its roots emerging from the lower spinal vertebrae L4 to S3, and merging to form a single nerve that runs down the leg, all the way to your feet. While sciatic nerve pain is most commonly felt on one side of your lower back, compression or entrapment of the sciatic nerve can cause pain, numbness and tingling anywhere along its path. Chronic sciatic nerve pain is not normal, and it can be completely eliminated with sciatica physical therapy.

Sciatic nerve pain can originate at the nerve roots in the lower spine, but the nerve often becomes compressed or entrapped in the subgluteal space – a condition called subgluteal space syndrome. It was previously thought that the main site of non-spinal sciatic nerve entrapment was at the space where the nerve passes near or through an enlarged or inflamed piriformis muscle. But thanks to advancements in high-resolution ultrasonography and MRI neurography, we now know that sciatic nerve compression can occur at multiple locations within the subgluteal space. High-resolution ultrasound allows us to visualize dynamic nerve compression with remarkable clarity. While MRI may offer some advantages in larger patients, ultrasound provides detailed images of nerve compressions as they happen. It allows us to consider anatomical nuances when identifying specific areas of compression and other related factors.

The three most common sites of subgluteal compression are:
The space where the nerve passes near or through an enlarged or inflamed piriformis muscle
At the junction of the sacroiliac joint and superior gluteal nerve
At the gemellus-obturator internus complex, where the sciatic nerve is dynamically entrapped

High resolution ultrasound allows us to trace the path of the sciatic nerve from its roots to the distal thigh. It is the ideal imaging tool for visualizing sacroiliac ligaments, and it provides guidance for local injections of anesthetics or cortisone.

The NYDNRehab clinic is equipped with the most advanced diagnostic tools available. Our expertise and vast array of treatment options make us well-equipped to tackle the complex nature of sciatica .

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Dr. Lev Kalika

Clinical director & DC RMSK

About Sciatica Specialist Dr. Lev Kalika

NYDNRehab clinical director Dr. Lev Kalika has devoted his life’s work to finding new and innovative ways to relieve human pain and dysfunction. Dr. Kalika has developed his own approach to treating sciatica via targeted release and regeneration of the sciatic nerve, using ultrasound guidance. Dr. Kalika’s approach combines:

Focused and radial shockwave therapy
Ultrasound guided percutaneous neuromodulation
Extracorporeal magnetic wave therapy to decrease inflammation
Nerve ultrasonography using the highest resolution ultrasound equipment, with matrix sensors that visualize the nerves of the hip

Dr. Kalika’s expertise in musculoskeletal ultrasonography and ultrasound guided dry needling make him a best-rated doctor for sciatica treatment in NYC. The NYDNRehab clinic is one of the best-equipped private rehabilitation clinics in the world, featuring cutting edge regenerative technologies and therapies that revolutionize the way sciatica is treated and resolved.

Why Physical Therapy Alone May Not Resolve Your Condition

Physical therapy is a valuable and effective approach to resolving musculoskeletal pain and dysfunction, but in many cases, physical therapy does not provide a stand-alone solution. Prior to beginning physical therapy, patients often need to address underlying issues that contribute to their pain and disability.

Unfortunately, mainstream physical therapy clinics are often not adequately equipped or experienced to identify and treat complications that undermine the effectiveness of physical therapy. They often rely on one-size-fits-all treatment protocols that overlook the unique characteristics of the individual condition, opting to treat the symptoms and not the patient.

Issues that should be addressed prior to beginning physical therapy include:

Scar tissue and fascia adhesions
Neurogenic inflammation
Joint edema
Inflamed soft tissues

Myofascial trigger points
Compressed or entrapped nerves
Tendons that have degenerated and lost their elastic properties
Compensation patterns developed post-injury

Holistic Non-Invasive Diagnosis and Regenerative Therapy

Identifying and treating underlying issues prior to beginning physical therapy is key to getting fast and effective results. Failure to do so can completely undermine your treatment protocol, and in some cases, your condition may even worsen. At NYDNRehab, we use a broad range of advanced technologies and innovative therapeutic approaches to resolve issues that can potentially undermine the success of physical therapy. Our talented staff is certified in a diverse array of treatment methodologies, rarely found in run-of-the-mill physical therapy clinics. Our one-on-one sessions are personalized, based on the patient’s unique diagnostic profile.

