Dr. Lev Kalika

💊 When your back hurts, the last thing you want to think about is exercise. But if you really want to get rid of your chronic low back pain, movement can be the quickest path to recovery.

📰 A brand-new 2024 study published in Nature examined the efficacy of flexion vs extension exercises for treatment of chronic axial low back pain. Participants were 56 adults with an average age of 55 who had suffered from low back pain for 6 months or longer. Baseline pain and functional scales were established, and patients were assigned to either flexion or extension exercise groups. All patients had 4 supervised treatment sessions and were given daily exercises to perform at home.

Results were assessed at 1, 3, 6 months, and 1-year. Findings revealed that extension-based lumbar exercise was more effective in reducing pain than flexion-based exercises at 1-year, supporting lumbar extension as a preferred therapeutic exercise modality for chronic LBP.

🔔 Please note: Exercise alone does not fix patients, and exercises posted on this account are not intended to diagnose, treat, heal or cure physical pain or dysfunction. To find exercises for your specific problem or condition, seek the guidance of a holistic physical therapist or chiropractor with a personalized approach to patient care.

Knee valgus – aka genu valgum – is an anatomical abnormality that causes the knees to cave inward toward the body's midline, a condition commonly known as "knock knees." Valgus knees can seriously interfere with gait mechanics and pose a higher injury risk during sports and physical activity. One new study published in BMJ found that athletes with knee valgus who suffered an ACL injury had a greater risk of a second injury during landing.

An early childhood behavior associated with knee valgus is the "W" sitting position, where the child sits on the floor with knees together and lower legs splayed outward, forming a "W." Children who W-sit are often the bane of ballet teachers and athletic coaches who struggle to improve the child's form. As children age, a propensity for the knees to cave inward can increase their risk of injury and reduce overall athletic performance. Parents of young children should discourage this sitting posture.

📌 A key contributing factor to knee valgus is weak gluteus medius muscles. Located beneath the gluteus maximus, the gluteus medius works as a hip stabilizer and dynamic knee controller in both single and double leg activities, including running, pivoting, cutting, dynamic balancing, and walking.

When it comes to sports, the anterior cruciate ligament (ACL) plays a key role in stabilizing your knee during dynamic movement. Your knee ligaments are pretty tough, able to withstand force loads many times your body mass. That being said, when force exceeds tissue capacity, ruptures can occur.

Standard procedure for ACL tears has long been immediate surgery. But surgery is expensive and poses multiple risks, with no guarantee of successful results. Rather than rushing into surgery, many athletes are opting for conservative care 💊

📌 New therapies and regenerative technologies offer safe and effective ACL rehabilitation without drugs and invasive surgery. While severe ruptures may still require reparative surgery, most ACL tears can be successfully rehabbed by tapping into your body's inherent healing mechanisms with the help of a sports physical therapist.

Home is Where the Heart Is 🏘

I have lived in the United States for nearly a quarter of a century, but in my heart, Odessa is still my home. Even in the midst of a war, the city retains its historic charm and beauty. These photos are from my recent visit to Ukraine 🇺🇦

🧬 The superficial fascia of the pelvic floor is a thin fibrous layer of connective tissue that plays an important role in exteroception – sensory awareness of stimuli outside the body. Pelvic fascia is densely embedded with nerves, making it highly sensitive to stress. It is intricately connected to the genitalia.

Fascia tissue has a high percentage of elastic fibers and a slippery coating of hyaluronan that facilitates the gliding of nerves and blood vessels. The pelvic fascia works together with the transversus abdominis, diaphragm and pelvic floor muscles to optimize abdominal pressure, providing spinal stability.

💊 Pelvic pain is mostly generated from hyperactive nerves embedded in the deep fascia of the pelvis. Other sensory nerves and their endings inhabit the superficial fascia. When your parasympathetic nerves are entrapped in the superficial fascia they become hyperactivated, generating pelvic pain.

When treating pelvic pain, most doctors and therapists focus on injections to block the pudendal nerve, and on manual release of trigger points. But the intimate connection between the deep and superficial fascia layers is largely overlooked in conventional pelvic pain treatment.

