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Knee Meniscus Rehabilitation

About Knee Meniscus Injuries

Each of your knees has two menisci – horseshoe-shaped spongy disks made of fibrocartilage that work like shock absorbers between the femur and tibia bones. The menisci can become torn or ruptured from trauma, or from everyday wear and tear over time, and even a small meniscus tear can be painful, making it difficult to walk. Traumatic meniscus tears are common in high intensity sports, especially contact sports like rugby and football. Degenerative tears are common among middle aged and older adults, especially those with sedentary lifestyles.

Up to 98% of meniscus tears can be successfully treated with conservative care and do not require surgical intervention. In fact, meniscus surgery has been shown to increase the risk of knee osteoarthritis later in life. Moreover, research confirms that patients who undergo surgical repair fare no better than patients treated with physical therapy alone.

Surgery may be necessary in cases of unstable tears that produce knee locking or catching, but a partial meniscectomy (removal of meniscus tissue) should be avoided and only considered as a last resort, as it can reduce knee stability and produce early-onset osteoarthritis.

Rehabilitative physical therapy at NYDNRehab is custom-designed to accelerate meniscus healing and help to prevent recurring meniscus injuries.

Click here to learn about the different types of meniscus tears…

We’re located on 25th street in Manhattan NYC.
Open Monday-Friday, 10am-8pm.

What are Dr. Kalika's credentials for knee rehabilitation? How are meniscus tears diagnosed? What is tensegrity, and how does it affect knee function? Will I start physical therapy right away? What are orthobiologic procedures, and how do they help knee rehab? What regenerative technologies are available at NYDNRehab? What are the symptoms, causes and risk factors of meniscus tears? What will my physical therapy plan include? How can I prevent knee meniscus injuries? Meniscus rehab FAQs

Meniscus Tear Types

Meniscus tissue is categorized by its relative vascularity. The meniscus “red zone” encompasses the outer edge that has a rich blood supply, making it faster to heal. The inner portion of the meniscus is the”white zone,” with low vascularity and minimal blood supply, making it slow to heal. Regenerative therapies are particularly effective for stimulating and accelerating meniscus healing in the white zone.

There are 6 main types of meniscus tears:

Horizontal (longitudinal) tears run up and down or front-to-back. They tend to be at least partially in the red zone, and are more likely to self-heal.
Radial (transverse) tears are the most common type. They run left-to-right across the meniscus and are commonly in the white zone, making them slow to heal.
Intrasubstance tears are incomplete degenerative tears in the midportion of the meniscus. They are more common after age 30.
Bucket-handle tears get their name from the meniscus being torn and flipped over like a bucket handle.
Flap tears occur when a small piece of the meniscus is torn and flipped over. They can cause knee-catching or alter the motion of the knee..
Complex tears are a combination of different types of tears in multiple areas of the meniscus, making them difficult to heal.

Dr. Lev Kalika

Clinical director & DC RMSK

Dr. Kalika and Dr. Brozgol: The Orthobiologic Team at NYDNRehab

Dr. Kalika has revolutionized knee pain treatment by introducing high resolution diagnostic ultrasonography for structural diagnosis, combined with gait and motion analysis technology to visualize and objectify the functional movement of the knees and lower extremities. We conduct an on-site diagnostic ultrasound exam on your first visit.

Dr. Kalika is a recognized expert in diagnostic ultrasonography, with over two decades of experience and multiple research publications to his credit. He has developed his own proprietary methodology for repairing and rehabilitating meniscus tears without surgery. His treatment approach leverages regenerative technologies and targeted physical therapy based on the patient’s gait analysis results.

For orthobiologic procedures like Prolotherapy and PRP, Dr. Kalika teams up with Dr. Uri Brozgol, an experienced neurologist and orthobiologic injection specialist. Their combined expertise ensures that patients get the most accurate and effective treatment possible.

The motion and gait analysis lab at NYDNRehab features research-grade technologies that are rarely found in private physical therapy clinics.

Accurate Diagnosis is Essential to Successful Meniscus Treatment

Traumatic knee injuries often involve multiple tissue types, and meniscus tears can be easily overlooked when other structures are damaged. At NYDNRehab, we use high-resolution diagnostic ultrasound to dynamically visualize the structures of the knee in real time, ensuring that nothing is missed.

Early detection of a meniscus tear with high resolution ultrasound can dramatically reduce the need for surgery. Research shows that diagnostic ultrasonography conducted by an experienced professional is as accurate as MRI in identifying dynamic meniscus extrusion, where the meniscus moves out of its normal position during knee flexion, altering knee mechanics.