Obstacles to physical therapy success include:

Scar tissue and fascia adhesions
Neurogenic inflammation
Joint edema
Inflamed soft tissues
Myofascial trigger points
Compressed or entrapped nerves
Tendons that have degenerated and lost their elastic properties
Compensation patterns developed post-injury

Sciatica Treatment at NYDNRehab is
Unparalleled in NYC

Due to the length of its pathway as it glides among the body’s structures, the sciatic nerve can be irritated by a broad range of mechanisms. Conventional medical practitioners are trained to treat the locus of pain, often managing sciatica with drugs and surgery, without diving deep into its underlying causes. Even chiropractors and physical therapists often take a cookie cutter approach to sciatica treatment, despite vast differences in patient profiles.

The sciatica specialists at NYDNRehab know that human anatomy varies immensely from one patient to the next, and that sciatica can have multiple causes that require specific treatment approaches. We never take a one-size-fits-all approach to patient care. Our one-on-one personalized treatment protocols are based on each patient’s specific diagnostic results, ensuring successful treatment that eradicates sciatic nerve pain.

Sciatica Symptoms, Causes and
Risk Factors

Symptoms

Low back pain on one side of your spine
Pain and tingling in the buttocks, legs or feet
Pain that gets worse during physical activity
Numbness in the lower extremities
Loss of bowel or bladder control
Reduced range of motion in the lumbopelvic region

Causes

Poor static and dynamic posture
Repetitive overuse from occupation, sports or exercise
Weak core and pelvic musculatur
Degeneration of the lower vertebrae
Poor lifting technique
Sciatic nerve compression or entrapment

Risk Factors

Sedentary lifestyle
Being overweight or obese
Excessive sitting for extending periods
Occupations that require driving or lifting
Pregnancy
Smoking cigarettes

Our Advanced Diagnostic Capabilities Ensure Successful Sciatica Treatment

During your preliminary exam, we will ask about your symptoms and health history, but it doesn’t stop there. We use the highest resolution diagnostic ultrasonography to visualize the sciatic nerve in motion along its entire length, in real time. This allows us to pinpoint the exact location and mechanism by which the sciatic nerve is impinged or entrapped. Once we fully understand the precise mechanisms underlying your sciatic nerve pain, we design a personalized treatment plan, to restore uninhibited gliding of the sciatic nerve and initiate the healing process.

Our Sciatica Treatment Toolbox

The sciatica specialists at NYDNRehab have diverse skills and expertise for treating sciatica. Our large inventory of advanced technologies and innovative treatment options give us all the tools we need to ensure that every patient gets the personalized care they deserve to eliminate sciatic nerve pain. Depending on your unique needs, your treatment plan may include a combination of some or all of the following treatment options:

Chiropractic care that may include spinal manipulation
Postural correction therapy to realign your spine
Physical therapy exercises to strengthen your core and pelvic muscles
Extracorporeal magneto transduction therapy (EMTT) to relieve pain and inflammation
Extracorporeal shock wave therapy (ESWT) to stimulate healing at the cellular level
Dynamic neuromuscular stabilization (DNS) to restore optimal movement patterns
Ultrasound guided dry needling to release myofascial trigger points
Patient education to prevent future bouts of sciatica

We Use Regenerative Therapies
to Accelerate Healing

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 Shockwave Therapy

Focused Extracorporeal Shock Wave Therapy (ESWT)

Focused ESWT is 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.

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 to trigger a regenerative response. EMTT waves can penetrate deep tissues, to target difficult-to-reach tendons, muscles, bones and nerves.

