Posterior Tibial Tendinopathy Treatment

About Posterior Tibial Tendinopathy

The tibialis posterior is a small but important muscle embedded deep in the lower leg that plays a key role in foot and ankle stability. Its insertional tendon contributes significantly to foot and ankle mechanics, helping to maintain the integrity of the medial longitudinal arch, and assisting in plantar flexion and foot inversion.

Early and aggressive treatment of posterior tibial tendinopathy can prevent its progression to dysfunctional chronic foot and ankle deformities. Regenerative technologies and specialized physical therapy can help to restore tendon integrity and promote optimal foot and ankle function and stability

During the loading phase of the gait cycle, the foot arch momentarily flattens and pronates (rolls inward) to provide shock absorption as the posterior tibial muscle lengthens, setting the foot up for the propulsion phase. The posterior tibial tendon dictates the speed and magnitude of pronation, which directly affects the mechanics of the entire lower kinetic chain.

Repetitive over-pronation can lead to injuries ranging from micro trauma to rupture of the posterior tibial tendon. If left untreated, an injured tendon may begin to degenerate, resulting in collapse of the medial arch and creating debilitating foot and ankle dysfunction that affects gait and posture.

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Dr. Lev Kalika
Dr. Lev Kalika

Clinical director & DC RMSK

About Tendon Specialist Dr. Lev Kalika

With over 25 years of experience treating tendinopathies, Dr. Kalika has formulated his own unique approach to diagnosis and treatment. As an expert in diagnostic ultrasonography, he has published multiple scientific publications that have helped to take diagnostic medicine to the next level. He has worked with some of the world’s leading radiologists in the field of musculoskeletal ultrasonography.

“My success in treating tendon injuries comes from a deep understanding of tendon pathologies, and from the ability to visualize each individual tendon. No two tendons are alike in their anatomy, biomechanics and function. Most tendons are superficial structures, and are much better visualized by high resolution ultrasonography versus MRI. A distinct advantage of diagnostic ultrasonography over MRI is its ability to visualize muscles and tendons in motion.” – Dr. Lev Kalika

Dr. Kalika has helped hundreds of patients to rehabilitate tendon injuries, restore functionality, and return to sports and physical activity. Dr. Kalika’s expertise in musculoskeletal ultrasonography, shockwave therapy, regenerative medicine and 3D gait analysis makes him one of the most sought-after specialists in NYC for posterior tibial tendinopathy diagnosis and treatment.

Accurate Diagnosis is the First Step to Successful Treatment

NYDNRehab features research-grade ultrasound equipment with the highest resolution available in New York City. Our equipment gives us capabilities for sonoelastography to test for tendon stiffness, and superior microvascular imaging (SMI) to assess inflammation and detect vascular neogenesis.

Sonelastography and SMI are the latest advancements in tendon imaging, and are not possible with other radiological modalities. NYDNRehab is among the first sports medicine clinics to feature dynamic ultrasonography using the USONO ProbeFix device

ProbeFix attaches directly to the athlete, allowing us to visualize damaged tissues during sport-specific actions. ProbeFix renders accurate real-time images of the body’s structures in motion, and it can even be synced with motion capture cameras to produce 3D images of muscles, fascia, bones and joints during physical activity. This game-changing technology gives us a huge advantage for diagnosing tendon injuries and restoring optimal sport-specific biomechanics.

NYDNRehab is the only clinic in New York with a fully equipped motion and gait analysis laboratory. Our motion and gait analysis technology and proprietary software lets us measure and quantify muscle and tendon function in real time.

At NYDNRehab, we are dedicated to rehabilitating your injury, not just treating your symptoms. To accurately diagnose and treat your tendinopathy, we conduct a comprehensive evaluation consisting of:

  • Thorough health history
  • Review of physical activity at onset of pain
  • Manual physical exam
  • Artificial intelligence assessment for strength and range of motion
  • High resolution ultrasonography and elastography
  • Surface electromyography
  • High-tech gait, running and motion analysis

For sport-specific injuries, we use the latest technologies to analyze movement mechanics and identify motor deficiencies. By eliminating movement and training errors, athletes and physically active patients are able to dramatically improve their performance while reducing their risk of injury.

