Your shoulder is a complex ball-and-socket joint designed to move in multiple planes. Your shoulder’s diverse range of motion enables you to perform a broad variety of movements and tasks, but its vast mobility also makes it the most unstable joint in the human body. Because of the complex network of structures involved in shoulder movement, pain can stem from multiple causes.
Our clinical director Dr. Lev Kalika has authored multiple medical publications and research articles on the topic of rehabilitative medicine. He is an international expert in the field of rehabilitative sonography, ultrasound guided dry needling and sports medicine.
Dr. Kalika believes that shoulder pain is too often mismanaged, focusing on the rotator cuff while ignoring the scapula. Physical therapy is most effective when the structural integrity of scapular muscles and nerves is restored, and that regenerative therapies for rotator cuff tendons yield only mediocre results if the shoulder girdle/neck complex is not addressed holistically.
Dr. Kalika has developed his own holistic methodology for diagnosing shoulder pain, using the highest resolution ultrasonography that yields images superior to MRI. Diagnosis includes a dynamic exam of the scapular muscles using motion analysis and ultrasound imaging of the scapular muscles.
Dr. Kalika studied directly under Dr. Ben Kibler, world-renowned orthopedic surgeon and pioneer of scapular dyskinesis. His diagnostic approach focuses on the structural integrity of the scapular muscles, and the nerves that innervate the shoulder complex. He addresses these issues with extracorporeal regenerative therapy and regenerative injection therapy.
Dr. Kalika was among the first in his field to become certified in dynamic neuromuscular stabilization (DNS), which is considered the most integrative evidence-based approach for treating shoulder pain. He worked directly with the creator of DNS, Dr. Pavel Kolar.
Dr. Kalika works with athletes, runners, dancers and mainstream clients to relieve pain, rehabilitate injuries, enhance performance and minimize the risk of injuries. The NYDNRehab clinic features some of the most technologically advanced equipment in the world, including high resolution ultrasound, rarely found in private physical therapy or medical clinics.
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Why Physical Therapy Alone May Not Resolve Your Condition
Physical therapy is a valuable and effective approach to resolving musculoskeletal pain and dysfunction, but in many cases, physical therapy does not provide a stand-alone solution. Prior to beginning physical therapy, patients often need to address underlying issues that contribute to their pain and disability.
Unfortunately, mainstream physical therapy clinics are often not adequately equipped or experienced to identify and treat complications that undermine the effectiveness of physical therapy. They often rely on one-size-fits-all treatment protocols that overlook the unique characteristics of the individual condition, opting to treat the symptoms and not the patient.
Issues that should be addressed prior to beginning physical therapy 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
Failure to identify and treat these underlying issues prior to beginning physical therapy can completely undermine your treatment protocol, and in some cases, your condition may even worsen.
At NYDNRehab, we use a broad range of advanced technologies and innovative therapeutic approaches to resolve issues that can potentially undermine the success of physical therapy.
Our talented staff is certified in a diverse array of treatment methodologies, rarely found in run-of-the-mill physical therapy clinics. Our one-on-one sessions are personalized, based on the patient’s unique diagnostic profile.
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
Why Shoulder Treatment at NYDNRehab is Better than Conventional Physical Therapy
Many mainstream physical therapists take a one-size-fits-all approach to patient care, using antiquated timelines and cookie cutter exercises that fail to fully rehabilitate shoulder injuries and restore optimal movement.
At NYDNRehab, we take an individualized approach to every patient and every condition. Using advanced technologies, we are able to accurately diagnose and measure individual parameters for joint angles, force loads, muscle firing patterns and gait. We then design personalized treatment programs based on collected data, measuring progress along the way to ensure full recovery.
Our experience combining innovative treatment methods with advanced technologies makes NYDNRehab the number one choice for shoulder physical therapy, chiropractic care and rehabilitation in NYC. We use FDA approved methodologies to successfully treat a broad range of conditions. Our patients include elite athletes and ballet dancers who come to us for rehab and performance enhancement.
We understand that every patient has a unique anatomy, and that each condition has unique characteristics. We tailor our one-on-one treatment plans to the individual patient, and never use cookie cutter approaches.
