Peripheral Neuropathy

About Peripheral Neuropathy

Your entire body operates via a complex network of nervous tissues that extend to the farthest reaches of your extremities. Your neural network serves to deliver and receive messages via electrical impulses between the peripheral nerves and the central nervous system of the brain. Without continual nervous impulses, your body would quickly shut down

Peripheral neuropathy is any condition that causes damage or dysfunction to the peripheral nerves — neural bodies that extend beyond the spinal cord. Peripheral nerves provide sensory information about the body’s position relative to gravity, the temperature of the environment and various surfaces, and sensations of pain or discomfort. They also carry messages from the brain to muscles, to tell them when, how quickly and how forcefully to contract, along with signals that regulate metabolism, digestion, circulation and more.

When peripheral nerves become damaged or compressed, they may send faulty information to the brain, or they may misinterpret directives from the brain. The goal of peripheral neuropathy treatment is to repair damaged nerve tissues and restore healthy channels of communication between the brain and body.

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Dr. Lev Kalika
Dr. Lev Kalika

Clinical director & DC RMSK

About Peripheral Neuropathy
Specialist Dr. Lev Kalika

As a holistic practitioner of rehabilitative medicine, Dr. Kalika has devoted his life’s work to better understanding the intricate and interdependent nature of the body’s structures. Dr. Kalika specializes in nerve disorders that affect human movement and cause pain, using a broad array of evidence-based approaches, including:

  • Ultrasound guided injection therapies
  • Nerve hydrodissection
  • Radian and focused shockwaves
  • Ultrasound guided fascia-nerve hydro manipulation
  • Ultrasound guided neuromodulation
  • Ultrasound guided dry needling
  • Electromagnetic technologies to improve the muscle-nerve interface
  • Radio frequency therapy

Dr. Kalika has developed his own methodology for treating nerve disorders, combining various advanced approaches with neurodynamic physical therapy.

Dr. Kalika is a world expert in high resolution ultrasonography, with multiple peer-reviewed studies to his credit. He is currently collaborating on a book chapter about conservative treatment of peripheral mononeuropathies.

Why Treatment at NYDNRehab is Superior to Conventional Peripheral Neuropathy Therapy

Getting effective treatment that delivers long-term results is the goal of every patient suffering from neuropathy. Medical doctors often look for pharmacological remedies that treat the symptoms of neuropathy without addressing its underlying causes. However, all medications have undesirable side effects, and many people do not want to be dependent on drugs long-term to control their symptoms.

Most neurologists only order electro-diagnostic tests, and if the diagnosis is a small fiber neuropathy, they tell you there is no treatment available. At NYDNRehab, we use new advanced technologies to detect neuropathies and treat them, to reduce pain symptoms and improve nerve function, without drugs or surgery.

The anatomy of nerve compression is unique to each nerve and its compartment. Nerves can become entrapped, stretched or compressed in the fascial tunnel, the myofascial tunnel, or the osteo-fibrous tunnel. Nerves glide with fascia in the spaces between muscles, and they also run within muscles, and next to bones. Before we treat a nerve with a procedure like hydrodissection, we need to address the surrounding fascia, muscles and joints.

Why Treatment at NYDNRehab is Superior to Conventional Peripheral Neuropathy Therapy

We treat compression syndromes of peripheral nerves in your arms, legs, hips, shoulders, spine and brachial plexus, along with mononeuropathies (pinched nerves) such as cubital tunnel, radial tunnel, carpal tunnel and tarsal tunnel syndromes, and median nerve entrapment in the pronator teres. We also treat the following nerves:

  • Axillary nerve

  • Musculocutaneous nerve

  • Suprascapular nerve

  • Dorsal scapular nerve

  • Long thoracic nerve

  • Thoracodorsal nerve

  • Spinal accessory nerve

  • Lateral pectoral nerve

  • Radial nerve

  • Ulnar nerve

  • Median nerve

  • Cluneal nerve

  • Sciatic nerve

  • Posterior and anterior femoral cutaneous nerves

  • Superior gluteal nerve

  • Peroneal nerve

  • Tibial nerve, and its heel and foot branches

In addition, we treat diabetic neuropathy, a condition that arises when blood vessels that feed peripheral nerves are damaged from high circulating glucose levels, depriving nerve tissue of oxygen and nutrients. We also treat post-radiation neuropathy that often develops in cancer survivors, sometimes appearing several years after radiation therapy.

Dr. Kalika uses a holistic and individual approach that addresses all components of nerve compression, entrapment and tension. Once we identify the type of neuritis, we are able to create a personalized treatment plan geared to restoring healthy functional neural pathways.

Our personalized one-on-one approach sets us apart from other clinics that rely on generalized protocols that treat the symptoms, not the patient. For lasting results without drugs or surgery, NYDNRehab is your clinic of choice for peripheral neuropathy rehabilitation in NYC.


