Tennis Elbow (Lateral

About Tennis Elbow

Pain, tenderness and weakness near your outer elbow may indicate lateral epicondylitis, commonly known as tennis elbow. The condition is an overuse injury affecting the tendons that attach your forearm muscles to your elbow. It can occur from incorrect form when playing tennis or other racquet sports. or from other types of repetitive overuse during sports, or from everyday activities like using tools.

In addition to overuse of tendons and muscles, lateral epicondyle pain can be caused by compression of the posterior interosseous nerve inside the radial tunnel, or by instability of the lateral collateral elbow ligaments. Accurate diagnosis that differentiates the underlying cause of your elbow pain is key to successful treatment.

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Dr. Lev Kalika
Dr. Lev Kalika

Clinical director & DC RMSK

About Elbow Pain
Specialist Dr. Lev Kalika

Dr. Kalika, clinical director of NYDNRehab, is one of the world’s foremost experts in musculoskeletal ultrasonography and has published peer-reviewed research on the topic. High resolution diagnostic ultrasonography is considered to be the best tool for diagnosing and differentiating the source of lateral elbow pain. Dr. Kalika’s expertise in ultrasonography makes him one of the most sought-after specialists in NYC for diagnosing and treating tennis elbow.

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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

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Holistic Non-Invasive Diagnosis and Regenerative Therapy

Identifying and treating underlying issues prior to beginning physical therapy is key to getting fast and effective results. Failure to do so 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 NYDNRehab is Your Clinic of Choice
for Tennis Elbow Therapy in NYC

At NYDNRehab, we never base our treatment protocols on symptoms alone. We use high resolution diagnostic ultrasound to image your elbow in real time, to precisely pinpoint the underlying mechanisms of your lateral elbow pain. Once the cause of your elbow pain has been accurately identified, we devise a personalized treatment plan based on your unique diagnostic results.

Run-of-the-mill physical therapy clinics often take a one-size-fits-all approach to lateral elbow pain, treating all patients with routine therapies and exercises that do not always promote healing. In some cases, inaccurate diagnosis can lead to treatment that aggravates your condition, prolonging the healing process. If you want to eliminate your lateral epicondylar pain for good, in the shortest time possible, NYDNRehab is your clinic of choice for tennis elbow treatment in NYC.

Symptoms, Causes and Risk
Factors of Lateral Epicondylitis


  • Tenderness, burning and outer elbow pain

  • Pain that spreads to your forearm and wrist

  • Pain while gripping small objects

  • Pain while carrying loads with the elbow extended

  • Weakened grip


  • Improper grip during tennis or racquet sport

  • Poor trunk rotation when striking

  • Poor backhand form

  • Frequent use of tools like jackhammers or chainsaws

  • Occupational overuse among dentists, musicians, butchers and carpenters

Risk Factors

  • Being out of shape for your activity

  • Using improper technique during racquet sports

  • Not being properly fitted for a racquet

  • Engaging in an occupation that overloads the arm

  • Being middle aged

High Resolution Diagnostic Ultrasound Means Accurate Diagnosis and Successful Treatment

Because multiple structures converge at the elbow, it is impossible to know, based on symptoms alone, if your lateral elbow pain is caused by damage to the tendons that connect your forearm muscles to your elbow, or if other structural damage has taken place. Pain may be due to posterior interosseous nerve compression, or to instability of the lateral collateral elbow ligaments. In severe cases, multiple structures involving the elbow and forearm may be affected.

At NYDNRehab, we use the highest resolution diagnostic ultrasonography available, to closely examine the elbow and its surrounding structures. Ultrasound enables us to view the tissues in real time, with the elbow in motion, to rule out all possible causes of lateral epicondylar pain. With a precise and accurate diagnosis, we are able to provide the best condition-specific elbow pain treatment, to speed up the healing process.

High Resolution Diagnostic Ultrasound Means Accurate Diagnosis and Successful Treatment

Our Regenerative Therapies are Game-Changers
for Knee Pain

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 Extracorporeal Shock Wave Therapy (ESWT)

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.

Extracorporeal Pulse Activation Technology (EPAT)

Extracorporeal Pulse Activation Technology (EPAT)

Extracorporeal Pulse Activation Technology (EPAT)

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.


INDIBA CT9 Radiofrequency Device

INDIBA CT9 Radiofrequency Device

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.

Regenerative 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.

Regenerative Ultrasound Guided Injection Therapies

Ultrasound Guided Injection

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.

Focused Shockwave Therapy

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.