Advantages of Diagnostic Ultrasonography over MRI

Patients with tendon injuries are often referred for MRI, but ultrasound imaging surpasses MRI in terms of visualizing tendons and surrounding structures in real time..

Advantages of ultrasound imaging over MRI:

  • Much higher resolution
  • On-site imaging and interpretation – no waiting for lab results
  • Capabilities for dynamic assessment in real time
  • Ability to visualize fascia adhesions related to tendon degeneration
  • Capabilities for superior microvascular imaging (SMI) to assess the inflammatory component of tendinopathies
  • Capabilities for sonoelastography to assess tendon stiffness
  • Ability to track patient progress via dynamic imaging during treatment

We Guide Our Procedures with Ultrasound for Accurate and Effective Treatment

High-resolution ultrasonography not only gives us a cutting-edge diagnostic tool – it is a game-changer when it comes to tendon treatment. Most injuries involve multiple tissue types, and each demands its own therapeutic approach. Ultrasound imaging lets us differentiate between various tissues and structures to ensure that our needling and regenerative procedures hit their mark.

Ultrasound also provides a dynamic feedback tool for motor retraining. Injuries often disrupt optimal muscle coordination patterns when patients adopt compensation strategies to off-load injured tissues. Once the tissues have healed, it is necessary to restore neuromuscular pathways that govern motor unit firing patterns. Ultrasound gives the patient visual feedback, to help restore optimal muscle activation patterns.

In addition, ultrasonography helps us track and confirm the effectiveness of our treatment protocols. Its capabilities for sonoelastography and superb microvascular imaging let us detect early signs of healing, and dynamic real-time imaging lets us measure the patient’s progress toward restoring optimal mobility.

Tensegrity is the Secret to Pain-Free Mobility

Most people take everyday mobility for granted until an injury occurs or pain sets in. Sometimes pain and reduced mobility seem to arise out of nowhere, with no apparent cause of onset. Regardless of whether your pain is caused by trauma or by something less obvious, tensegrity plays a key role.

Tensegrity refers to tensile integrity – a state where a system of individual components is held together under continuous elastic tension. In the human body, tensegrity is created by the myofascial system, the network of muscles and fascia that work together to produce, control, and guide forces, and to hold the body’s various organs and structures in place during movement.

Tensegrity can be disrupted when myofascial tissues are injured or damaged in some way. When that happens, nerves and blood vessels can become entrapped, preventing them from gliding among other structures and producing pain. At the same time, the elastic tension that governs joint alignment and controls movement becomes compromised, creating motor deficits that undermine mobility and stability.

Factors that disrupt myofascial tensegrity include:

  • Traumatic injury that affects multiple tissue types
  • Overuse injuries from sports, exercise or occupation
  • Old injuries that were never properly rehabilitated
  • Sedentary lifestyle with excessive sitting
  • Obesity that overloads the body’s structures
  • Inadequate hydration that deprives soft tissues of water needed to function
  • Diet high in sugar and carbs that causes myofascial tissue glycation, making it dense and sticky

Many doctors do not understand the crucial role of the myofascial system in preventing pain syndromes, movement disorders, and disease. In fact, most medical doctors have no idea how to correct myofascial dysfunction or even recognize it as a factor. They simply treat pain symptoms with medications and eventually recommend surgery.

At NYDNRehab, we understand that the body’s systems work together as an integrated whole, and that treating pain is not enough to eliminate its source. We use dynamic high-resolution ultrasound to explore the myofascial system in real time. Ultrasound imaging lets us visualize muscles, fascia, nerves and other structures in motion, to identify places where tensegrity has been disrupted.

Once we identify the problem, we use the most advanced therapeutic approaches to restore myofascial integrity and promote tissue healing.

Why Physical Therapy Alone is Not
Enough to Rehabilitate Tendinopathies

Physical therapy is an important component of tendon rehabilitation, but it does not provide a stand-alone solution. Prior to beginning physical therapy, we need to identify and treat complications that can undermine the effectiveness of physical therapy.