In addition to restoring strength and range of motion to the structures surrounding the shoulder, we retrain the brain-body connection, to restore optimal neuromuscular recruitment patterns that are often disrupted after an injury. By doing so, our athletes are able to return to sport safely, with reduced risk of re-injury.
Shoulder Conditions We Treat
Rotator cuff tendinitis
Shoulder bursitis
Impingement of the tendons, bursa or nerves
Labral cartilage ruptures
Shoulder instability
Frozen shoulder
Shoulder osteoarthritis
Postural issues that contribute to shoulder pain
Accurate Diagnosis Means Successful Treatment
The sports medicine specialists at NYDNRehab are experts in diagnostic musculoskeletal ultrasonography. Diagnostic ultrasound not only enables the doctor to identify the structural causes of shoulder pain, but it allows your clinician to view the shoulder region in real time, with the shoulder in motion. In addition, biomechanical movement analysis helps us to identify faulty movement and compensation patterns that contribute to shoulder pain.
By visualizing the shoulder in motion and gathering quantitative data about shoulder mechanics, we are able to establish a baseline against which to measure progress. Once the exact cause of shoulder pain is determined, an effective treatment plan can be initiated and objectively measured for effectiveness.
Symptoms, Causes and Risk Factors of Shoulder Pain
Symptoms
Pain in the shoulder, back and neck
Bruising
Clicking or popping noises
Grinding sensation
Muscle stiffness and weakness
Restricted overhead movement
Causes
Occupational or athletic repetitive shoulder use
Arthritis and gout
Bone fractures
Bursitis
Frozen shoulder syndrome
Poor posture
Rotator cuff ruptures or tendinitis
Shoulder joint dislocation
Chronic stress and inflammation
Risk Factors
Advanced age
Repetitive occupational tasks
Overhead sports
Poor posture
Sedentary lifestyle
Previous shoulder injuries
We Use Innovative Therapies and High-Tech Equipment for Optimal Results
At NYDNRehab, we use a combination of non-invasive treatment methods, aimed at reducing pain and improving shoulder mobility.
Physical Therapy Exercises
To strengthen the muscles and connective tissues that support and stabilize the shoulder joint, to improve stability and relieve nerve pain. Postural correction therapy is often necessary to help realign the shoulder and surrounding structures.
Manual Therapy
A hands-on approach can help to increase shoulder mobility and range of motion to a frozen shoulder.
Dynamic Neuromuscular Stabilization (DNS)
We use DNS to restore innate functional movement patterns and correct motor deficiencies.
Proteus Collinear Resistance
Proteus uses the latest intelligent exercise and rehab technology to quickly strengthen the shoulder complex and restore sports movements, with patented 3D resistance training and quantitative 3D measurements.
Our Combined Regenerative Technologies Bring Fast Therapeutic Results
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 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.
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.
Our INDIBA Tecar therapy machine converts electrical current into a stable radio frequency current of 448 kHz, designed to increase and stabilize the exchange of ions in damaged cells, evoking a regenerative response that accelerates healing. INDIBA can be used to successfully treat joint and muscle disorders, low-back pain, sports injuries, surgical incisions and various pain syndromes. Another therapeutic effect of INDIBA is extreme and prolonged cellular hyperthermia. Due to this effect, INDIBA therapy combined with manual therapy and soft tissue tissue manipulation enables instantaneous release to occur, significantly shortening the number and duration of physical therapy sessions. What is normally accomplished in two months of physical therapy can be accomplished in 3-4 sessions with INDIBA.
Ultrasound Guided Dry Needling
Trigger points are tiny knots of muscle tissue that often form near the tendon-bone junction, causing pain and weakness. Ultrasound guided dry needling accurately targets trigger points to elicit a twitch response, instantly relieving pain and tension.
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.
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.
Best Treatment Options
Acute shoulder pain
The best treatment options for acute shoulder pain depend on the diagnosis. Rotator cuff issues are the most common type of shoulder conditions in people over 30.