For the patient, on-site ultrasound imaging offers multiple advantages over MRI:

Convenient in-office imaging takes place on your first visit
No exposure to harmful radiation
Become an active stakeholder in the diagnostic process
Significantly less expensive than MRI
Ability to compare the left and right knees in the same session
Immediate diagnostic interpretation – no waiting for lab results

3D Gait and Motion Analysis
Helps Us See the Big Picture

We use sophisticated 3D gait and motion analysis technology to identify sub-optimal gait mechanics and inefficient movement patterns that contribute to knee pain. Our high-tech motion and gait analysis lab features some of the most advanced technologies available for quantifying knee mechanics. Systems like ForceFrame and Kineo Intelligent Load equip us to objectively and accurately measure knee strength and range of motion.

Our rigorous diagnostic process involves:

Testing for functional knee movement and regional interdependence

Evaluating biotensegrity by looking for fascial tears and fraying, and examining the integrity of fascial connections affecting the knee

Clinical exam for hidden nerve entrapments (pinched nerves) and exploring neural dynamics using high resolution ultrasound

Examining muscle mechanics with dynamic ultrasound

Manual exam to detect fascial densifications, followed by ultrasound to identify adhesions and trigger points

3D motion analysis

3D walking/running gait analysis

Comprehensive imaging evaluation with high resolution ultrasound

After visualizing the knee in motion and gathering quantitative data about knee biomechanics, we are able to establish a baseline to measure your progress. Once we pinpoint the exact cause of your knee pain, we customize the most effective treatment plan, based on your unique profile.

Examining muscle mechanics
with dynamic ultrasound

3D motion analysis

3D walking/running gait analysis

Tensegrity is the Secret to Pain-Free Mobility

Most people take everyday mobility for granted until an injury occurs or pain sets in. Sometimes pain and reduced mobility seem to arise out of nowhere, with no apparent cause. When it comes to knee stability, tensegrity plays a key role.

Tensegrity refers to tensile integrity – a state where individual structures are held in place by elastic tension generated by the myofascial system. The myofascia is a network of muscles and fascia that work together to produce, control, and guide forces, and to hold the body’s various organs and structures in place during movement.

When myofascial tissues are injured or damaged, tensegrity can be disrupted, altering muscle coordination patterns and inhibiting the gliding capabilities of nerves and blood vessels.

Factors that disrupt myofascial tensegrity include:

Traumatic injury that affects multiple tissue types
Overuse injuries from sports, exercise or occupation
Old injuries that were never properly rehabilitated
Sedentary lifestyle with excessive sitting
Obesity that overloads the body’s structures
Inadequate hydration that depletes soft tissues of necessary fluids
Tissue glycation due to high blood sugar that makes the myofascia dense and sticky

Most medical doctors do not understand the crucial role of the myofascial system in pain syndromes and movement disorders. They are trained to treat musculoskeletal pain symptoms with medications, without considering their root cause.

At NYDNRehab, we understand that the body’s systems work together as an integrated whole, and that treating pain is not enough to eliminate its source. We use dynamic high-resolution ultrasound to explore the myofascial system in real time. Ultrasound imaging lets us visualize muscles, fascia, nerves and other structures in motion, to identify places where tensegrity has been disrupted. Once we identify the problem, we use the most advanced therapeutic approaches to restore tensegrity and promote tissue healing.

Why Physical Therapy Alone is Not Enough
to Resolve Meniscus Tears

Identifying and treating underlying issues prior to beginning physical therapy is key to getting fast and effective results. Failure to pre-treat your tissues can completely undermine your treatment protocol, and in some cases, your condition may even worsen.

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

At NYDNRehab, we use a broad range of regenerative technologies and integrative therapeutic approaches to resolve issues that can stand in the way of successful physical therapy. Our staff is certified in a diverse array of holistic methodologies, and our one-on-one therapy sessions are personalized, based on your unique diagnostic profile.

Once we pre-treat your damaged tissues and eliminate compensation patterns, your body will be ready to begin physical therapy.

We Guide Our Needling and Orthobiologic
Procedures with High-Resolution Ultrasound Imaging

Injection therapies use orthobiologic or neutral solutions that stimulate cellular repair by either nourishing or irritating the targeted cells. Dr. Kalika teams up with an orthobiologic injection specialist, guiding needling procedures by ultrasound to ensure 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, 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 meniscus healing.

Alpha-2-Macroglobulin (A2M)

Alpha 2 macroglobulin (A2M) is a naturally occurring blood plasma protein that acts as a carrier for numerous proteins and growth factors. As a protease inhibitor, A2M reduces inflammation in arthritic joints and helps to deactivate a variety of proteinases that contribute to cartilage degradation.

Prolotherapy

Prolotherapy uses a biologically neutral solution to irritate stubborn tissues, triggering the body’s innate healing mechanisms to grow new normal tendon, ligament and muscle fibers. Prolotherapy has been shown to repair and replenish eroded knee cartilage.