📌 Pelvic fascia manipulation therapy not only releases densified layers of superficial and deep fascia to restore gliding, but also calms hyperactivated nerves. Other therapies, such as ultrasound-guided electro acupuncture, are often used in conjunction with fascial manipulation for the neuromodulation of hyperactive pelvic nerves.

🤔 Have you had pelvic pain therapy? Share your experience in the comments!⬇️

👵🏼 The aging process is part of the cycle of life, but you have more control over how well you age than you may think. Billions of dollars are spent each year on anti-aging products, services and devices, but if you really want to stop aging in its tracks, the fastest way to rejuvenate your body is resistance training!

Here's how lifting weights keeps you young:
📌 Builds resilient mitochondria. Mitochondria are the powerhouses of every cell, playing a key role in energy production. A massive body of research indicates that healthy mitochondria play a key role in slowing the aging process.
📌 Stops and reverses sarcopenia. Sarcopenia is the clinical term for muscle wasting, a key characteristic of aging.
📌 Promotes strong connective tissues. Your tendons, ligaments and fascia are made up of mostly collagen. When challenged with progressive overload, your body automatically shores up collagen to support and protect your joints.
📌 Fosters good posture. Bent-over posture is a key characteristic of old age, mostly caused by weak and imbalanced muscles. Weight training is an effective way to restore muscle balance and realign your body, for a more youthful appearance.
📌 Reduces risk of falls and injury. Your muscles and fascia work together to keep your body stable. When you lose your muscle mass, you lose your ability to recover from perturbation caused by changes in terrain or outside forces. Put simply, weight training promotes good balance.
📌 Enhances mood. When you lift, your body releases endorphins that make you feel euphoric.
📌 Combats loneliness. Gym culture is positive, upbeat and welcoming, and a great place to interact with a diverse range of like-minded people.

🔔 Before you start a weight training program, consider a biomechanical analysis to correct any mechanical issues that can prevent you from getting the most out of your workout.

I recently came across this photo of my Eagle Scout son and Fedor as a puppy 🐶🐾 Hard to believe it was 8 years ago!

It reminds me to appreciate every moment with the people and pets I love – the only constant in life is change, so embrace every moment!

When it comes to joint health, ligaments and tendons take center stage as the stars of joint stability. But behind the scenes, fascia is the real workhorse of overall stability, connecting your body’s structures from head to toe, and affecting every bone, nerve, muscle, blood vessel, lymph node and organ.

🤔 So what exactly is fascia? 
Fascia is a thin tough sheath of connective tissue made up of layered collagen fiber bundles, interspersed with elastic fibers, and lubricated by hyaluronan, a slippery fluid infused with water molecules. Fascia encases individual muscles, muscle groups and muscle fibers, creating a tensile network of pliable tissue that connects structures throughout your body. Fascia tissue is highly innervated, constantly informing the brain of the body’s movements and making it a major pain producer when injured. 

💊 Fascia’s tensile integrity – aka tensegrity – is its main functional property. Tensegrity supports your muscles as they contract in coordinated patterns to produce movement. It provides a strong and pliable framework that helps to absorb and distribute forces during physical activity.  

Healthy fascia is smooth, slippery and elastic, enabling nerves and blood vessels to glide among other structures and reducing friction among soft tissues and bony structures. But when injured, neglected or deprived of water and nutrients, fascia can start to densify, losing its elastic properties and becoming sticky, sometimes adhering to other structures.

🧬 Densified fascia restricts movement, compresses nerves and blood vessels and alters muscle firing patterns. Over time, densified fascia can cause muscle weakness and inhibit range of motion. It can create balance issues, cause joint wear-and-tear, produce chronic pain and dysfunction, and even interfere with vital
organs.

Learning from the World’s Best 🌍🔬

I recently had the pleasure of participating in the cadaver course at Sonoanatomy XVI, held at the University of Barcelona, January 18-19, 2024. Thanks to dedicated experts like my friends and colleagues, and to advancements in technology, musculoskeletal ultrasonography is gaining traction as the premier mode of visualizing the body’s structures. It was an honor to rub elbows with some of the world’s most renowned radiologists, and a special treat to work alongside Ingrid Moller, one of the world’s greatest anatomists.🫀

I am eagerly looking forward to the 21st International Congress of Endocrinology in March, in Dubai UAE, where our recent research will be presented. This year the Conference theme focuses on obesity and its associated pathologies.