Peripheral Neuropathy Symptoms and Causes

Scientists have identified over 100 types of peripheral neuropathy, and symptoms can vary widely, depending on the type of nerves affected. There are three subcategories of peripheral nerves:

Motor nerves stimulate muscle contraction to produce movement. Symptoms of peripheral motor nerve damage include:

  • Muscle weakness

  • Muscle tingling or numbness

  • Muscle cramps

  • Muscle spasms

  • Muscle atrophy (shrinkage)

Sensory nerves transmit information about touch, temperature, pain and other sensations from the periphery to the brain. Symptoms of sensory nerve damage include:

  • Reduced or exaggerated sensitivity to touch or environment

  • Reduced balance or coordination

  • Loss of reflexes

Autonomic nerves control involuntary body processes such as breathing, digestion, circulation and gland and organ function. Symptoms of peripheral autonomic neuropathy include:

  • Excessive sweating

  • Heat intolerance

  • Inability to regulate blood pressure

  • Gastro-intestinal issues

  • Complex regional pain syndrome

Causes of peripheral neuropathy are as diverse as its symptoms. Some of the most common causes include:

  • Physical trauma that damages or disrupts nerves

  • Local or systemic infections

  • Diabetes

  • Smoking

  • Cardiovascular disease

  • Autoimmune disorders

  • Hormonal imbalances

  • Malnutrition

  • Kidney and liver disorders

  • Certain medications and cancer treatments

As is the case with many musculoskeletal disorders and pain syndromes, peripheral neuropathy often has its roots in unhealthy lifestyle behaviors and/or exposure to environmental toxins.

Diagnosis of Peripheral Neuropathy

In addition to a comprehensive medical history and physical exam, there are a number of tests that can be conducted to identify peripheral neuropathy, depending on nerve type.

  • Muscle strength and function tests

  • Electromyography (EMG) tests

  • Nerve conduction tests

  • Blood tests

  • Tests using ultrasound imaging

Once we understand the nature and extent of your nerve damage, we create a personalized treatment protocol based on your results.

Diagnosis of Peripheral Neuropathy
Peripheral Neuropathy Physical Therapy and Treatment Options

Peripheral Neuropathy Physical Therapy and Treatment Options

Neurodynamic physical therapy is generally a part of peripheral neuropathy rehabilitation, but prior to beginning physical therapy, we need to address other issues that interfere with nervous function. Your peripheral neuropathy therapy may include:

  • Ultrasound guided injection therapies, to stimulate cellular healing
  • Nerve hydrodissection, to free entrapped nerves from surrounding scar tissues
  • Ultrasound guided fascia-nerve hydro manipulation, to free up nerves entrapped by fascia
  • Ultrasound guided neuromodulation, to modulate the nervous system
  • Microcurrent autonomic nervous system neuromodulation
  • Ultrasound guided dry needling, to relax trigger points that interfere with neural function
  • Electromagnetic technologies to decrease neurogenic inflammation

Our New Technologies are Game-Changers
for Peripheral Neuropathy Therapy

INDIBA CT9 Radiofrequency Device

NESA Neuromodulation Therapy

NESA 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 CNS.

INDIBA Radiofrequency Therapy

INDIBA therapy is a type of transfer of energy capacitive and resistive (TECAR) therapy that helps to restore the ionic charge of damaged cells, for faster injury healing and rehabilitation.

Regenerative Ultrasound Guided Injection Therapies

Ultrasound Guided Hydrodissection

Hydrodissection is a technique for treating peripheral nerve entrapment. It uses a saline solution to separate an entrapped nerve from surrounding fascia adhesions or adjacent structures. Ultrasound guidance ensures accuracy of the procedure, and confirms successful results.


Ultrasound Guided Shock Waves for
Neurological Disorders

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

Preventing Peripheral Neuropathy

Staying active and making healthy lifestyle choices is the best way to avoid developing peripheral neuropathy. You can make many positive changes right away that keep all your body’s systems running smoothly, including your nervous system.

  • Exercise daily — walking is the best exercise for most people

  • Stretch your joints and muscles daily

  • Get 7-8 hours of sleep nightly

  • Drink plenty of plain filtered water

  • Avoid processed, fast and fried foods

  • Eat a variety of organic fruits and vegetables

  • Stay away from sugary foods and beverages, and baked goods

  • Eat organic pasture-raised meats and wild caught fish

  • Take frequent breaks from sitting

  • Don’t smoke

  • Avoid excessive alcohol use

  • Minimize drug use (over-the-counter, prescription and street)

Preventing Peripheral Neuropathy

Get the Most Advanced Peripheral
Neuropathy Treatment in NYC

If you are ready to go beyond treating your peripheral neuropathy symptoms and want to find a solution that restores neural function, you need an experienced peripheral neuropathy specialist who has access to the latest treatment technologies. Dr. Kalika’s holistic patient-first approach ensures that you get the exact treatment you need for fast and effective results. Contact NYDNRehab today, and see why we are the best clinic for peripheral neuropathy recovery in NYC.

Clinical Case Studies

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

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.

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Peripheral Neuropathy FAQs

Is peripheral neuropathy a dangerous condition?
While in general, peripheral neuropathy is not life-threatening, it can be painful and in some cases debilitating, depending on the type and location of the affected nerves.
Will peripheral neuropathy go away on its own?
In certain cases some nerve entrapments may self-resolve over time, but there are no guarantees. Early diagnosis and treatment can prevent your condition from getting worse.
Can peripheral neuropathy be treated with drugs?
There are a number of drugs used to treat peripheral neuropathy, but most are geared to managing pain and inflammation, to mask the symptoms of neuropathy. Drugs alone cannot resolve your peripheral neuropathy.
Is peripheral neuropathy treatment painful?
While some peripheral neuropathy procedures may be moderately uncomfortable, most treatments are minimally invasive, and do not cause significant pain.
How does diabetes cause peripheral neuropathy?
Neuropathy is a long-term complication of diabetes, where persistently high blood sugar causes damage to the small blood vessels that supply nerve fibers with oxygen and nutrients. Depleted nerves eventually become damaged, and may disappear altogether. A healthy lifestyle can help prevent diabetes and its complications.
Peripheral Neuropathy

We specialize in treatment of compression and entrapment neuropathies.

The diagnosis of compression/entrapment neuropathies is made by nerve conduction studies and diagnostic ultrasound. We take a three step process to inquire about your condition.


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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