Treatment options include:
A combination of EPAT (Extracorporeal Pulse Activation Technology) and ESWT (extracorporeal shock wave therapy) to relieve pain and balance tension in the rotator cuff muscles
EMTT (electromagnetic transduction therapy) for pain treatment and regenerative therapy
Ultrasound guided dry needling to release myofascial trigger points and relieve pain
Chronic shoulder pain
Physical therapy is the single best choice for chronic shoulder pain
Preventing Shoulder Pain
There are a number of things you can do to protect your shoulder joints from pain and dysfunction:
Begin a balanced resistance training program to strengthen the structures that support and stabilize the shoulder girdle complex
Avoid forward-slumping posture while using computers and mobile devices
Allow yourself ample recovery time between workout sessions, especially if you are a swimmer, or play overhead sports like tennis, lacrosse or baseball
Do yoga or other stretching exercises to optimize mobility in the shoulder complex
Take measures to manage stress and eliminate chronic inflammation
Get Pain-Free Shoulder Treatment That Really Works
Conventional medicine seeks to treat and manage the symptoms of shoulder pain without attempting to identify the underlying cause. Many of our patients suffer through multiple rounds of steroid injections, narcotic pain medications and even surgeries before they finally come to us for help.
Our high-tech diagnostic tools and non-invasive conservative treatment methods are aimed at getting to the root cause of shoulder pain and dysfunction and eradicating it for good.
At NYDNRehab, we never take a cookie-cutter approach to patient care. The causes and symptoms of shoulder pain can vary greatly from one patient to the next, and each case requires a unique treatment approach. We thoroughly examine each patient and base our treatment solutions on your personal diagnosis. We provide one-on-one Physical Therapy, custom-designed for the individual patient.
NYDNRehab is the top rated physical therapy clinic for shoulder pain treatment in NYC. We accept most health insurance plans, and we are happy to set up payment plans for our patients.
Range of Available Unique Physical Therapy Treatments at Nydnrehab
Shoulder pain is one of the most common musculoskeletal complaints. It can occur in any age group for various reasons. Most frequently the shoulder pain results from trauma and overuse of the shoulder joint and surrounding tissues. Because of the unique anatomy, versatility and overall importance of the shoulder complex the treatment needs to be multilateral. Spanning across various medical disciplines is essential in order to achieve long-lasting positive effects.
The Shoulder Joint
The structure and functionality of the shoulder are unique for human species. The anatomy of shoulder joint is in fact the highlight of human evolution. The versatility and mechanics of the motion of the shoulder is far more complex than of any existing precision machine. Human shoulder joint is one anatomical structure that showed marked morphological changes, compared to the corresponding area in closely related animals, even before the beginning of the vertical life of the mankind. The evolution of the shoulder anatomy is intimately connected with development of human posture and locomotion. The posture and locomotion depend on neuromuscular coordination of shoulder girdle muscles. These develop in parallel, one slightly preceding another, during the postural ontogenesis that takes place in the first months of infants life mirroring the lengthy process of the human evolution. The stability of the scapula-humeral articulation (shoulder joint complex) during this time defines future posture and locomotion. In fact, the child is not able to walk until he can lift his arm above 120 degrees.
Why is Shoulder Joint Is so Frequently a Site of Pain?
It is a scientific fact that anatomical structures and functions, acquired the latest during the evolution, are the most fragile and prone to failures. The human shoulder is a vivid example of that. The enhanced ability to perform complex multilateral movement has developed at the expense of diminished osteo-ligamentous stability, which is so important for all other joints in human body. At the shoulder, strong bone-and-tendon composition of the joint is replaced by an intricate, if delicate, muscular support mechanism known as the rotator cuff. The rotator cuff is designed to reinforce the otherwise unsupported shoulder joint and hold the ball-shaped head of the shoulder bone (humerus) in the glenoid fossa, the socket of the shoulder blade (scapula). Rotator cuff is made up of four muscles that originate from the scapula surface and are connected to the upper humerus forming a tight elastic blanket of muscle tissue over the shoulder joint holding it together. Without the rotator cuff support, the head of the humerus would freely ride in and out of the shallow glenoid fossa, rendering the joint inoperable. The function of the rotator cuff
Rotator Cuff
is not limited to the structural support. Besides keeping the joint intact, the rotator cuff assists in some shoulder and arm movements. During the throwing motion, for example, the rotator cuff muscles undergo series of rapid eccentric contractions (they are lengthened under tension) decelerating the arm and softening the impact of the exertion. Diverse functionality of the shoulder joint puts considerable stress on the tendons of the rotator cuffs muscles making them susceptible to overuse injuries. Relatively poor ability of the rotator cuff tissues to withstand excessive forces is frequently exacerbated by inadequate postural support of the shoulder girdle. The pain due to rotator cuff tear, tendonitis, various arthritic inflictions and overuse is the price we pay for exchanging structural stability of the shoulder for mobility and motor versatility.
