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.
Dr. Lev Kalika is clinical director of NYDNRehab, and author of multiple medical publications and research. He is an international expert in the field of rehabilitative sonography, ultrasound guided dry needling and sports medicine
Dr. Kalika has over 17 years of experience successfully practicing dynamic neuromuscular stabilization (DNS), one of the most advanced methods for treating shoulder pain. He learned the technique directly from Pavel Kolar, the creator of DNS, and is fully certified in the discipline.
Dr. Kalika works with athletes, runners, dancers and mainstream clients to relieve pain, rehabilitate injuries, enhance performance and minimize the risk of injuries. His clinic features some of the most technologically advanced equipment in the world, rarely found in a private clinic.
Dr. Kalika has revolutionized shoulder pain diagnosis and treatment by introducing high resolution diagnostic ultrasonography to visualize and objectify the functional movement of the shoulder. Ultrasound provides us with invaluable information to accurately identify and treat the underlying causes of shoulder pain, to restore normal pain-free function.
Dr.Kalika’s expertise is sought by professional athletes across the United States.
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
EPAT
Also known as defocused shock wave therapy, uses acoustic pressure waves to enhance blood circulation to targeted tissues, stimulating cellular metabolism, to speed up the healing process.
ESWT
Is 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.
EMTT
Is a new technology that transmits high energy magnetic pulses to targeted tissues at extremely high oscillating frequencies. The magnetic waves synchronize with the body’s magnetic fields, causing a disturbance that triggers a regenerative response in difficult-to-reach tendons, muscles, bones and nervous tissues.
Ultrasound Guidance Makes Our Injection Therapies More Accurate and Effective
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
We sometimes use injection therapies to reduce pain and inflammation, or to elicit a regenerative response in damaged cells. Corticosteroids, platelet rich plasma, hyaluronic acid and other injections may be used when deemed appropriate.
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.
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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