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Head/Neck Pain

Experience a completely different approach to long-term head or neck pain-relief. Connect the dots from the deepest root & eliminate your pain from the source.

Elbow Pain

Experience a completely different approach to long-term elbow pain-relief. Connect the dots from the deepest root & eliminate your pain from the source.

Foot/Ankle Pain

Experience a completely different approach to long-term foot or ankle pain-relief. Connect the dots from the deepest root & eliminate your pain from the source.

Shoulder Pain

Experience a completely different approach to long-term shoulder pain-relief. Connect the dots from the deepest root & eliminate your pain from the source.

Hip Pain

Experience a completely different approach to long-term hip pain-relief. Connect the dots from the deepest root & eliminate your pain from the source.

Knee Pain

Experience a completely different approach to long-term knee pain-relief. Connect the dots from the deepest root & eliminate your pain from the source.

Back Pain

Experience a completely different approach to long-term back pain-relief. Connect the dots from the deepest root & eliminate your pain from the source.

The Only Way to
Long-Term Pain Relief

You’ve tried everything, but why hasn’t it worked? 

You may have experienced 1 or all of the following:

  • They told you to stretch because you had “tight muscles”
  • They gave you exercises because you had “weak muscles” 
  • You went and got adjusted because there was some “misalignment”
  • You received surgery because they found a “tear” 

These methods only give temporary relief because they are just fighting the symptoms and not connecting the dots from the deepest root. The body is too complex for such a basic approach. 

You need a specialized solution that will treat the body as a whole and get to the root cause of your pain.