Interfascial Plane and Nerve Hydrodissection

Knee injuries often involve fascial tissue that has become densified and/or formed adhesions, entrapping nerves and blood vessels, causing pain and restricting movement. During the hydrodissection procedure, a saline solution is injected into densified fascia under ultrasound guidance. The solution works by separating fascial layers and freeing up entrapped nerves and blood vessels. We often use hydrodissection in conjunction with manual fascial manipulation.

Our Regenerative Technologies Accelerate Healing

The human body has its own innate healing mechanisms, but stubborn tissues like the knee meniscus sometimes need 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.

Regenerative Therapies At NYDNRehab

SoftWave Electro-Hydraulic Shockwave Therapy

SoftWave is a regenerative mechanotransduction technology that delivers high-speed soundwaves to damaged tissues. SoftWave’s defocused and linear focused shockwaves recruit maximum stem cells to the treatment site to promote healing. According to recent research, SoftWave’s defocused waves combined with focused and radial shockwaves have maximum regenerative potential.

Myofascial Acoustic Compression Therapy (MyACT)

MyACT is a new type of focused shockwave technology that allows for deeper compression of the focused waves. Its higher frequency allows for precise neuro modulation under ultrasound guidance, with a special linear head for treating myofascial pain. MyACT transforms the mechanical energy of shockwaves into biochemical signals that precisely target damaged tissues. Most injuries involve more than one tissue type. When used together, our advanced shockwave technologies enable us to specifically target multiple tissue types in the same session.

Myofascial Acoustic Compression Therapy (MyACT)

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 transmits high energy magnetic pulses to targeted tissues that synchronize with the body’s own magnetic fields, triggering a regenerative response. EMTT waves can penetrate deep tissues to target difficult-to-reach tendons, muscles, bones and nerves.

Extracorporeal Magnetic Transduction Therapy (EMTT)

Extracorporeal Pulse Activation Technology (EPAT)

EPAT, sometimes called defocused shock wave therapy, is not a true shockwave. It uses mechanical pressure waves to enhance blood circulation, improving oxygen and nutrient delivery to muscle and fascia tissues. EPAT has minimal regenerative properties, but it can be especially effective when used in combination with focused shockwaves during fascial manipulation.

High Energy Inductive Therapy (HEIT)

HEIT delivers high-intensity magnetic pulses to peripheral nerve tissues, to stimulate neuroplasticity. We leverage this FDA-approved methodology to treat pain and regenerate nerve fibers, for enhanced motor control.

High Energy Inductive Therapy (HEIT)

INDIBA Radiofrequency Therapy

INDIBA is a form of TECAR therapy that helps to restore the ionic charge of damaged cells, for faster injury healing and rehabilitation. We use INDIBA in conjunction with other regenerative technologies.

NESA Neuromodulation Therapy

NESA generates a low-frequency electrical current that soothes hypersensitized nerves and restores optimal signaling between the autonomic nervous system and the brain. We leverage this FDA-approved methodology to treat pain and regenerate nerve fibers, to enhance motor control.

NESA Neuromodulation Therapy

Click here to learn about regenerative technologies at NYDNRehab…

More Advanced Therapies at NYDNRehab

SM Neuromuscular Electrical Stimulation (SMNMES)

SM neuromuscular electrical stimulation (NMES) dynamically interacts with the patient during therapeutic exercises, providing real-time sensory, auditory and visual biofeedback to the patient. This breakthrough technology helps patients to recalibrate muscle actions, to optimize joint function. SMNMES has helped numerous patients to avoid unnecessary shoulder, knee and ankle surgeries, even in complex scenarios.

Ultrasound Guided Percutaneous Neuromodulation (PENS)

During PENS treatment, filament-thin needles are inserted through the skin into muscle tissue adjacent to the targeted nerve. A low frequency electrical current is then delivered via the inserted needles to stimulate the dysfunctional nerve. PENS normalizes nerve activity, improves brain plasticity and optimizes muscle recruitment patterns. This therapy is so effective that patients typically need only 4-6 treatment sessions.

Meniscus Tears Symptoms, Causes and Risk Factors

Symptoms

Mild to severe knee pain
A stiff and swollen knee joint
A knee that locks out or hitches
Snapping or popping sounds or sensations
Reduced knee range of motion

Causes

Trauma during sports or exercise
Sedentary lifestyle
Knee osteoarthritis
Certain medications
Overweight and obesity

Risk Factors

Participation in high intensity contact sports
Occupations that require kneeling or climbing
Poor nutrition/hydration
Taking medications that promote inflammation
Muscle weakness and limited range of motion

Get One-on-One Physical Therapy, Designed Just for You

At NYDNRehab, we treat the whole patient, not just your symptoms. We never use one-size-fits-all rehab protocols or antiquated recovery timelines. We believe that every injury is unique, and treatment should be based on a holistic approach that factors in the patient’s unique profile.