Our paper, “Ultrasound Assessment of Collagen Content in Contracted and Non-Contracted Muscle Areas: A Comparative Study,” discusses the efficacy of ultrasound imaging in detecting the prevalence of collagen fibers in the muscles of obese and diabetic patients.

The extracellular matrix (ECM) is a dynamic network of collagen fibers and biologically active factors that provides structural support in the extracellular environment of muscles. As a protective mechanism, the ECM helps to maintain normal tissue function, and remodels in response to injuries and inflammation to facilitate wound healing.

The ECM also remodels in response to obesity, to provide structural support to overloaded tissues. However, in obese patients, persistent expansion of the ECM can evolve into maladaptive fibrosis – a condition that can cause muscle weakness and lead to the formation of scar tissue.

It is extremely gratifying to conduct research in my area of expertise, knowing that my contribution to the scientific community can improve the health and wellbeing of patients around the world.

May your holidays sparkle with joy and laughter! Merry Christmas 🎄 ☃️

Osteoarthritis (OA) is a painful and debilitating pro-inflammatory condition where cartilage within a joint erodes over time. The NIH reports that the world-wide prevalence of knee OA in 2020 was 16.0% in individuals over age 15, and 22.9 % in people over age 40.

Medical doctors try to manage OA pain with steroid injections and non-steroidal anti-inflammatory drugs (NSAIDs) until knee replacement surgery becomes inevitable. ❗️But those treatments actually worsen the symptoms of OA and accelerate cartilage erosion.

With one-fifth of the world’s population suffering from OA and growing concerns about pain medications, people are searching for holistic alternative therapies that treat OA pain and regenerate cartilage without drugs or surgery.

A holistic approach to OA includes lifestyle modification, physical therapy and cartilage regenerative therapy. Regenerative therapies can dramatically reduce joint pain, encourage the regrowth of healthy cartilage, and help to restore optimal joint function.

Four evidence-based therapies to slow or even halt the progression of OA are:
📌 Fascia manipulation therapy:
📌 Extracorporeal shockwave therapy (ESWT):
📌 Platelet rich plasma (PRP) injections
📌 Hyaluronic acid (HA) injections

🔔 At NYDNRehab, our shockwave and injection therapies are guided by ultrasound imaging, ensuring accurate delivery of ESWT, HA and PRP to the joint capsule. We use the Stecco method of fascia manipulation to restore joint integrity. Our approach to OA therapy helps patients regain pain-free mobility and dramatically enhances their quality of life.

One of my favorite mottos is “What cannot be measured cannot be successfully treated.” At NYDNRehab, we have multiple tools at our disposal to accurately measure
parameters of human movement. With our tools and technologies, we are able to create an objective baseline profile for every patient, which we then use to measure their progress and gauge the success of our treatment protocols.

Without objective analysis and monitoring, patients are often set on the wrong path with ineffective therapies that can sometimes do more harm than good. In addition to gold-standard assessments, we use diagnostic ultrasonography to confirm our prognosis and visualize changes in tissues and structures. Our technologies take the guesswork out of therapy and accelerate the healing process.

Running Gait Retraining 🔎

Our running lab is one of the most advanced in NYC. With running injuries estimated to impact upwards of 50 percent of runners per year (according to Yale Medicine), 3D running gait analysis and retraining helps runners to avoid injuries while dramatically enhancing their performance.

Our state-of-the-art running lab is equipped with research-grade technologies that are rarely found in a private clinic. We are able to measure joint angles, mass distribution, ground reaction forces and other parameters in three planes of motion. 3D analysis is a game-changer because it reveals deficits in the transverse plane where most running injuries occur. Any runner, from novice beginner to elite competitor, can benefit from periodic 3D running analysis.

