Knee Osteoarthritis

About Knee Osteoarthritis

Osteoarthritis (OA) is a term used to describe degenerative joint disease resulting from progressive loss of cartilage, the protective tissue that covers the ends of bones and allows them to glide without friction. In the later stages of knee OA, reduced lubrication from synovial fluid contributes to further degeneration of the joint. New regenerative technologies are now available to help combat knee OA by renewing eroded cartilage, to relieve pain and restore function.

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Dr. Lev Kalika
Dr. Lev Kalika

Clinical director & DC RMSK

About Knee Pain Specialist Dr. Lev Kalika

NYDNRehab clinical director Dr. Lev 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 lower extremity. In addition, new regenerative technologies, along with ultrasound guided injection therapies, are transforming the way in which we view and treat degenerative knee osteoarthritis.

Dr.Kalika’s expertise is sought by professional athletes and physically active adults across the United States.

To hear Dr. Kalika talk about knee osteoarthritis, listen to his podcast interview with AOR.US: link.

Knee OA Treatment at NYDNRehab vs Conventional Treatment

Many people, including medical professionals, view joint osteoarthritis as an inevitable consequence of aging. Yet multiple studies have proven that the true causes of joint degeneration in most people are sedentary lifestyles and obesity. In fact, one analysis revealed that the prevalence of knee osteoarthritis has more than doubled since the mid-20th century, and another peer-reviewed article debunks the notion of “wear and tear” as the underlying cause of joint OA.

Despite the growing body of research pointing to lifestyle as the primary cause of knee OA, conventional medicine is geared to managing symptoms rather than addressing their underlying source. Common treatments often involve pain killers, NSAIDs, prescription pharmaceuticals, corticosteroid injections, knee braces and abstaining from physical activity, allowing for further degeneration without hope of a cure. When all else fails, surgery may be prescribed as a last resort, with little hope of fully restoring normal mobility.

Knee OA Treatment at NYDNRehab vs Conventional Treatment
Knee OA Treatment at NYDNRehab vs Conventional Treatment Image 2

At NYDNRehab, we take a holistic and individualized approach to patient care. We go beyond treating symptoms to getting to their underlying cause, with the goal of restoring pain-free fluid movement. Our regenerative and diagnostic technologies equip us to help our patients eliminate pain and dysfunction without drugs or surgery, so you can get back to doing the things you love.

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Regenerative Therapies are Game
Changers for Knee OA

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)

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.

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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.

Focused Shockwave Therapy

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.

Electromagnetic Transduction Therapy (EMTT)
Ultrasound Guided Dry Needling

Ultrasound Guided Dry Needling

Myofascial trigger points often contribute to pain syndromes and motor dysfunction. 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.

Knee Osteoarthritis Symptoms, Causes and Risk Factors

While knee OA involves the degeneration of cartilage, it is considered to be a chronic disease of the entire joint, affecting the cartilage, meniscus, ligaments, and muscles surrounding the knee. Its debilitating nature is strongly associated with metabolic disease and premature death.

Symptoms
  • Knee stiffness and swelling, making it difficult to bend the knee
  • Increased pain and swelling after sleeping or relaxing
  • Increased pain during physical activity
  • Sensations of the knee locking or sticking
  • Knee joint creaking, popping or crackling
  • Weakness in the knees
  • Weather-sensitive joint pain
Causes
  • A pro-inflammatory diet high in sugars and chemicals
  • Lack of physical activity
  • Being overweight or obese
  • Poor sleep habits
  • Faulty gait mechanics
  • Chronic dehydration
  • Overuse from occupation, sports or exercise
Risk Factors
  • Diabetes
  • Heart disease
  • Cancer
  • Impaired ability to walk
  • Obesity
  • Sedentary lifestyle
  • Advanced age combined with other risk factors

Our Advanced Technologies mean Accurate Diagnosis and Superior Treatment Results

The knee pain specialists at NYDNRehab are experts in diagnostic musculoskeletal ultrasonography. Diagnostic ultrasound not only enables the doctor to identify the exact location where cartilage has eroded, but it allows your clinician to view your knee in motion, in real time, to assess how OA impacts your joint function. In addition, our 3D gait analysis lab lets us identify faulty gait mechanics that contribute to knee OA pain.

Armed with this information, we are able to create a personalized treatment plan for you, to relieve OA pain and put you on the path to recovery.

Our Advanced Technologies mean Accurate Diagnosis and Superior Treatment Results

Our Unique Treatment Approach to Knee OA

At NYDNRehab, we treat every patient as a unique individual, and we recognize that every condition is impacted by the patient’s lifestyle and health profile. We never use a one-size-fits-all approach to patient care. Depending on your diagnosis, your treatment plan may include a combination of some or all of the following therapies.