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

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.

We Treat the Whole Patient, Not Just Your Symptoms

The human body is made up of integrated parts and systems, designed to work in harmony. Today’s modern reductionist approach to medical treatment fails to acknowledge the integral relationship between structure and function, focusing on the locus of pain without considering its broader implications.

Most injuries involve multiple structures and tissue types, and pain is only a symptom that signals your brain to protect and heal the damaged tissues. It is not uncommon for an injury to stop hurting while damaged structures remain dysfunctional.

At NYDNRehab, our diagnostic process takes into account the interrelated nature of the body’s structures and systems, along with the unique anatomical characteristics of the individual patient. We use high resolution diagnostic ultrasound to visualize your injury dynamically, in real time, to determine whether structural (anatomical) changes are causing pain and dysfunction, or if dysfunction is causing structural changes.

Your ultrasound exam takes place on-site, on your first visit, where we examine multiple areas of the body in a single session – with no waiting for lab results!

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Our Regenerative Technologies Accelerate Healing

The human body has its own innate healing mechanisms, but tendons sometimes need 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.

Regenerative Therapies At NYDNRehab

SoftWave Electro-Hydraulic Shockwave Therapy

SoftWave Electro-Hydraulic Shockwave Therapy

SoftWave is a groundbreaking regenerative mechanotransduction technology that accelerates tissue healing. Its patented electro-hydraulic applicator delivers high-speed soundwaves that can penetrate up to six inches in depth. SoftWave’s defocused and linear focused shockwaves recruit maximum stem cells to the treatment site to promote healing. SoftWave’s wider and deeper penetration using defocused energy is a preferred treatment option for a broad spectrum of conditions, ranging from orthopedic injuries to pelvic health. SoftWave is the only unfocused shockwave technology currently available. According to recent research, SoftWave defocused waves combined with focused and radial shockwaves have maximum regenerative potential.


Myofascial Acoustic Compression Therapy (MyACT)

MyACT is a new type of focused shockwave technology that allows for deeper compression of the focused waves. Its higher frequency allows for precise neuro modulation under ultrasound guidance, with a special linear head for treating myofascial pain. MyACT transforms the mechanical energy of shockwaves into biochemical signals that precisely target damaged tissues. Most injuries involve more than one tissue type. When used together, our advanced shockwave technologies enable us to specifically target multiple tissue types with the most effective shockwave treatment.

Myofascial Acoustic Compression Therapy (MyACT)
Focused Extracorporeal Shock Wave Therapy (ESWT)

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 transmits high energy magnetic pulses to targeted tissues that synchronize with the body’s own magnetic fields, triggering a regenerative response. EMTT waves can penetrate deep tissues to target difficult-to-reach tendons, muscles, bones and nerves.

Extracorporeal Magnetic Transduction Therapy (EMTT)

Extracorporeal Pulse Activation Technology (EPAT)

Extracorporeal Pulse Activation Technology (EPAT)

EPAT, sometimes called defocused shock wave therapy, is not a true shockwave. It uses mechanical pressure waves to enhance blood circulation, improving oxygen and nutrient delivery to muscle and fascia tissues, but has minimal regenerative properties.The mechanical properties of EPAT make it especially effective for fascial manipulation in combination with focused shockwaves. We combine EPAT with different types of shockwaves for holistic treatment, without additional cost to the patient.


High Energy Inductive Therapy (HEIT)

HEIT delivers high-intensity magnetic pulses to peripheral nerve tissues, to stimulate neuroplasticity. We leverage this FDA-approved methodology to treat pain and regenerate nerve fibers, for enhanced motor control.

High Energy Inductive Therapy (HEIT)

INDIBA Radiofrequency Therapy

INDIBA Radiofrequency Therapy

INDIBA is a form of TECAR therapy that helps to restore the ionic charge of damaged cells, for faster injury healing and rehabilitation.