Conditions Treated

  • ACL injury
  • Arthritis & Joint Pain
  • Broken/Fractured Bone
  • Bursitis
  • Collateral Ligament Injury
  • “Jumper’s Knee”
  • Knee Dislocation
  • Meniscus Tear
  • Osgood Schlatter’s
  • Patellofemoral Pain Syndrome
  • Patella Chondromalacia
  • Patellar Maltracking
  • Patellar Tendinits
  • Post-Surgical Rehab
  • “Runner’s Knee”
  • Tendon Tears
  • TFL Syndrome
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Your Guide To Returning To Squatting After A Knee Injury
If you’re going to be pushing the envelope on strength training and challenging your limits to produce force or handle a substantial amount of exercise involving a high amount of force, you’re not always going to be feeling great physically.  Exercise is a stress on the body. Stress can be both a potential positive, and a potential negative, based on how the body responds to it.  Everyone’s ability to take a physical stress from exercise and adapt to it is different based on a whole host of variables. This is why not everyone has the same response to the same exact fitness or training program.  In the case of chasing improved ability to squat heavier weights, something that may arise is symptoms in and around the knee with increased loading or periods of intensity. This might commonly be called an “overuse injury” – which is just an over-accumulation of physical stress on an area of the body that is larger than it can buffer and have a positive reaction to.  If your symptoms seem to improve with rest but come back as soon as your intensity (the amount of force you are having to produce) or volume (the total amount of pounds lifted), only resting will NOT help you continue to chase your ability to train intensely. Rest WILL give your body more time to recover and heal, but it will not help your knee learn to handle increasing amounts of force, or to be able to absorb and produce force in different ways.  Here are some of my go-to methods, and my reasoning for why we are applying them, to help someone’s knee become more resilient when returning from a training related knee injury.  1) Use cable assisted split squats to improve the ability for the knee to absorb force [embed]https://www.youtube.com/watch?v=n1p8nYAR4zM[/embed] Split squats are a useful way to train loading each leg with a bias towards the front leg. They aren’t true single leg loading because both feet are on the ground, but split squats bias loading towards the front leg.  The front foot elevated version shifts some of the weight off of the front leg to make it more of a 55%, 45% distribution of weight between the front and back legs.  The force of the cable helps to reduce your body weight slightly and allow you to load your knee in deeper ranges of motion than traditional bilateral squatting can sometimes allow, while assisting in helping to distribute the load between your hips and ankles.  This is especially useful when we need to rebuild your confidence in being able to load your knee and is a very friendly variation when we are first reteaching your knee to absorb force, and to help the structures above and below the knee do their part so less focal stress gets put onto only your knee.  2) Use regular split squats to load the knee more aggressively  A split squat without the lead leg elevated will let the shin move more forward relative to the ankle, which will put more force into your knee.  I’ll start programming regular split squats into client’s programs once they are performing front foot elevated variations without any pain or hesitation with an emphasis on having them being able to do sets of higher volumes (12 to 15 reps) with moderate load.  3) Reintroduce bilateral squatting with an emphasis on absorbing force first  [embed]https://www.youtube.com/watch?v=wjk8LYtZy34[/embed] The box squat is a great way to get back to a symmetrical stance squatting activity and can be tweaked in many ways to change how quickly the knee is loaded.  Starting with a box squat, you can use moderately heavy loads mimicking your training weight and work on a complete rock back onto the box.  A simple way to progress this is to use a progressively smaller box so you use greater ranges of motion over time as your body allows you to.  Come to a complete stop on the box, then push the floor away and return to the starting position.  4) Reintroduce training load of squatting without any constraints Now that we’ve improved tolerance of the knee to loading in several different ways, we must reintroduce the actual movement without any constraints so that, using the principles of Physical Stress Theory, your knee can be exposed to and adapt to the specific forces it experiences when doing your desired squatting movement.  The big takeaway from this article is that experiencing overuse injury type knee pain during a squat can be common. Rest has its place at times, but it is no substitution for making sure that your body is able to absorb and create force under many different situations to have a knee capable of doing many different physical tasks.  Try some of the activities we talked about above, and reach out to your trusted coach or physical therapist if you need specific guidance customized to your unique situation! 
Patellofemoral Pain Syndrome (PFPS): It May Not Be About Your Knee
