Tennis Elbow (Lateral Epicondylitis)

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.

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 sports
  • 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. In many cases, lateral elbow pain does not originate in the tendon, but arises from compression of the posterior interosseous nerve (PIN). Even when PIN compression is not the primary cause of pain, it can be a significant contributor. Pain can also be caused by 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. Our use of regenerative technologies gives us nearly 100% success in resolving lateral elbow pain.


Our Regenerative Therapies are Game-Changers

Damage to connective tissues is often slow to heal, because tendons and ligaments have low vascularity that limits the delivery of oxygen and nutrients to the cells.

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.

Your tennis elbow treatment plan may include a combination of regenerative therapies, along with physical therapy to restore pain-free functional movement.

Focused Extracorporeal Shock Wave Therapy (ESWT

Extracorporeal Shockwave 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.

Focused Extracorporeal Shock Wave Therapy (ESWT

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.

High Energy Inductive Therapy (HEIT)


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.

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.

Ultrasound Guided Dry Needling

Myofascial trigger points often contribute to tennis elbow pain. Dry needling is an outpatient procedure that inserts non-medicated needles into the trigger point to evoke a twitch response, releasing the trigger point and immediately relieving pain. Ultrasound guidance eliminates the need for multiple insertions, reducing pain and discomfort for the patient.


Superior Microvascular Imaging (SMI)

SMI is one invaluable feature of our high resolution ultrasound equipment that enables us to detect microscopic vascular activity in soft tissues, indicating the advent of healing. SMI helps us to confirm that your tennis elbow treatment protocol is generating the desired outcomes, and to measure your healing progress.

Stecco Method Fascia Manipulation

Stecco fascia manipulation is one of the most effective methods for treating dysfunctional fascia tissue, a key contributor to lateral elbow pain. The Stecco method reverses densification of fascia tissue that makes it sticky and inelastic, restricting movement. Patients often report immediate pain relief and improved movement after a single Stecco session.

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.

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!

Clinical Case Studies

Case Study: Patient with Elbow Pain Self-Misdiagnoses

Our Patient Our patient is a 57 year-old barber and recreational bodybuilder complaining of “tennis elbow” that would not go away. The pain worsened while lifting weights at the gym, and he reported pain and stiffness after waking up in the morning. He had previously had physical therapy, and an orthopedist had blindly injected a […]

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Case Study: Lateral Epicondylitis

Our Patient Our patient is a 56 year-old male jeweler who came to us with lateral elbow pain. The patient is a very athletic tennis player who works out at the gym on a regular basis. He stated that his pain initially started at the front of his elbow and eventually moved toward his lateral […]

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    Range of Available Unique Physical Therapy
    Treatments at Nydnrehab


    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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