NESA Neuromodulation Therapy

NESA generates a low-frequency electrical current of intermittent and cyclical stimuli that soothes hypersensitized nerves and restores optimal signaling between the autonomic nervous system and the brain. We leverage this FDA-approved methodology to treat pain and regenerate nerve fibers, to enhance motor control.

NESA Neuromodulation Therapy

We Guide Our Needling and Orthobiologic
Procedures with High-Resolution Ultrasound

Injection therapies use orthobiologic 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 tendon healing in chronic injuries and accelerate repair in acute injuries.


Alpha-2-Macroglobulin (A2M)

Alpha 2 macroglobulin (A2M) is a naturally occurring blood plasma protein that acts as a carrier for numerous proteins and growth factors. As a protease inhibitor, A2M reduces inflammation in arthritic joints and helps to deactivate a variety of proteinases that typically degrade cartilage.


Prolotherapy

Prolotherapy uses a biologically neutral solution to irritate stubborn tissues, triggering the body’s innate healing mechanisms to grow new normal tendon, ligament and muscle fibers.


Interfascial Plane and Nerve Hydrodissection

Condition injuries often involve fascial tissue that has become densified and/or formed adhesions, entrapping nerves and blood vessels, causing pain and restricting movement. Hydrodissection is a procedure where a saline solution is injected into densified fascia under ultrasound guidance. The solution works by separating fascial layers and freeing up entrapped nerves and blood vessels. We often use hydrodissection in conjunction with manual fascial manipulation.

Ultrasound Guided Dry Needling

Myofascial trigger points often contribute to musculoskeletal pain and dysfunction. The dry needling procedure inserts filament-thin non-medicated needles into trigger points to evoke a twitch response, relaxing contracted fibers and immediately relieving pain. Ultrasound guidance eliminates the need for multiple insertions, reducing discomfort for the patient.

More Advanced Therapies at
NYDNRehab

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SM Neuromuscular Electrical Stimulation (SMNMES)

SM neuromuscular electrical stimulation (NMES) dynamically interacts with the patient during therapeutic exercises, providing real-time sensory, auditory and visual biofeedback to the patient. This breakthrough technology helps patients to recalibrate muscle actions, to optimize joint function. SMNMES has helped numerous patients to avoid unnecessary shoulder, knee and ankle surgeries, even in complex scenarios.

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Ultrasound Guided Percutaneous Neuromodulation (PENS)

During PENS treatment, filament-thin needles are inserted through the skin into muscle tissue adjacent to the targeted nerve. A low frequency electrical current is then delivered via the inserted needles to stimulate the dysfunctional nerve. PENS normalizes nerve activity, improves brain plasticity and optimizes muscle recruitment patterns. This therapy is so effective that patients typically need only 4-6 treatment sessions.

Symptoms and Causes of Posterior Tibialis
Tendinopathy, and PTTD Imposters

While posterior tibial tendon dysfunction (PTTD) can develop in athletic populations, it is most prevalent in up to 10% of obese middle-aged women. Co-factors such as diabetes, hypertension, obesity, previous surgery, foot/ankle trauma and corticosteroid use are found in up to 60% of PTTD patients.

It is important to note that multiple other conditions share similar symptoms to PTTD, and misdiagnosis is not uncommon. Diagnostic ultrasonography gives us a superior tool for differentiating posterior tibial tendinopathy from imposters, ensuring you get the most effective treatment for your condition.

Symptoms

  • Inner foot and ankle pain and inflammation
  • Pain that worsens with high-impact physical activities
  • Pain when standing and walking
  • Outer ankle pain as the foot flattens during the gait cycle

Causes

  • Overstriding with heavy heel strike while running
  • Excessive foot pronation
  • Flat arches
  • Weak intrinsic foot muscles
  • Joint hypermobility
  • Muscle imbalances in the lower kinetic chain
  • Previous ankle injuries and/or surgery
  • Non-supportive footwear
  • Obesity
  • Diabetes melitus
  • Gout
  • Sedentary lifestyle
  • Corticosteroid overuse

PTT Imposters

  • Tarsal tunnel syndrome
  • Medial ankle impingement
  • Tendon subluxation
  • Saphenous nerve entrapment
  • Subtalar joint osteoarthritis
  • Achilles tendinopathy

Specialized Physical Therapy Helps Restore Functional Movement

At NYDNRehab, we treat the whole patient, not just their symptoms. We never use one-size-fits-all rehab protocols or antiquated recovery timelines. We believe that every injury is unique, and treatment should be based on a holistic approach that factors in the patient’s unique profile.