If you’re here to read about your knee, you’ve come to the wrong place. We’re not here to talk about your hips and ankles either. Ok, that’s not ENTIRELY true, but we’re here mostly to talk about your diagnosis; patellofemoral pain syndrome, or PFPS for short, which typically describes pain in the front of your knee. Unfortunately, PFPS is more of a description than an actual diagnosis. Before we dive any deeper, let’s talk quickly about the relevant anatomy. A joint exists anywhere that bones meet, and your knee is no different. The knee joint is where your femur (thigh bone) and tibia (shin bone) meet. From the outside it might look like your knee bends and straightens like a door hinge, but it doesn’t. Your knee, just like every other joint in your body, works via rotation. As you straighten your knee the femur rotates inwards while the tibia rotates out; bending your knee goes the other direction. The top of your tibia is a relatively flat plateau, and the bottom of your femur looks like two big knuckles resting on top. How does your knee stay together? You can thank your ligaments and muscles for that. There are a lot of muscles that control the position and orientation of your knee, but the group most commonly discussed in PFPS is the quadriceps. That’s because the patella, or kneecap, literally floats within the tendon. Now that we know what we’re looking at, let’s discuss how none of that really matters. What really matters is force management. As your foot hits the ground the shock must travel up the leg and through the body, you then drive a return force back through the body and into the ground so you can push off. This is called walking, and when you do it really fast, running. The same rules apply when lifting weights, even if your feet never leave the ground. How efficiently you absorb and redistribute forces determines how much strain the joint, muscles, and ligaments take on. Don’t go worrying about “wear and tear”. Tissue strain is a completely normal part of being a human and is critically important for building a strong body. One of the hallmarks of being a living organism is the ability to self-heal. In a typical scenario you would use your body to move around in the world, tissues get stressed out, and then you heal and recover with food and rest. The problem is when the stress you take on begins to exceed your ability to recover from it. You can think of it like a budget where you’re slowly going into debt. This debt, over time, is what leads to the pain you’re feeling. When you started reading this article I said that PFPS is a description and not a diagnosis. What I meant was that PFPS tells you what hurts, it doesn’t tell you why it hurts. The diagnosis itself therefore has little to do with how you treat it. Typical advice for PFPS is to strengthen your quadriceps, hamstrings, calves, and glutes. The idea is that stronger muscles will both help you to resist force better and allow you to take on more strain before going into debt. For many reasons that go beyond the scope of this article, that approach is short-sighted. Strength training is an essential part of the rehab process, but it needs to be applied at the right time and for the right reasons. The strongest muscles on earth don’t mean a thing if they don’t turn on at the right time, in the right sequence, and coordinate with muscles throughout the rest of your body. There are a lot of people who get complete relief through strength training alone, but if you’ve gone the strengthening route and are still having pain you missed something. Even if you have an old injury - a torn meniscus, arthritis, an injured or missing ligament - it might not matter when it comes to your pain. Address and improve the way you manage forces through the knee, and you will be surprised at how much you can improve. If you’re reading this and have anterior knee pain that just won’t quit, I hope you now see that you don’t have to be stuck with it forever. All mechanical pain has a source, and with the right approach you can absolutely solve it.
Why Stretching Isn’t Working: Hamstring Edition
Stretching is something a lot of us do, but have we ever thought about why? Of course we have. The muscle is tight, so to fix it we stretch it. That makes sense, if the only reason why a muscle is “tight” or “restricted” is because it was shortened and we have to stretch it to elongate it. What happens if the reason why it’s “tight” is not because the muscle is actually shortened. If that’s the case what good is stretching it. Hear me out. To help illustrate this and help this make more sense, let’s use the hamstrings as an example.  And don’t worry at the end of this I will show you my Top 3 Exercises To Fix “Tight” Hamstrings.  Almost everyone has tight hamstrings and stretches their hamstrings. Common tests we use to assess the hamstrings are the active straight leg raise or the toe touch. We all probably remember the sit and reach test in physical education class as kids too. Do they still do that?    Anyways, if you couldn’t lift your leg straight, touch your toes or reach far down the ruler, you were told you have tight hamstrings and you had to stretch them.  Just because it’s tight doesn’t mean the solution is stretching!  How many of you have stretched and stretched, but never saw much change or any real lasting change? If stretching doesn’t change it, maybe the muscle isn’t shortened and stretching isn’t the answer. What is it then? “Because I really do feel tension and tightness in the back of my leg when I try to touch my toes or when someone lifts my leg up”. I believe the tension and tightness individuals feel are real, I’m not saying it isn’t, but the reason is not because the muscle is shortened.  One thing we need to look at and appreciate is POSITION. To understand this, it comes back down to anatomy and neuro, like most things do. Let’s take a look at the hamstrings... The hamstrings originate on the ischial tuberosity of the pelvis, or the “sit bone”. They insert across the knee joint at the tibia or fibula, the lower leg bones.   Think of the hamstrings as a rubber band that extends from the butt down to the back of the lower leg.  When you bring the leg up, like in the straight leg raise, we can see how you put tension on, stretch, or elongate the hamstring. Remember though, while it inserts into the lower leg, it originates at the pelvis, so the position and orientation of the pelvis will have an effect on tensioning the hamstrings as well. Pelvis Position: Let’s say someone starts in an anterior pelvic tilt. That means the pelvis is tipped and rolled forward. If the pelvis is rolled forward and anteriorly tilted, that will put the hamstrings on tension. If an individual naturally stands, sits, or lays down with an anterior pelvic tilt, that means their hamstrings are already on tension, and the rubber band is stretched. So when you go and try to reach for your toes or you go and lift the leg up, you feel a pull before you’re able to touch your fingers to the floor or straighten your leg out. This is because your brain and your body is stopping to protect you!  