Once we have successfully pre-treated damaged tissues, we can begin one-on-one physical therapy to restore strength and stability, optimize mobility, and re-establish optimal neuromuscular pathways and muscle coordination patterns.

Your physical therapy protocol may include a combination of the following approaches:

Stecco fascial manipulation, to eliminate densifications and adhesions, and restore fascia’s gliding properties
Postural restoration therapy to optimize total-body joint alignment
Dynamic neuromuscular stabilization (DNS) to recalibrate developmental motor strategies
Integrated systems model (ISM) to optimize function and performance
Anatomy in motion (AIM) to enhance movement quality
Neurodynamics, to restore communication pathways between the brain and body
Conventional eccentric loading and strengthening exercises

Your back-to-sports physical therapy protocol may include sport-specific training to optimize motor skills and restore peak athletic performance. We carefully monitor patient progress with ultrasound imaging to confirm complete recovery before releasing athletes back to the playing field.

Preventing Meniscus Tears

Athletes can avoid meniscus tears by training for both strength and flexibility, staying hydrated, and regularly analyzing and correcting mechanical skills execution. Older adults can avoid knee problems in general by staying hydrated, eating a whole foods diet and remaining physically active. Weight management reduces load on the knees and lowers wear-and-tear of the knees’ structures.

Certain medications like statins, estrogen drugs, antidepressants, osteoporosis medicines and blood pressure drugs can affect the quality and performance of muscle, fascia and connective tissues. Making healthy lifestyle choices on a daily basis can steer you away from harmful prescription medications that can damage your joints and increase your risk of injury.

A nutrient-dense, protein-rich diet that promotes collagen production and muscle growth can help to maintain the integrity of the knee joints. Steer clear of sugar, refined carbohydrates and seed oils, all of which contribute to joint inflammation that can set you up for knee injuries and osteoarthritis.

Get the Most Advanced Knee Meniscus Rehab in NYC

If you are experiencing knee pain and suspect you have a torn meniscus, you should not delay seeking help. Early treatment can prevent your meniscus tear from getting worse and reduce your risk of needing surgery.

The knee pain specialists at NYDNRehab have 20+ years of experience in meniscus tear diagnosis and treatment, with a stellar track record of success. We will design a personalized knee meniscus rehab plan that keeps you moving toward your goal. We measure your progress every step of the way, to ensure your therapy delivers effective results.

Don’t settle for mediocre knee pain treatment that fails to restore pain-free functional movement. Contact NYDNRehab today, and get the best knee meniscus rehabilitation in NYC.

Our Awards

Range of Available Unique Physical Therapy
Treatments at Nydnrehab

How can I tell if I have a torn meniscus?

Be on the lookout for symptoms like knee pain, swelling, catching or locking, and popping sensations. You may have difficulty fully extending your knee, and your knee may give way when you try to stand. If you suspect you have a torn meniscus, seek early treatment from a holistic practitioner.

Can I walk with a torn meniscus?

You may be able to walk and do other weight-bearing activities with a torn meniscus, but doing so can make it worse. Avoid activities like pivoting and twisting on a loaded knee, and activities requiring fast directional changes. If your knee becomes stiff and swollen, seek professional attention. It is always best to err on the side of caution.

Can I heal my meniscus tear on my own?

Small minor tears, especially in the red zone, may heal on their own. However, it is impossible to detect a meniscus tear or know its size or severity without dynamic imaging. Early treatment is more likely to render positive results – don’t wait to seek professional help.

When is surgery for a meniscus tear absolutely necessary?

Meniscus surgery may be necessary if the tear is severe and other approaches have failed. Surgery may be recommended for tears that cause the knee to catch or lock, and a complex tear may require surgical repair. Meniscus surgery is most successful in patients under age 40.

What can make a meniscus tear worse?

In the early stages of a meniscus tear, avoid movements that can worsen the tear. Actions like squatting and pivoting can overload the knee and make it worse. Early regenerative treatment followed by progressive physical therapy exercises is the best approach to restore knee stability and pain-free mobility.

Certificates and Continuing Education

Research at NYDNRehab

February, 2024Single-Dose Radial Extracorporeal Shock Wave Therapy Modulates Inflammation During Meniscal Tear Healing in the Avascular Zone

Physical therapy and rehab can be time consuming,

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.

Learn more »

Accurate Diagnosis Is the ONLY way to

Successful Treatment

A bad physical therapy experience is one of the primary causes of unnecessary surgery

At NYDNR, we believe in

medical innovation

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.