Once we have successfully pre-treated damaged tissues, we can begin one-on-one physical therapy to restore strength and stability, optimize mobility, and re-establish optimal neuromuscular pathways and muscle coordination patterns.

Your physical therapy protocol may include a combination of the following approaches:

  • Stecco fascial manipulation, to eliminate fascial densifications and adhesions and restore fascia’s gliding properties
  • Postural restoration therapy to optimize total-body joint alignment
  • Dynamic neuromuscular stabilization (DNS) to restore developmental motor strategies
  • Integrated systems model (ISM) to optimize function and performance
  • Anatomy in motion (AIM) to enhance movement quality
  • Neurodynamics, to restore communication pathways between the brain and body
  • Conventional eccentric loading and strengthening exercises
  • Foot core training
Your back-to-sports physical therapy protocol may include sport-specific training to optimize motor skills and restore peak athletic performance. We carefully monitor patient progress with ultrasound imaging to confirm complete recovery before releasing patients back to play. Click here to learn more…

To restore functional movement during tibial tendinopathy rehab, we look at all the factors that play into lower kinetic chain mechanics. Our personalized approach ensures that every patient gets the exact physical therapy needed, based on their unique diagnostic profile.

Foot Core Training

Foot core training is a physical therapy approach for strengthening the intrinsic foot muscles that provide foot stability and arch support. Strong intrinsic foot muscles help to mitigate force loads placed on the posterior tibial tendon, prevent excessive foot pronation, and preserve the arch's capacity for storing and releasing elastic energy during the gait cycle.

3D Gait Analysis and Retraining

Inefficient gait mechanics during walking and running can originate anywhere along the lower kinetic chain, affecting all other structures involved in the gait cycle. Our state-of-the-art gait analysis lab is fully equipped with advanced technologies for detecting and quantifying gait deficiencies that affect the posterior tibial tendon. Gait retraining uses intrinsic and extrinsic feedback to optimize gait mechanics.

COLLAPSE

Our High-Tech Equipment Produces Superior Results

Advancements in technology are changing the game in rehabilitative medicine, enabling us to accelerate healing and restore performance at an unprecedented pace. The clinic at NYDNRehab features some of the most advanced therapeutic equipment currently available, and rarely found in private clinics.

Your tendinopathy therapy may include the use of technologically advanced equipment:

C.A.R.E.N Computer Assisted Rehabilitation Environment

Originally developed to rehabilitate injured soldiers, this multifaceted system gives us a broad range of tools for assessment, feedback and performance enhancement. Dr. Kalka has integrated his own unique selection of technologies to optimize the ways in which C.A.R.E.N helps patients to achieve their goals.

Blood Flow Restriction Training (BFRT)

Rebuilding muscle strength while joints and connective tissues are still healing is a challenge for athletes who need to return to sport in the shortest time possible. BFRT enables you to increase muscle size and strength at much lower training volumes, to reduce stress on still-healing structures while rapidly restoring muscle performance.

Kineo Intelligent Load System

We use the Kineo intelligent loading system to create customized training and rehabilitation programs for our patients. With Kineo, we can customize variable load protocols for functional training, core training, agility drills and more. The Kineo variable resistance system lets us design a personalized variable load curve based on the needs of the individual patient.

Cryotherapy

Cold therapy has long been used for injury treatment and recovery from sports and exercise. Modern cryotherapy has replaced ice baths and ice packs with a dramatically faster and more convenient technology using nitrogen gas, directed via a specialized device to target injured tissues.