One of the favorite parts of my career is the opportunity to travel and re-connect with friends and colleagues. Here I am attending a conference in beautiful Almaty, Kazakhstan with its breathtaking mountain views! 🏔️

👤The human body has its own electromagnetic fields that synchronize with the earth’s natural energy fields. When the body’s energy fields are disrupted by injury, illness, environmental toxins or medications, it can lead to pain syndromes, movement disorders, and chronic metabolic conditions that undermine health.

⚠️ Extracorporeal Magnetic Transduction Therapy (EMTT) is a new technology that
transmits high energy magnetic pulses to targeted tissues, synchronizing with the body’s own magnetic fields to trigger a regenerative response at the cellular level. EMTT waves activate the body’s own innate healing mechanisms to accelerate patient recovery and restore optimal function.

At NYDNRehab, we use EMTT and other regenerative therapies to pre-treat injured tissues prior to beginning physical therapy. EMTT waves can pe*****te deep tissues to target difficult-to-reach tendons, muscles, bones and nerves

The Healing Power of Electromagnetic Fields 💊

Master of Energy Nicola Tesla famously said, “If you want to find the secrets of the universe, think in terms of energy, frequency and vibration.” Decades later, we are finally understanding how energy, frequency and vibration affect human health, and we are learning to harness their power for healing.

It all begins with your heart, which generates electric current that runs through your entire body, to every cell. Whenever electric current flows, it generates a magnetic field that synchronizes with that of the earth. Electromagnetic fields enable signal transmissions within and between cells that regulate all bodily functions.

Most of the body’s electromagnetic activity takes place in the cell membrane, where ions move in and out of membrane channels, altering the electrical charge (potential) of the cell membrane. This is a continual process that enables cellular communication and function.

If some type of interference occurs that disrupts the body’s electromagnetic currents – say an injury or illness – pain and dysfunction arise. New technologies enable us to stimulate and accelerate tissue healing at the cellular level by delivering electromagnetic impulses to damaged cells. Such technologies can also help to restore neural signaling between the brain and body, and to calm hypersensitized nerves.

📌 Extracorporeal Magnetic Transduction Therapy (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.

📌 INDIBA Radiofrequency Therapy helps to restore the ionic charge of damaged cells, for faster injury healing and rehabilitation.

📌 EMTT and INDIBA are just two of the regenerative technologies we use at NYDNRehab to promote healing and restore functional pain-free movement.

Nature itself is the best physician 🌱

Plantar fasciitis is a common condition that can be extremely painful and debilitating. Traditional treatment for PF often involves stretching, steroid injections, taping, and orthotics, but those approaches do not provide immediate relief. In many cases, the condition is misdiagnosed based on symptoms alone, hence efforts to resolve it are futile.

In fact, only a small amount of patients with pf have self-resolution, although it can take months, sometimes years, so it is unclear whether conventional treatments have any significant effect at all.

⚠️ At NYDNRehab, we treat the patient, not just their symptoms. Our high-resolution diagnostic ultrasound equipment lets us visualize the heel and plantar fascia in detail to identify myofascial trigger points, heel spurs, stress fractures, plantar fat pad ruptures, nerve entrapments mimicking heel pain, and other issues that contribute to – plantar fasciitis.

Once we have an accurate diagnosis, we use our advanced technologies and cutting edge approaches to jumpstart the healing process. Our patients notice significant pain relief after the first session, and their pain is often completely gone after the second or third session. Accurate diagnosis + cutting edge treatment = successful outcomes! ☺️

For most people, having good flexibility is considered desirable – it enhances mobility and allows for good functional joint range of motion. But some people have hypermobile joints that extend beyond normal range of motion. While extremely mobile joints can be an asset in activities like ballet, gymnastics and yoga, excessively mobility can create joint instability, increasing your risk of injury. People with joint hypermobility are often unable to participate in sports and other physical activities that require balanced measures of stability and mobility. They may move awkwardly and be prone to falls and accidents.

We use a variety of approaches to treat hypermobile joints:
🔸Specialized physical therapy to strengthen supporting tissues and structures
🔹Dynamic neuromuscular stabilization (DNS) to promote global joint control and stabilization
Integrated Systems Model (ISM) for local control and stabilization
🔸Ultrasound imaging for guided muscle activation training
🔹Posture correction therapy to realign joints and minimize stress
🔸Gait analysis and retraining to correct motor deficiencies that increase your risk of walking or running injuries
🔹Sport-specific training to increase joint stability and reduce your risk of injury

⚠️ Do you or someone you know have hypermobile joints? What problems do they create? Like, share and comment!

