Rotator Cuff & Shoulder Pain
Trigger points in the infraspinatus and supraspinatus mimic and perpetuate rotator cuff pain. Releasing them restores pain-free range so the strengthening work can actually take hold. See shoulder pain treatment.
Manual Therapy · Fells Point
Dry Needling in Baltimore, for the knots massage can't reach.
Rotator cuff pain. Piriformis syndrome. Patellar tendinopathy. Sciatica. IT band tightness. Plantar fasciitis. The trigger points behind these conditions sit deep in the muscle, and if you've already tried massage or acupuncture without lasting results, that depth is exactly the problem. I'm Maksim Birikov, DPT, and dry needling is the most requested treatment at my Fells Point studio, minutes from Canton, Butchers Hill, and Harbor East.
The Mechanism
What Is Dry Needling and How Does It Work?
A myofascial trigger point is a band of muscle fibers locked in contraction, the "knot" you can feel but can't release. It restricts blood flow, irritates local nerves, and refers pain to places that seem unrelated: a trigger point in your glute can send pain down your leg that feels exactly like sciatica.
Dry needling puts a thin filament needle directly into that trigger point. The needle provokes a local twitch response, a brief, involuntary contraction that resets the fibers, releases the contraction, and restores blood flow to tissue that's been starved of it. "Dry" simply means nothing is injected. The needle itself is the treatment.
This is why it works when other things haven't: massage and foam rolling treat the surface tissue; dry needling targets the neuromuscular trigger point directly. The precision isn't in the needle, it's in the assessment. As a DPT, I identify the specific trigger point driving your pain through clinical evaluation, not guesswork. That's usually the difference between "I've tried dry needling and it didn't work" and results that hold.
Where It Works
Conditions Dry Needling Treats at Physica Medica
Sciatica & Piriformis Syndrome
When the piriformis clamps down on the sciatic nerve, needling the trigger point releases the compression at its source, often within a few sessions. Related: sciatica treatment and neural tension release.
Low Back Pain
Chronic back pain often lives in the deep spinal stabilizers: quadratus lumborum, multifidus. These are muscles too deep for hands to treat effectively. Needling reaches them. See back pain treatment.
Tension Headaches & Migraines
Trigger points in the upper traps and suboccipitals refer pain directly into the head. Releasing them reduces both frequency and intensity. See headache treatment.
IT Band Syndrome & Knee Pain
The IT band itself doesn't "stretch." The tension comes from the TFL and glute. Needling those drivers, plus patellar tendinopathy work at the quad, changes what years of foam rolling couldn't.
Plantar Fasciitis
Heel pain often starts in the calf. Trigger points in the gastrocnemius and soleus overload the plantar fascia, and treating them takes the strain off the foot. See plantar fasciitis treatment.
The Session
What to Expect During Your Session
Afraid of needles? You're in good company. Half my dry needling patients were too. Here's exactly what happens, so nothing is a surprise.
01
Assessment first, always
I evaluate your movement, palpate the tissue, and identify the specific trigger points driving your symptoms. I review your medical history first. If dry needling isn't appropriate for you, I'll tell you directly and we'll use a different tool.
02
The needle goes in
The needles are sterile, single-use, and far thinner than a hypodermic needle. Most patients don't feel the insertion at all. What you will feel is the twitch response: a quick, deep cramp-and-release. Odd, brief, and for most people, satisfying. That's the knot letting go.
03
Integrated follow-through
Needling is never the whole session. In the same hour I follow it with manual therapy and targeted movement work, so the released muscle learns a better pattern immediately. This is why results hold instead of fading in two days.
04
The next 48 hours
Expect mild soreness for a day or two, like a hard workout, not an injury. It's a normal sign of trigger point release. Most patients feel a clear change in pain or range of motion within one to three sessions.
A Common Confusion
Dry Needling vs. Acupuncture: Key Differences
Same needle, entirely different discipline. If acupuncture didn't help your muscle pain, that says nothing about whether dry needling will.
What I Practice
Dry Needling
- Based on Western neuroanatomy: muscles, nerves, and referred pain patterns.
- Targets specific trigger points identified through hands-on clinical assessment.
- Goal: release the contraction, producing measurable change in pain and range of motion.
- Performed by a DPT as one tool inside a complete treatment plan.
A Different Discipline
Acupuncture
- Based on traditional Chinese medicine: meridians and energy flow.
- Needle placement follows mapped points, not palpated muscle dysfunction.
- Goal: restore systemic balance, a broader, wellness-oriented aim.
- A legitimate practice, but not a treatment for myofascial trigger points.
Straight Answer
Is Dry Needling Safe? Who Should Avoid It?
Performed by a trained DPT, dry needling is very safe. Every needle is sterile and single-use. I know the anatomy under every insertion point, including depth, angle, and what to avoid, because that's what doctoral-level training in physical therapy is for. Infection and serious complications are rare precisely because of that training.
It isn't for everyone, and I'll tell you when it isn't. I don't needle patients with certain blood clotting disorders or those on specific medications, over areas of active infection, or in the first trimester of pregnancy. Fibromyalgia and chronic pain patients often do benefit, but I start conservatively and calibrate to your nervous system's response, not a protocol.
If needle phobia is the barrier: you never have to commit in advance. Book the assessment, and if needling is the right tool, we start with one point and you decide from there. Many of my most needle-averse patients now ask for it by name. And if it's not the right tool, IASTM and myofascial cupping attack the same problem from a different angle.
Cost & Logistics
Dry Needling Questions, Answered Directly
At Physica Medica, dry needling isn't a 15-minute add-on billed through insurance. It's part of a full 60-minute, one-on-one session with a DPT that includes assessment, needling, manual therapy, and movement work. Pricing depends on the scope of your plan, so call or text (443) 228-8029 and I'll quote it straight. See Insurance & Pricing for how the model works.
Most plans don't cover dry needling, regardless of where you get it. Billing codes for it are inconsistent state to state. Physica Medica is cash-pay by design: no prior authorization, no session caps, no billing surprises. HSA and FSA funds are typically eligible.
People with blood clotting disorders or on certain anticoagulants, anyone with an active infection at the treatment site, and women in the first trimester of pregnancy. Unmanageable needle phobia is also a real contraindication. Treatment you dread doesn't work. I screen for all of this at your first visit, and if needling is out, we use a different tool from the same toolbox.
Get Started
Schedule Dry Needling in Baltimore
If you've been managing the same knot, the same sciatica, the same heel pain for months, the treatments you've tried weren't wrong, they were shallow. One assessment in Fells Point and you'll know exactly what's driving it and what it takes to fix it.
Book Your Assessment
Your first visit is a full 60-minute, one-on-one assessment with Maksim Birikov, DPT.
Physica Medica · 800 S Bond St, Baltimore, MD 21231