Factors that Increase Your Risk of Tendinopathy

Certain uncontrollable factors can potentially increase your risk of a tendon injury:

Female sex

Women have smaller tendons, with a lower capacity for hypertrophy due to lower protein turnover, lower levels of insulin-like growth factor (IGF-1), and less collagen synthesis in response to exercise. In addition, higher estrogen levels in females reduce tendon stiffness, potentially increasing injury risk.

Age

The ability of tendons to store and release energy diminishes with age. Physical activities that load tendons to the point of fatigue have been shown to cause greater damage to the tendon matrix in older adults.

Preventing Tendon Injuries

There are several things you can do to reduce your risk of tendon injuries:
  • Achieve and maintain a healthy body weight.
  • Optimize your nutrition for protein and collagen synthesis. Bone broth and collagen supplements provide the fundamental building blocks for post-exercise tendon recovery. High-quality protein from grass-fed, pasture-raised and wild-caught beef, poultry and fish are the best sources of amino acids essential to muscle and tendon repair.
  • Drink plenty of water. Dry tendons are less elastic and more likely to rupture.
  • Choose supportive footwear that provides shock absorption, and frequently replace worn athletic shoes.
  • Avoid sudden increases in physical activity or training intensity.
  • Get a biomechanical analysis to trouble-shoot and retrain faulty biomechanics.
  • Allow for ample recovery time after sports and exercise, especially if you have delayed-onset soreness. Most people need at least 48-72 hours to recover from intense physical activity.
Avoid corticosteroids, statins, and other drugs that increase your risk of tendon injuries.
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Leverage Our Innovative Approach to Tendon Rehabilitation

Recent evidence-based methodologies have dramatically changed the way tendinopathies are treated and rehabilitated. At NYDNRehab, we steer clear of invasive surgeries and pharmacological approaches. Our innovative and non-invasive therapies work with the body’s own self-healing mechanisms to optimize treatment outcomes and restore pain-free functional movement.

The tendon clinic at NYDNRehab was created to successfully treat and prevent tendon injuries. Our personalized approach to patient care ensures you get the best one-on-one Physical Therapy, custom-designed for your unique profile. Our expertise in tendon rehab combined with our advanced technologies and methodologies make the tendon clinic at NYDNRehab your top choice for tendinitis treatment in NYC.

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    Tendinopathy FAQs

    How can I tell if my tendon injury is serious enough to seek treatment?
    If you have chronic pain that never goes away or has gotten worse, it’s a good idea to see a tendon specialist. Failure to treat a ruptured tendon could result in degeneration of the tendon tissue that reduces performance and causes undesirable compensation patterns. In the case of posterior tibial tendinopathy, research recommends early and aggressive treatment to prevent tendon degeneration that leads to foot deformities.
    Can an old tendon injury be rehabilitated?
    Tendon injuries that were never properly rehabilitated can cause additional problems anywhere along the kinetic chain. Regenerative therapies have the potential to stimulate tissue healing, even when the injury is several years old. Physical therapy can help improve foot and ankle stability and mobility in cases of posterior tibial tendinopathy.
    Can I return to sports after a serious tendon rupture?
    Prior to getting back on the playing field, you should make sure your tendon is completely rehabilitated. Not only do you need to fully heal damaged tissues, but you should also restore neurodynamics that were disrupted by your injury, to reestablish coordinated muscle firing patterns and reduce your risk of re-injury.
    My tendon stops hurting once I warm up. Is it OK to work out?
    Absence of pain does not always indicate that the tendon is functioning properly. If the pain returns once you cool down, you may have serious tendon damage. Loading a ruptured tendon can make it worse. Best to see a specialist.
    What is the treatment for a detached tendon?
    When a tendon tears away from bone, it must be surgically re-attached, followed by intensive physical therapy to restore its mechanical properties and strength. The clinic at NYDNRehab features some of the most advanced technologies available for rehabilitating tendon injuries.
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    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)

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    Complete tear of rectus femoris
    with large hematoma (blood)

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    Separation of muscle ends due to tear elicited
    on dynamic sonography examination

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