EMTT
EMTT

Electromagnetic Transduction Therapy (EMTT) uses electromagnetic fields to reduce pain and stimulate cellular progenesis in cartilage and meniscus tissues. It is often used in conjunction with ESWT to optimize cellular progenesis and speed healing.

ESWT
ESWT

Extracorporeal shock wave therapy (ESWT) delivers pulses of energy at near-supersonic speeds into damaged and painful tissues. Shockwave therapy promotes blood vessel formation and increases blood flow for greater oxygen and nutrient delivery. ESWT has been shown to accelerate knee tissue healing and reduce pain.

Alter-G Antigravity Treadmill
Alter-G Antigravity Treadmill

Our gravity-reducing treadmill unloads the knee joint, to enable retraining of gait patterns without placing undue stress on your knees. This approach speeds recovery by allowing gradual reloading of the knee and gradual improvement of gait patterns.

Blood Flow Restriction Training
Blood Flow Restriction Training

BFR makes it possible to rehabilitate injured tissues using much lighter loads, eliciting a regenerative response in damaged cells. BFR helps to strengthen the muscles that surround and support the knee without overloading the joint. It speeds the recovery process for faster return to pain-free activity.

DD Robotech
DD Robotech

DD Robotech (DDR) is AI-powered robotic training equipment that provides neuromuscular and neurocognitive training for patients with chronic pain and reduced mobility. DDR is based on linear force impedance robotic technology.

Physical Therapy for Knee Pain
Physical Therapy

Physical therapy exercises work to strengthen and rebalance the muscles that support the knee joint, taking pressure off of nerves and connective tissue, and realigning the joint for optimal function.

Ultrasound Guided Injection Therapies
Ultrasound Guided Injection Therapies

We sometimes use injection therapies for knee OA, to reduce pain and inflammation, and to promote the regeneration of new collagen cells. Corticosteroids, platelet rich plasma, hyaluronic acid and other injections may be used when deemed appropriate. Ultrasound guidance ensures that the injected substance reaches its target with precision and accuracy, for superior results and minimal patient discomfort.

Preventing Knee Osteoarthritis

There are a number of things you can proactively do to prevent the onset of knee OA or to halt its progression:

  • Achieve and maintain a healthy body weight.
  • Drink plenty of water to keep your joints lubricated.
  • Eat a nutrient-dense diet high in fresh vegetables, healthy fats and clean proteins, and avoid sugars, refined grains and processed foods.
  • Exercise daily. Your knees in particular were designed for walking. Add resistance training to strengthen the structures that support your knees.
  • Request a gait analysis and gait retraining, to correct faulty gait mechanics that contribute to OA.
Knee OA Treatment at NYDNRehab vs Conventional Treatment

Get Personalized Knee OA Treatment, Designed Just for You

Don’t let yourself be stereotyped by doctors who want to manage your knee OA symptoms with drugs and surgery, without trying to reverse your condition. The knee pain specialists at NYDNRehab are dedicated to resolving your knee OA and restoring fluid pain-free movement.

Our personalized one-on-one approach makes NYDNRehab the clinic of choice for knee OA in NYC. Contact us today, and get rid of debilitating knee pain so you can get back to doing the things you love.

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    Dr. Lev Kalika
    Dr. Lev Kalika

    Clinical director & DC RMSK

    Research at NYDNRehab

    An, Senbo, et al. “Extracorporeal shockwave treatment in knee osteoarthritis: therapeutic effects and possible mechanism.” Bioscience Reports 40.11 (2020): BSR20200926.
    Bagnato, Gian Luca, et al. “Pulsed electromagnetic fields in knee osteoarthritis: a double blind, placebo-controlled, randomized clinical trial.” Rheumatology 55.4 (2016): 755-762.
    Bridges, Patricia S. “Prehistoric arthritis in the Americas.” Annual Review of Anthropology 21.1 (1992): 67-91.
    Heidari, Behzad. “Knee osteoarthritis prevalence, risk factors, pathogenesis and features: Part I.” Caspian journal of internal medicine 2.2 (2011): 205.
    Wallace, Ian J., et al. “Knee osteoarthritis has doubled in prevalence since the mid-20th century.” Proceedings of the National Academy of Sciences 114.35 (2017): 9332-9336.

    Our Specialists

    HyunJu YOO, PT, MPT, DPT, CPI (Licensed Physical Therapist)
    Dr. Christina Pekar DC
    Dr. Michelle Agyakwah DC
    Dr. Mikhail Bernshteyn MD (Internist)
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    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)

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    Complete tear of rectus femoris
    with large hematoma (blood)

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    Separation of muscle ends due to tear elicited
    on dynamic sonography examination

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