Request Telehealth
Request in office visit
Book now
For many people, dysfunction and pain in the pelvic region are uncomfortable to talk about, even with a doctor. For that reason, people often wait until mild discomfort and minor symptoms escalate into unbearable pain with embarrassing and unmanageable symptoms before seeking help.
Because of the complex anatomy of the pelvic region, many things can be at the root of pelvic pain and dysfunction, and until the cause is identified, the issue cannot be resolved. Treatment with internal manual therapy, drugs and steroid injections may dull the pain and mask the symptoms, but the condition often remains unresolved, relegating patients to a vicious cycle of pain and therapy.
or
Clinical director & DC RMSK
Dr. Lev Kalika has been an active member of the International Society of Medical Shockwave (ISMST ) since 2007, and has performed over 3000 ESWT procedures. He is a world renowned expert in ultrasound guided dry needling and has published multiple peer-reviewed articles about ultrasound guided procedures. Dr. Kalika uses ultrasound guidance to perform dry needling and ESWT to treat pelvic floor dysfunction. His unique approach to pelvic pain treatment is cardinally different from conventional pelvic pain physical therapy. His external approach is focused on rehabilitation of the underlying cause of pelvic pain, which in most cases is outside of the pelvic floor. It involves the regeneration of pelvic floor tissues using a combination of extracorporeal shock wave therapy (ESWT), extracorporeal electromagnetic transduction therapy (EMTT) and ultrasound guided dry needling, along with restorative physical therapy to address the external neuro-musculoskeletal causes of pelvic pain.
Dr. Kalika’s expertise makes NYDNRehab the clinic of choice for pelvic floor physical therapy in NYC.
Most traditional approaches to pelvic pain fail to get at the root cause of pelvic floor dysfunction and correct it. Instead, we see an excessive amount of internal, intravaginal, intrarectal myofascial work, which does not really address the underlying cause of pelvic problems. Those methods merely treat the symptoms without fixing the problem. While this type of treatment may be useful or even necessary at times, we do not overemphasize it at our clinic.
We believe that pelvic pain and dysfunction is caused by trigger points located deep within the pelvis, along with pudendal nerve compression. However, these trigger points in themselves are not causative, they are merely a reaction to the dysfunction in the hips, deficits in the mechanisms that generate intra abdominal pressure, and deep intrinsic instability of the spine and the entire locomotor system.
Watch this video to learn more about NYDNRehab’s unique approach to pelvic pain treatment.
Pain in the genital area
Pain in the perineum
Rectal pain
Pain in the pelvis
Pain during sexual intercourse
Urine leakage during intercourse
Urine leakage during exercise
Leakage when coughing, sneezing or laughing
Difficulty emptying your bladder or bowels
Prolapsed uterus or internal organs
Low back or hip pain
Postural issues affecting the pelvis and low back
Trauma
High-impact physical activities
Surgery
Obesity
Sedentary lifestyle
Pregnancy and childbirth
Pregnancy and childbirth
Advanced age
Obesity
Chronic constipation
Chronic coughing
Pelvic muscle atrophy post-menopause
Radiation or pelvic surgery
Smoking
Enlarged prostate
Diagnosis begins with a medical history and physical exam of the pelvic floor, low back, hips and pelvis. Gait analysis may be performed as well. Your clinician will ask for detailed information about pregnancies and childbirth, and any difficulties or abnormalities you experienced associated with childbearing.
At NYDNRehab, we use high resolution dynamic ultrasound to visualize the structures of the pelvic floor with the patient in motion. Since the pelvic region is closely related to the low back and hips, we perform diagnostic and functional sonography to rule out hip and low back issues.
During a diagnostic ultrasound session, both patient and clinician can view the muscles of the pelvis and abdominal wall in motion, to assess for muscular deficits, excessive force production (pressure) and trigger points.
With real-time ultrasound imaging, we are able to diagnose and treat a number of issues related to pelvic dysfunction, including:
Low back pain
Chronic pelvic pain
Hip and groin pain
Postpartum issues
Urinary and bowel incontinence
Post-surgical issues
At NYDNRehab, we use a combination of treatment approaches for pelvic pain, based on the specific needs of the individual patient. We combine regenerative shock wave therapy with electromagnetic transduction therapy to relieve pain and stimulate healing. Our regenerative technologies and innovative therapeutic approaches make NYDNRehab the premier clinic for treatment of pelvic pain in New York.
This proprietary technology is based on a unique set of pressure waves that stimulate the metabolism, enhance blood circulation and accelerate the healing process. These non-invasive outpatient procedures represent breakthrough treatment options for pelvic pain and dysfunction.
Extracorporeal magnetic transduction therapy (EMTT) is a new technology that transmits high energy magnetic pulses to targeted tissues at extremely high oscillating frequencies, to trigger a regenerative response.
Extracorporeal shock wave therapy (ESWT) uses high frequency sound waves to stimulate the body’s own reparative mechanisms.
When combined, ESWT and EMTT work together to revitalize damaged cells and instigate healing, for immediate therapeutic results, including significant pain relief and regenerative effects on the pelvic floor muscles.
