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About Lymphedema

Lymphedema is a chronic condition marked by swelling and fluid accumulation in the interstitial spaces of the extremities. It is caused by a blockage in the lymphatic system — a critical part of the immune system that serves to keep body fluids in balance. Blockages prevent lymphatic fluid from being transported to the lymph nodes.

Lymphedema is common among cancer patients whose treatment has damaged the lymphatic system. It is especially common among breast cancer patients, due to the close proximity of the breasts to lymph nodes. It may also occur in obese people with chronic inflammation and metabolic disease.
Extracorporeal shockwave therapy (ESWT) is an evidence-based therapeutic approach for lymphedema treatment.

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Dr. Lev Kalika
Dr. Lev Kalika

Clinical director & DC RMSK

About Lymphedema Specialist
Dr. Lev Kalika

Dr. Kalika has dedicated his life’s work to finding the most effective therapies and technologies for treating pain syndromes and movement disorders. As an expert in diagnostic ultrasonography and extracorporeal shockwave therapy, he has successfully brought relief to hundreds of grateful patients.

The clinic at NYDNRehab features some of the most advanced technologies and therapies available, many of which are rarely found in a private clinical setting. Dr. Kalika’s expertise, coupled with years of hands-on experience, make him one of the most sought-after lymphedema doctors in NYC.

Get the Best Lymphedema Physical Therapy at NYDNRehab

Get the Best Lymphedema Physical Therapy at NYDNRehab

One thing that makes cancer so insidious is the harsh side effects of many cancer treatments. Lymphedema is a chronic condition caused by damage to the lymphatic drainage system. When lymph fluids cannot drain, swelling, inflammation and accumulation of protein occur in body tissues. Over time, lymphedema patients may develop fibrosis, a thickening and hardening of the tissues,

At NYDNRehab, new technologies are changing the game in lymphedema treatment. Therapies like shockwaves, TECAR therapy, specialized lymphedema manual therapy, and physical therapy can help to move fluid out of the tissues, to keep the condition from advancing and prevent fibrosis.

Our personalized one-on-one approach ensures that you get a customized treatment protocol based on your unique diagnosis. We closely monitor your progress and make adjustments to your lymphedema treatment plan as needed, to give you the best results possible in the shortest amount of time.

Lymphedema Symptoms and Causes

  • Pain and swelling in an arm or leg
  • Swelling in fingers or toes
  • Limited range of motion
  • Recurring infections
  • Dimpled skin on arms or legs
  • Swollen lymph nodes
  • Water retention
  • Thickening of the skin (fibrosis)
  • Cancer surgery that removes lymph tissue
  • Radiotherapy
  • Infections
  • Trauma or injury
  • Obesity
  • Chronic inflammation
  • Congestive heart disease
  • Prolonged immobility

Diagnosing Lymphedema

There are various modalities for diagnosing lymphedema. Until recently, lymphoscintigraphy was considered the gold standard, where a radioactive substance is injected into the body and its pathway traced to see if it is taken up by the lymph nodes. However, poor image resolution and variables in protocol can make diagnosis difficult using this approach.

High-resolution diagnostic ultrasonography offers a simpler and less invasive alternative to lymphoscintigraphy. With ultrasound imaging, we are able to measure tissue thickness and locate obstructions in the lymphatic system. In addition, we use sonoelastography, a new technology that measures tissue stiffness — fluid-filled tissues are much denser and stiffer than non-affected tissues.

The clinic at NYDNRehab features the most advanced, highest-resolution ultrasonography equipment available, with capabilities for sonoelastography. Dr. Kalika is an expert in ultrasound imaging, with years of experience and multiple scientific publications to his credit. We believe that accurate diagnosis is fundamental to effective and successful lymphedema treatment.

Diagnosing Lymphedema
Treatment for Lymphedema

Treatment for Lymphedema

Standard treatment for lymphedema focuses on managing the condition using compression wraps and stockings, and massage. The goal is to force fluid out of interstitial spaces and transport it to the lymph nodes for clearance.

Exercise is also an important management tool. Rhythmic muscle contraction facilitates the movement of lymphatic fluid out of the tissues, for transport to the lymph nodes. Complex decongestive lymphedema physical therapy combines skin care, lymphatic drainage, compression tools, and exercise, to promote lymph flow.

At NYDNRehab, we combine standard lymphedema treatment and lymphedema physical therapy with advanced technologies and lymphedema alternative treatment methods to optimize patient outcomes.


Lymphedema Alternative Treatments

INDIBA Radiofrequency Therapyy

INDIBA Radiofrequency Therapy

Shockwave for Lymphedema

Extracorporeal shockwave therapy (ESWT) is a non-invasive treatment approach that promotes lymphatic neovascularization – the genesis of new lymph vessels for fluid transport. Shockwave therapy is especially effective for treating fibrotic lesions in swollen tissues.

TECAR Therapy with INDIBA

INDIBA therapy is a type of transfer of energy capacitive and resistive (TECAR) therapy that helps to restore the ionic charge of damaged cells. TECAR therapy has a thermal effect that helps to prepare tissues for manual therapy, to facilitate the movement of lymphatic fluids out of interstitial spaces.

Specialized Lymphedema Manual Therapy

We employ specialized manual lymph drainage techniques to promote the movement of lymphatic fluid out of affected tissues. Unlike regular massage therapy, lymphedema manual therapy zeros in on lymph vessels, to increase the flow of lymphatic fluid and decongest the affected region.


Get Cutting Edge Treatment for
Lymphedema that Really Works!

Managing lymphedema is an ongoing battle, but you don’t have to fight it alone. At NYDNRehab, we use the most advanced techniques and cutting-edge technologies to keep your lymphatic fluid on the move. Our professional staff works one-on-one with you, to ensure you get the best results from your therapy. Don’t settle for mediocre treatment for lymphedema. Get superior results with the lymphedema specialists at NYDNRehab.

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    Lymphedema FAQs

    Will I eventually recover from lymphedema?
    Lymphedema is a chronic condition that you will need to manage for the rest of your life. Treatment for lymphedema should include regular exercise and close adherence to lymphedema treatment protocols prescribed by your lymphedema doctor.
    Is obesity-induced lymphedema reversible?
    Multiple peer-reviewed studies indicate that lymphedema related to obesity and metabolic disease is irreversible. However, regular rhythmic exercise combined with weight loss can dramatically improve your lymphedema and slow its progression.
    What is the relationship between lymphedema and heart disease?
    Like other organs, the heart relies on the lymphatic system to maintain fluid balance. Heart muscle contractions help to keep lymphatic fluid flowing. When the heart muscle is impaired by conditions like congestive heart failure, fluid can back up in the extremities, causing swelling and weight gain.
    How frequently will I need to do lymphedema physical therapy?
    The frequency of treatment for lymphedema varies from one patient to the next. You may need to see your lymphedema doctor more frequently in the early stages, where you will learn strategies to manage lymphedema on your own. Being consistent and compliant is key to successful lymphedema management.
    Is lymphedema treatment painful?
    Lymphedema manual therapy is a gentle massage approach, but it can be a bit uncomfortable. However, the relief provided from reduced swelling overshadows any discomfort experienced from lymphedema treatment. Our trained specialists do their best to minimize discomfort and maximize results.

    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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