Electromagnetic Transduction Therapy (EMTT)

Tips for Preventing Tennis Elbow Pain

The following tips will help you avoid lateral epicondylitis:

  • Seek professional guidance when choosing your racquet, to ensure you have the proper size racquet with the appropriate grip circumference.
  • Procure a coach or trainer to learn proper form for striking the ball.
  • If you use tools, take frequent breaks throughout the day to allow your arm muscles to rest.
  • Apply ice to your achy elbow at the first sign of pain, or submerge it in an ice bath.
  • Allow yourself adequate recovery time between sports or work sessions.
  • Get a biomechanical analysis from the sports medicine lab at NYDNRehab, to pinpoint mechanical errors and perfect your racquet skills.
Tips for Preventing Tennis Elbow Pain

Eliminate Elbow Pain for Good with Tennis Elbow Therapy in NYC

Without proper treatment, tennis elbow pain can take months to heal on its own, taking you away from the sports or activities that caused it. The sports medicine professionals at NYDNRehab are equipped to help speed up healing with accurate diagnosis, regenerative therapies, chiropractic care and physical therapy. You don’t have to live with tennis elbow pain. Contact NYDNRehab today, and start healing so you can get back out there!


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    Lateral Epicondylitis (Tennis Elbow)

    Lateral epicondylitis, commonly called tennis elbow, is a painful inflammatory condition felt at the outside of the elbow. While the condition is often associated with tennis, it can also occur from occupational overuse from repetitive twisting motions.

    Tennis Elbow Symptoms

    Tennis elbow is marked by pain, burning and tenderness at the outside of the elbow, usually on the doorknob.

    Causes of Tennis Elbow

    • Tennis elbow is most commonly caused by repetitive wrist and arm movements, particularly in young and middle aged adults.
    • In older adults, tennis elbow may be associated with joint degeneration, cervical nerve compression, and a heightened sensitivity to pain stimuli.

    There are four subcategories of lateral epicondylitis:

    • Osteogenic, originating from the bony prominence of the lateral epicondyle
    • Myofascial, stemming from too lax muscle tension at the elbow
    • Tendinosis, caused by degeneration of the common extensor tendon that extends the wrist
    • Arthrogenic, hyperactivity of the elbow musculature secondary to cervical spine degeneration

    Diagnosis of Lateral Epicondylitis

    Clinical diagnosis begins with a health histo confirm diagnosis and rule out other causes of elbow pain.

    Some conditions that mimic tennis elbow include:

    • Impingement of the radial nerve
    • Arthritis of the elbow
    • Cervical nerve compression
    • Lateral epicondyle fracture
    • Posterior interosseous nerve impingement

    Case Study

    A 48 year old female writer presented at our clinic with pain in her lateral elbow. She had been diagnosed with lateral epicondylitis, and treated with steroid injections. When her sympto another practitioner who treated her elbow with extracorporeal shock wave therapy (ESWT) and five months of physical therapy. Nine months later, she was still in pain.

    We used diagnostic ultrasonography to the nature and cause of the patient’s elbow pain. Early diagnosis with ultrasound can spare the patient ineffective conservative treatment approaches, and unnecessary surgery.

    Risk Factors

    There are several risk facto tennis elbow:

    • Postural support: The distribution of forces along the elbow and forearm are directly affected by postural support of the spine, shoulder and neck. Inadequate support of the neck and shoulder blades contributes to muscle imbalances at the shoulder, elbow and wrists. Clinical evidence shows that recovery time for tennis elbow is shortened when shoulder blade stability is also addressed.
    • Wrist mobility: Wrist and finger mobility are key facto lateral elbow strain.
    • Tissue texture quality: The quality of soft tissues can affect upper extremity musculoskeletal health. The presence of knots, adhesions and scar tissue can inhibit fluid joint movement. Weakened or tight tissues can cause muscle imbalances that increase injury risk.
    • Female gender: Women are at higher risk of painful wrist and elbow conditions due to a hormonal profile that affects the tensile quality of soft tissues.

    Treatment for Tennis Elbow Pain

    Poor grip strength associated with disrupted coordination of the shoulder-elbow-wrist connection is a primary dysfunction of people with tennis elbow, which in turn leads to have a high rate of success in treating lateral epicondylitis.

    Tennis Elbow Treatment at NYDNRehab

    At NYDNR, we use a holistic and comprehensive approach to treat our patients with tennis elbow pain. After diagnosis using real-time ultrasound, we follow up with innovative therapeutic treatments, including:

    • DNS (Dynamic Neuromuscular Stabilization) to upper body structures
    • Myofascial manipulation tor control and lengthen myofascial tissue
    • Acupuncture to eliminate active trigger points in the forearm
    • ESWT (Extracorporeal Shock Wave Therapy) to enhance circulation and promote cellular regeneration

    For the best elbow pain treatment to treat tennis elbow in NYC.


    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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