Dry Needling — Baltimore, MD
Dry Needling with a Doctor of Physical Therapy
I use dry needling as a precision tool — not a trend. Every session is one-on-one, performed by me, with a clinical rationale specific to what your tissue is actually doing. If you have questions before booking, call 443-228-8029.
The Definition
What Is Dry Needling — And How Is It Different From Acupuncture?
Dry needling is an intramuscular technique. A thin monofilament needle is inserted directly into a trigger point — a hyperirritable, contracted band within a muscle — to produce a local twitch response. That twitch is the muscle releasing. It resets the neuromuscular activity in the tissue, reduces the chemical irritants that accumulate in chronic trigger points, and restores blood flow to an area that has been effectively starved of it.
Acupuncture works from a different framework entirely. Traditional acupuncture is guided by meridian theory — a system of energy channels mapped across the body in classical Chinese medicine. The needles may look identical. The underlying logic is not. Dry needling is guided by anatomy: muscle origin and insertion, referred pain patterns, nerve innervation, and movement mechanics. When I decide where to place a needle, I am working from a physical therapy assessment, not a meridian map.
That distinction matters clinically. Dry needling is performed here by a Doctor of Physical Therapy with post-graduate training in the technique. It is integrated into a broader treatment plan — not offered as a standalone procedure. The needle is one tool in the session, not the entire session.
Clinical Applications
Conditions Dry Needling Treats at Physica Medica
Dry needling is most effective when the pain involves active trigger points, restricted fascia, or muscles that have stopped responding to stretching and exercise alone. These are the presentations I treat most frequently with it.
Chronic back and neck pain. Muscles in sustained contraction — from posture, repetitive loading, or compensating around an old injury — develop trigger points that refer pain well outside the area you feel it. Needling the source, not just the symptom site, is often what produces lasting change when other treatments have not. Tension headaches and migraines. The suboccipital muscles at the base of the skull, the upper trapezius, and the sternocleidomastoid are common contributors to head pain. Trigger points in these muscles can refer directly into the head and behind the eyes. Sciatica and radiating leg pain. When the piriformis or deep hip rotators are involved, dry needling can release the muscular compression contributing to nerve irritation — an approach that addresses the mechanical driver rather than only the nerve. Rotator cuff and shoulder pain. The infraspinatus, subscapularis, and teres minor respond well to needling when they have developed trigger points that restrict range of motion and reproduce shoulder or arm pain. IT band syndrome and hip pain. The TFL and gluteus medius are frequent culprits in lateral knee and hip pain. Needling combined with movement retraining addresses the pattern, not just the irritated tissue. Post-surgical scar tissue and stiffness. Dry needling can be used around scar tissue to address the fascial restrictions and muscular guarding that often persist after surgery, when the wound is fully healed and the tissue is ready for it. Fibromyalgia and widespread pain. This requires a modified approach — lower needle density, careful monitoring, and integration with breathing and nervous system regulation techniques. It is not a contraindication, but it changes how I work.
Root cause is the operating principle: effective treatment requires understanding why your body is in pain, not just where. Manual therapy addresses tissue restrictions. Movement analysis finds the compensation patterns. Postural correction addresses the structural drivers that keep re-creating the problem. Separate those, and you get temporary relief. Integrate them, and you get lasting results.
What Happens in the Room
What to Expect During a Dry Needling Session With Dr. Birikov
The session begins with assessment, not assumptions. I ask about your history, what you have already tried, and what has and has not worked. I watch how you move. I palpate the tissue to locate the active trigger points — the ones that reproduce your pain when compressed. That mapping determines where the needles go.
Back Pain
The needles are thin — significantly thinner than a hypodermic needle. Most patients feel little or nothing on insertion. What you will likely feel is the local twitch response: a brief, involuntary muscle cramp or deep ache when the needle contacts the trigger point. That sensation typically lasts one to three seconds. It is the target response, not a side effect.
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.Back Pain
The needles are thin — significantly thinner than a hypodermic needle. Most patients feel little or nothing on insertion. What you will likely feel is the local twitch response: a brief, involuntary muscle cramp or deep ache when the needle contacts the trigger point. That sensation typically lasts one to three seconds. It is the target response, not a side effect.
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.Back Pain
The needles are thin — significantly thinner than a hypodermic needle. Most patients feel little or nothing on insertion. What you will likely feel is the local twitch response: a brief, involuntary muscle cramp or deep ache when the needle contacts the trigger point. That sensation typically lasts one to three seconds. It is the target response, not a side effect.
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.Candidacy and Cautions
Is Dry Needling Right for You? Contraindications and Candidacy
Comprehensive Assessment
Dry needling is not appropriate for everyone, and I will tell you that directly at assessment if it applies to you. Absolute contraindications include needle phobia severe enough to prevent informed consent, local infection or open wounds at the treatment site, and certain blood clotting disorders or anticoagulant medications that significantly elevate bleeding risk. Pregnancy is a relative contraindication — needling over the abdomen and certain points is avoided, but it is not a blanket exclusion.
Movement Screening
Patients with fibromyalgia, central sensitization, or a history of adverse reactions to needling are not excluded, but the approach is modified. Lower needle density, shorter retention time, and close monitoring across sessions. The goal is a therapeutic response — not a provocation.
Hands-On Evaluation
If you have had prior dry needling that felt ineffective or caused significant worsening, that history is worth examining. Outcomes depend heavily on accurate trigger point identification and whether needling is integrated with a treatment plan that addresses the mechanical reason the trigger points are forming. Needling in isolation, or needling the wrong tissue, produces inconsistent results. That is not a failure of the technique — it is a failure of the protocol.
Plan & First Treatment
I explain what I found, give you a session estimate, and treatment begins the same day.
Plan for sixty minutes. Frequency depends on the condition. Most patients start weekly, and we taper as your body holds the changes. You will know within three to five sessions whether the approach is working, and I will tell you honestly if it isn't.
Before You Book
Dry Needling Cost and Insurance Coverage in Baltimore
Physica Medica operates as a cash-pay practice. I do not bill insurance. A session is $200. That covers a full 60-minute appointment with me — not a tech, not an aide, not a split-attention hour while I manage three other patients down the hall.