Electromagnetic Transduction Therapy (EMTT)

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, 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.

HIGH ENERGY INDUCTIVE THERAPY (HEIT)

NESA Neuromodulation Therapy

The NESA device generates an algorithm that delivers a biphasic low-frequency electrical current via semi-electrodes attached to the hands and feet. It emits a series of intermittent and cyclical stimuli that travel through autonomic neural pathways, restoring optimal neural signaling to the brain.

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 Injection
Therapies

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.

Ultrasound Guided Dry Needling

Myofascial trigger points often contribute to sciatic nerve pain. Dry needling is an outpatient procedure where non-medicated needles are inserted into trigger points 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 Shock Waves for
Nerve Entrapments

When guided by high resolution ultrasound imaging, focused extracorporeal shockwave therapy (ESWT) is an evidence-based therapeutic approach to treating nerve entrapments, peripheral neuropathy and neuralgia.

Dr. Kalika is an expert in neural ultrasonography and extracorporeal shockwave therapy. The clinic at NYDNRehab features the highest-resolution research-grade ultrasound equipment currently available.

Ultrasound guided ESWT provokes the following effects in neural tissue:

Improved axonal transport
Provokes axonal regeneration
Promotes reinnervation
Limits and slows muscle atrophy associated with peripheral neuropathy
Accelerates remyelination
Modulates neurogenic inflammation
Improves intraneural vascularisation

The effects of ESWT are achieved via the following mechanisms:

Stem cell proliferation
Mediation of Schwann cell function
Endothelial cell recruitment/migration
Regulation of pro- and anti-inflammatory cytokines
Voltage-gated sodium channel blocking

Get Personalized Sciatica Physical Therapy in NYC that Really Works!

If you are tired of taking dangerous drugs and getting the runaround from doctors who fail to resolve your sciatic nerve pain, it’s time to take charge of your own health. The sciatica specialists at NYDNRehab never stop until they get to the root cause of your sciatic nerve pain and resolve it, without drugs or surgery.

At NYDNRehab, our personalized one-on-one sciatica treatment approach uses cutting edge technologies and advanced physical therapy and regenerative medicine that really works. We help you eliminate sciatica pain for good, so you can enjoy the very best quality of life with pain-free mobility. Contact NYDNRehab today!

Our Awards

Clinical Case Studies
NYDNRehab

Case Study: Resolving Chronic Sit Bone Pain in a Female Runner

Our Patient Our patient is a 45 year-old female runner complaining of left sit bone pain when running and sitting. She has a history of proximal hamstring tendinopathy, and had been treated with plasma injections about 5 years prior, along with physical therapy. Her pain was initially resolved by the injections, and she continued 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: 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: 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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Case Study: Ultrasound Reveals Sciatic Neuropathy and Life-Threatening Peripheral Vascular Disease

Our Patient Our patient is a 62-year-old female complaining of leg pain, calf and foot muscle weakness, and sensations of numbness in her lower extremities. Our Diagnostic Approach Our initial clinical exam indicated neuropathy, which we confirmed with multiple EMG tests. We followed up with an examination by high-resolution diagnostic ultrasonography. Our ultrasound exam of […]

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Case Study: Hamstring and SI Joint Dysfunction in Female Runner

Our Patient Our patient is a 52 year-old female runner who came to us after unsuccessful treatment elsewhere, complaining of mild low back pain shooting down her right leg. She explained that she had never had low back pain before, and that her locus of pain was slightly lower than her lumbar spine and closer […]

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SCIATICA SPECIALIST

ABOUT SCIATIC NERVE PAIN

About Sciatica Specialist Dr. Lev Kalika

Why Physical Therapy Alone May Not Resolve Your Condition

Issues that should be addressed prior to beginning physical therapy include:

Holistic Non-Invasive Diagnosis and Regenerative Therapy

Obstacles to physical therapy success include:

Sciatica Treatment at NYDNRehab is
Unparalleled in NYC