Manual Therapy · Fells Point
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
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
After leaving Dr. Maks table I felt so inspired by his knowledge. I had chronic pain in my right glute and leg muscles and did not know how to escape it. I was in pain most days, but especially sitting in class all day or driving long distances.
I have had a low back/piriformis/hip flexor problem for years. As a yoga, Pilates, and barre instructor, managing that has been tough. When the pain became unignorable, I turned to dry needling. It has been the only method that truly helped me.
Max, a PT at Physica Medica is the most incredible therapist. I have suffered from chronic back pain for almost a decade, have been to literally a dozen doctors and last March had back surgery all to no avail. Max has been the only person to take my pain away.
Had lower back spine disk herniation and nerve inflammation as a result. Couldn't walk; couldn't sit; couldn't bend. Max worked his magic, and in a matter of a short couple of months I'm back to 100% without surgery. Mind blowing.
I had a great experience getting treatment from Dr. Maks. I was having lower back problems and felt like my self-treatment stalled so I started to work with him. He helped me diagnose my injury and was very knowledgeable around different strategies that helped me get to full recovery.
Maks is not only knowledgeable, but highly intuitive, thus making him a natural healer. He's attentive and compassionate, and if you are willing to put in the work he is willing to support you every step of the way.
The 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.
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.
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.
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.
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
Same needle, entirely different discipline. If acupuncture didn't help your muscle pain, that says nothing about whether dry needling will.
Straight Answer
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
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
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.
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