Figure 5: The picture above illustrates the influence of pelvis position on hamstrings. On the left, the pelvis is neutral and balanced. On the right the pelvis is anteriorly tilted and tipped forward. Observe how the black line (hamstrings), is longer. Again, based on your pelvis’s position (anteriorly tilted), your hamstrings are already on a tension and “stretched”, so when you try and ask your body for more and more, eventually it will stop and not let you. If you haven’t found success with stretching, before you stretch and stretch, or have someone jump on your back and push your down, please take a look at and appreciate position.  Get your body into a better position and then check and see if you still have the problem. If this is you, correcting something like an anterior pelvic tilt or getting out of an over extended posture, will not only help your mobility, but probably your pain if you’re experiencing any, and your risk of injury.  Disclaimer: I’m not saying stretching is bad. There are many benefits to and it is necessary to have good tissue quality, elasticity, and durability, but if you aren’t having success with improving your mobility by stretching, you may be attacking your issue wrong. Click here to learn my Top 3 Exercises To Fix “Tight Hamstrings”
Why Bands Aren’t Helping Weak Hips
Many people are told that their knee pain, hip pain, or low back pain is due to weakness in their hips. This is often determined after strength tests show weakness in the ability to use muscles like your glutes, which are important for hip and pelvis stability. The fix is often doing banded hip strengthening exercises, such as putting the band around your legs and doing sideways steps, or exercises such as clamshells. However, these exercises often fall short and don’t actually help reduce pain. Let’s dig into why that might be, and what would be a more appropriate and successful approach.  The first thing to understand is that all muscles have what’s referred to as a “Length-Tension Relationship”. What this means is that the amount of tension that a muscle is able to produce (aka force or strength) is dependent on its length. An easy way to think about this is to imagine you’re doing a pull up. If you start from a dead hang at the very bottom, it is difficult to initiate the force required to start your pullup. However, if you “cheat” and start with your arms already bent, you’ll notice it’s much easier. At the top of the pullup, you will also notice the last 10% tends to be the hardest, when you are fighting to get your chin over the bar. Here it is clear to see that the range in the middle of the movement is the easiest, and you feel the strongest. The reason for this is when you’re at the bottom of the pullup hanging, your muscles are fully stretched and in as long of a position as possible. At the top, they are fully contracted and shortened. Neither fully stretched or fully contracted are ideal positions to generate force from. Just like goldilocks – something right in the middle is ideal to produce as much force as possible.  The science behind this is simple if you understand how a muscle contracts. Within muscle fibers, there are tiny filaments called actin and myosin. These filaments lie parallel to each other, creating the “fiber” of your muscle. Small arms called “myosin heads” reach forward from the myosin and attach to the actin, then pull the actin together to cause the muscle to shorten and squeeze. The picture below will help demonstrate this.  If a muscle is stretched out there will be less overlap between the actin and myosin, and therefore there cannot be as many cross bridge connections and it is harder to contract the muscle. Likewise, if a muscle is fully shortened or squeezing, there is not much more room for the myosin to pull the actin together, as it is nearly all the way together. In either case, this results in lower force production even with higher efforts. The chart below demonstrates the highest force production happens around the middle point of a muscle length.  Now let’s go back to looking at your “weak” hips. While sometimes there are true weaknesses in the hips, this can easily be exacerbated by the position of your hips. If your glutes for instance are extremely tight and rest in more of a contracted position, it will be hard for them to squeeze any further, and will present as “weak”. Likewise, if your glutes are in a more stretched position there won’t be enough overlap to create a strong contraction. These resting positions are influenced not by “tight” or “loose” muscles, but rather tight or loose muscles are a result of the underlying position that they are held in based on the position of your pelvis. This is something that can be easily assessed and screened for in a discovery session at Next Level.  If we do find that the position of your hips is contributing to your “weakness”, the solution is not to just add a band around your knees and try to strengthen your glutes. If anything, this may even contribute further, especially if you are someone who is already in an over contracted state; this old-school strengthening approach may actually be further exacerbating your inability to create force from your hips.  Instead, the first priority should be getting your hips in that nice middle ground, like the goldilocks example, so that your hips will feel like you’re at that mid range of a pullup – strong, healthy, and supported. The right exercises to do this will require a deeper assessment to determine the position of your hips, where we can determine if the muscles are starting in a contracted or relaxed position, from which we can determine the best next steps to get you back to neutral. After that, then we can reinforce this position with strengthening exercises that will help not hurt you, and get you back to 100%. Whether you have knee, hip, or back pain, or are just feeling like you aren’t able to perform at your highest level, addressing these restrictions can help unlock your ability to finally progress. 