🦮🧡 Dogs are not our whole life, but they make our lives whole
– Roger Caras

❗️Proteus Motion System for Sale❗️

The Proteus Motion System is the perfect equipment for testing and quantifying dynamic strength and power. It also provides a revolutionary tool for skills training, with real-time feedback that measures strength, speed, and power throughout your range of motion.

Benefits of Proteus training include:
📌 Constant resistance throughout the entire movement pattern
📌 Concentric resistance in both directions during each repetition
📌 Full body engagement, for sport-specific training
📌 Adapts to your unique movement patterns, reducing stress on joints

This system is in excellent condition. To purchase or for pricing info, contact me via DM or call me at 917-880-0138.

❗️Redcord Therapy System for Sale❗️

Redcord is an innovative system of elastic resistance based on the NEURAC (neuromuscular activation) method of total body training. It is a painless, holistic approach to treating musculoskeletal conditions that allows for gradual exercise progression. 

This system is in excellent condition. To purchase or for pricing info, contact me via DM or call me at 917-880-0138.



Surface electromyography (SEMG) gives us information on the myoelectric output of muscles. Muscle firing patterns determine the quality of movement. For optimal high-quality movement, muscles must fire in a specific coordinated sequence. 

When injuries occur, your neuromuscular system adapts by creating compensation patterns to reduce the load on injured tissues. However, once tissues are fully healed, compensation patterns remain in place. To restore optimal movement, we must retrain the brain-muscle connections that were disrupted☝🏼 

SEMG allows us to identify and quantify erratic muscle firing patterns via electrodes attached strategically to the skin’s surface. We then use that information for feedback retraining to eliminate compensation patterns and optimize performance.

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.

Kineo provides real-time quantitative feedback on movement quality, helping the patient to correct and fine-tune inefficient motor patterns that lead to pain and injury. The system helps athletes to eliminate compensation patterns developed post-injury and restore optimal performance.



We had a new patient who presented with pain in the lateral (outer) foot. He had previously been treated by a physical therapist and later a chiropractor with a diagnosis of cuboid syndrome.

☝🏼Cuboid syndrome occurs when the cuboid bone moves out of alignment, often as a result of injury or trauma to the joint and/or ligaments surrounding the small tarsal bone on the lateral side of the foot.

When symptoms persist after treatment, it’s time to take a look inside. Diagnostic ultrasonography is the best friend of any clinician treating musculoskeletal conditions, whether it is an orthopedic surgeon or a chiropractor👨🏻‍⚕️

But recent statistics show that fewer than 5% of orthopedic surgeons, podiatrists, chiropractors and physical therapists have true expertise in diagnostic ultrasonography. Statistics are somewhat better among pain management specialists, and is best with young sports medicine doctors have the greatest expertise in ultrasound imaging.

It is projected that it will be 5-10 years before the majority of musculoskeletal practitioners adopt ultrasound use on a regular basis. Yet diagnostic musculoskeletal sonography is the equivalent of a stethoscope for any musculoskeletal practitioner.

🦶🏻The Os Peroneum is an “extra bone” in the foot, located next to the calcaneocuboid joint and embedded within the peroneus brevis tendon. The OS peroneum can become symptomatic, presenting as lateral foot pain and tenderness, a condition known as OS peroneum syndrome. It may arise due to a fracture or degeneration of the ossicle, or as a result of friction and increased pressure within the peroneus brevis tendon.

Ultrasonography can reveal this condition, but it requires a lot of experience compared to MRI or X-ray. In this instance, we can see a fragmented ossicle, which is a sign of degeneration.

In other words, the patient had been misdiagnosed and treated for the WRONG CONDITION. This case presents a prime example of why ultrasound is an essential diagnostic tool for musculoskeletal practitioners.

Have you ever been misdiagnosed? Share your story in the comments below ⬇️