What Are the Predisposing Factors of Shoulder Pain?
Abnormal morphology (aberrant development of shoulder anatomy)
Poor posture
Overuse
Overhead activities
Repetitive trauma
How Does Poor Posture Create Shoulder Pain?
The function of shoulder joint depends not only on the integrity of rotator cuff muscles and sinews, but on the stabilization of the scapula. The ideal position of the scapula is achieved when the body is erect. Poor posture impedes scapular stability, generating excessive loads to the rotator cuff muscles. For example: Try to lift your arm sideways after slumping your thoracic spine or protruding your chin forward and then compare the results to the range of motion of the same movement during the erect spinal position.
How Is Shoulder Pain Diagnosed?
Clinical examination allows diagnostic certainty while further radiological investigation by MRI, and/or diagnostic ultrasound allows diagnostic precision.
What Are the Conservative Methods of Dealing with Shoulder Pain?
The combination of physical therapy and rehabilitation exercise constitute scientifically proven and sound method for treatment of shoulder pain. Many shoulder conditions respond well to extracorporeal shock wave therapy, prolotherapy and platelet-rich plasma injections. Whatever the shoulder pain condition is at stake the combination of any of the above described methods and measured exercise brings the best results.
How Often Shoulder Surgery Is Necessary for Shoulder Pain?
Shoulder surgery is only necessary when the conservative therapy fails or after a destructive traumatic event. It is a responsibility of a conservative care clinician to make a timely referral for the surgery.
What Kind of Treatment for Shoulder Pain Is Used at Dynamic Neuromuscular Rehabilitation?
At DN Rehabilitation we use combination of physical therapy exercises, DNS exercises and regenerative treatments such as extracorporeal shockwave therapy, prolotherapy and Platelet-rich Plasma injections. Depending on the diagnosis, individualized treatment plans are developed on the individual basis consisting of balanced combination of the above-listed therapies.
How Different Is DNS Approach from the Conventional Physical Therapy for the Shoulder Pain?
Most conventional physical therapy is based primarily on strengthening of the rotator cuff muscles. DNS approach is different in a way that the treatment begins with restoration of the motor control and muscular synergies before strengthening the rotator cuff. Doing this allows reestablishing muscular balance that is imperative for the ideal function of the shoulder. Muscle synergies that are established during the early childhood development serve as foundation of human posture and movement. During early development muscular synergies around shoulder girdle must develop first to ensure the shoulder stability, which is critical for establishment of the first point of support by the child. DNS reenacts these muscular synergies, reestablishing muscle balance, responsible for ideal function of the shoulder prior to strengthening of rotator cuff.
Is DNS Treatment Only Useful for Atheletes?
Professional athletes use DNS therapy and exercises to prevent injuries and, should an injury occur, expedite post-traumatic recovery. The general application of DNS extends far beyond sports medicine and is equally effective for all patient groups.
What Is the Regenerative Shoulder Treatment?
Regenerative treatment is a form of stimulation of bodys own regenerative abilities by different physical or biological agents introduced into the injured area.
Treatments
ESWT is used for subacromial bursitis, shoulder tendinitis or calcific tendonitis. Please click here to explore our ESWT page… Platelet-rich Plasma injections are used for moderate rotator cuff tears and frozen shoulders. Prolotherapy is used for unstable and hyper mobile shoulders, shoulder dislocations and A-C joint suluxation.
PREVENTING SHOULDER PAIN AND SHOULDER INJURY
Always warm up before exercising
Create proper work station which supports shoulder blades
Train shoulder fluidity by engaging in Pilates, Yoga or consult with your local chiro or physio
Strengthen your rotator cuff muscles
Be extremely careful with lifting heavy objects from overhead position
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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