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Reviews

Rob L.
Powerlifter

As a 46 yr old competitive power lifter and police officer I was very skeptical that anyone could help me with the serious pain in my knees. After the pain in my right knee started to effect my daily life and my mobility resulting in a close call at the gym I decided to take a chance on next level. From day one I knew I was in the right place. Dr. Ben understood my goals and concerns. I was surprised how much he knew about power lifting. Starting out slow he watched some of my videos and was able to break them down. Working on my flexibility he had me squatting without pain in a few weeks. During training I had a setback with my shoulder but Dr Ben was able to quickly adjust and had me ready for a meet in a couple weeks where I set records in my class and federation. This is not a place where they take your money and have you squeeze a ball for ten minutes. They are the real thing. I’m very grateful that I gave them a try!

Mike B.
Runner

I am a 52 year old runner and coach. I was experiencing knee pain and lower leg weakness about 8 weeks into my training for the Shamrock Marathon (my first marathon in 10 years). I saw that Next Level Physical Therapy had opened in Southampton, PA and made an appointment to be evaluated. Dr Artem Imnadze was great to work with. After discussing my symptoms & history and physical evaluation we started to design a program to that would not just get me to the starting line but would allow me to continue running. Success!. I was able to finished the marathon within my goal time. I will continue to follow up with Dr Imnadze as needed for continued healthy running. Nicolette was great at getting me scheduled around my work schedule and always greeted me with a smile. I highly recommend Next Level Physical Therapy!

Marla G.
Active Adult

If I can give 10 stars, I will. This team is the gold standard of physical therapy services.

I am 53 and quite active. I love zumba, hiphop, biking, swimming and walking. However, I have had many unaddressed injuries in the past which finally caught up with me. I found myself with progressive knee and hip pain on my right side to the point that I wake up in the middle of the night with throbbing pain and unable to sleep. I still managed to do my regular brisk walks but I tried to stay away from dancing. I also felt pain going up and down the stairs, so I had to hold on to the railing and proceed one step at a time going down, or having to pull myself when going up the stairs. I avoided sitting or squat down to the floor because it was so difficult to get up. I would have to get on all fours and pull myself up.
Xrays showed nothing wrong with my knee and hip, so physical therapy was prescribed. I have tried a couple of physical therapy facilities where I was on heat packs, ice packs, a water massage bed, TENS device and the usual exercises. I was given a piece of paper with exercises to do at home. Nothing seemed to help. I just chalked this up to getting old, as my friends also complained about body aches and pains.
One day, I saw a Youtube advertisement about Next Level Physical Therapy. While I felt that they were really geared towards athletes,, I decided to just sign up for a discovery visit. I thought this would be my final attempt at physical therapy. I met with Dr. Leor who explained their holistic approach and how it is different from the usual physical therapy sessions that people go to. Since I have and engineering background, we talked a lot about physics and how the body follows the tensegrity structural principle. I decided to get a more comprehensive assessment the following week and signed up for the program. I could tell this would be a different experience from my previous PT sessions.
Dr. Leor was the one who worked with me. He created a personalized plan to address my issues. He is very knowledgeable and takes the time to explain each of the techniques, why he is asking me to do them and which muscles I should feel engaging in the movement. In addition to his scientific know-how, he is also intuitive in that he is able to connect the dots as to what is causing my pain. He is very patient and makes sure that the movement are executed correctly. When I run into movements that will cause pain on my knee or hip, he would figure out how to adjust the position (or the exercise) to make sure I was executing it without pain. Halfway through my program, I felt less knee and hip pain, I felt a lot stronger and moved a lot better. I learned how to do resets if I had some soreness. By the end of the program, my hip and knee are pain-free, I can squat and stand up with no problem at all, I have regained my inner strength and confidence and I am back to Zumba, hiphop and Bollywood dancing. Next Level has really brought me to a level I never thought possible. Thank you, Dr Leor and team!
Do try them out! Your search is over. They will be the last physical therapists you would need to see.

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