In addition, we use Ultrasound Guided Dry Needling as an effective technique for releasing painful trigger points buried deep in pelvic tissues. Ultrasound imaging is used to locate the trigger point and visualize the dry needling procedure. Dr. Kalika is an expert in this discipline, and has contributed to several peer reviewed studies on the topic.
Sudden onset pelvic pain should not be ignored. It is essential to immediately rule out visceral pathology (organ dysfunction).
Treatments for acute pelvic pain include:
Pudendal or genitofemoral nerve blocks followed by tibial nerve neuromodulation
Ongoing or intermittent pelvic pain that lingers for weeks or months can often be eliminated with non-invasive conservative treatment.
Treatment options for chronic pelvic pain include:
Extracorporeal shockwave therapy (ESWT)
Extracorporeal magnetic transduction therapy (EMTT)
Ultrasound guided dry needling
Comprehensive Pelvic floor physical therapy
Home treatment options for pain management and restoration include:
Sitz bath
Foam rolling on the painful region
Physical therapy exercises
Meditation with focus on your pelvic floor
At NYDNRehab, we take a one-on-one approach to patient care. We understand that every patient has a unique anatomy, and that each condition has unique characteristics. We tailor our treatment plans to the individual, and never use cookie cutter approaches.
Our experience using innovative treatment methods and advanced technologies makes NYDNRehab the number one choice for pelvic floor physical therapy and rehabilitation in NYC.
Request a TeleHealth ConsultThe muscles and connective tissues that make up your pelvic floor form a hammock that spans from your tailbone to your pubic bone, creating a wall of separation between your perineal region and your pelvic bowl. The pelvic floor provides support for your intestines, bladder and uterus, and its muscles govern bladder, bowel and sexual function.
Signs that your pelvic floor may not be doing its job often begin with bladder and bowel leakage, urinary hesitancy or urgency, or constipation.
High-impact sports like gymnastics, basketball and running create downward pressure on the pelvic floor muscles, putting athletes in those sports at risk for dysfunction. Pregnancy and childbirth may also lead to pelvic pain and dysfunction.
Pain that persists for six months or longer is categorized as chronic pelvic pain (CPP) which can seriously interfere with normal daily activities. CPP is common in women, accounting for about 10% of all visits to the gynecologist. It is also a common urologic complaint among men under age 50.
We strongly believe that the pelvic floor muscles are not the underlying cause of pain. Experience tells us that pelvic pain originates in walking gait deficits and imbalances in the hips and low back, interfering with the body’s ability to balance intrapelvic and intra abdominal pressure. While ESWT, EMTT, and USGDN are effective in relieving pain, restorative pelvic floor physical therapy provides the ultimate solution to pelvic pain and dysfunction.
Lifestyle factors play a key role in pelvic dysfunction. Eating whole organic foods and drinking plenty of plain filtered water can help you avoid urinary and bowel issues that lead to pelvic pain. Regular exercise that targets muscles throughout the entire body helps to strengthen the pelvic and core muscles and promote healthy function. Managing your weight, avoiding smoking, and stress management are all important lifestyle factors that help to prevent pelvic issues. Staying fit and active throughout your pregnancy can reduce your risk of developing pelvic floor issues.
In addition, you should rule out visceral pathologies by consulting your healthcare provider. If you suffer from hip or back pain, you should seek treatment, as untreated pain in those areas can affect the pelvic region. A 3D gait analysis can help to identify and correct asymmetrical gait patterns. Try to remain aware of your pelvic floor, and do not clench your pelvic muscles when stressed. Be sure to void your bladder and bowels when you feel the urge – do not hold your urine. Eating an organic whole foods diet and drinking plenty of purified water will help you avoid constipation.
Pelvic floor physical therapy helps your body heal itself, to eliminate pelvic floor dysfunction for good. However, not all physical therapy is effective. Conventional therapy uses manual intra vaginal or intrrectal release techniques to target the internal pelvic floor muscles. In our experience, this type of treatment only provides temporary relief with no significant progress, making patients dependent on ongoing therapy to relieve pain.
At NYDNRehab, we help our patients get long-term relief using a combination of extracorporeal shock wave therapy (ESWT), extracorporeal magnetic transduction therapy (EMTT) and ultrasound guided dry needling (UGDN). Our treatment approach goes beyond pain management, to actually regenerating damaged tissues and promoting healing. We are the top rated physical therapy clinic for pelvic pain in NYC.
Dr. Kalika is the first practitioner on the East Coast of the US to have the privilege of introducing the DNS method It has made a world of difference in how back pain and other locomotor issues are approached and treated.
HyunJu
YOO, PT, MPT, DPT, CPI (Licensed Physical Therapist)
Dr. Christina Pekar
DC
Dr. Michelle Agyakwah
DC
Mariam Kodsy
Physical Therapist
Research at NYDNRehab
Conference: The 50th ICS Annual MeetingAt: Las Vegas, USA
Dry needling of trigger points under ultrasound guidance effective to treat chronic pelvic pain and pelvic prolapse
Below is a prime example of how ultrasound can take the guesswork out of diagnosis.
A bad physical therapy experience is one of the primary causes of unnecessary surgery
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
