Question 1

What is dry needling and how does it work?

Accepted Answer

A thin filament needle is placed into a trigger point — a contracted band of muscle that will not release on its own. The needle produces a local twitch response that resets the neuromuscular contraction and restores blood flow to the tissue. Full details are on the dry needling page.

Question 2

Does dry needling hurt?

Accepted Answer

You feel the twitch response — a brief, deep cramp that lasts about a second. Most patients describe it as strange rather than painful, and the muscle typically feels looser the same day. Some soreness for 24 hours is normal.

Question 3

How is dry needling different from acupuncture?

Accepted Answer

Different training, different intent. Acupuncture follows meridian theory. Dry needling targets myofascial trigger points identified by anatomical assessment, and here it is performed by a licensed Doctor of Physical Therapy as part of a broader treatment plan.

Question 4

How much does a dry needling session cost, and does insurance cover it?

Accepted Answer

Dry needling is included within a standard one-on-one session — it is a technique, not a separate charge. This is a concierge practice: I do not bill insurance, pricing is stated plainly before you book, and documentation is provided for out-of-network reimbursement.

Question 5

Are there contraindications for dry needling?

Accepted Answer

Yes, and I screen for them: significant needle phobia, blood clotting disorders or anticoagulant use, active infection at the site, and certain conditions in the first trimester of pregnancy. With fibromyalgia or widespread pain, I start conservatively and dose the technique to your response.

Question 6

How is myofascial cupping different from spa or traditional cupping?

Accepted Answer

Clinical myofascial cupping is performed by a Doctor of Physical Therapy who uses it as an assessment and treatment tool within a broader plan — the cups are placed based on where your fascia is restricted, and often moved to restore glide. Spa cupping is a standalone relaxation service. Same equipment, different discipline.

Question 7

What does cupping actually treat?

Accepted Answer

Fascial restrictions, tissue adhesions, and chronic muscle tightness. The negative pressure lifts tissue layers apart — the opposite of compression — which restores glide between fascia and muscle that hands-on pressure cannot always reach.

Question 8

Will the cupping marks be visible or embarrassing?

Accepted Answer

The marks are round, painless discolorations — a normal tissue response that actually maps where restriction was found. They fade within a few days to a week. If visible marks are a problem for an event, tell me and we schedule around it.

Question 9

Is cupping evidence-based?

Accepted Answer

The mechanism is mechanical and well described: negative pressure decompresses tissue layers, increases local circulation, and improves fascial mobility. I use it where the assessment shows fascial restriction — not as a default ritual.

Question 10

How many sessions will I need?

Accepted Answer

It depends on severity, chronicity, and how consistently you do your part between visits. Acute problems often resolve in four to six sessions; chronic patterns take longer. I give you an estimate after the first assessment — not before I have examined you.

Question 11

What happens at the first visit?

Accepted Answer

A comprehensive assessment: your history, a movement screening, and hands-on evaluation of fascia, joints, and neural tension. I explain what I find, we agree on a plan, and treatment begins the same day. Plan for sixty minutes.

Question 12

Will treatment hurt?

Accepted Answer

Some techniques involve brief discomfort — a needling twitch response, pressure on a restricted band of tissue. I explain what to expect before each technique, and nothing is done without your understanding. Discomfort during treatment is momentary; you should not leave sessions feeling worse.

Question 13

Can't I just do exercises on my own?

Accepted Answer

Exercises are part of every plan. But exercises alone rarely fix the root cause, because without clinical assessment and hands-on treatment, you are strengthening around a restriction instead of removing it. If therapy failed you before, this is usually why.

Question 14

Do you accept insurance?

Accepted Answer

No — and the reason is the treatment model. Insurance dictates session length, frequency, and approved modalities. I design the plan around what your body needs. You get the full hour, every technique your case requires, and a clear price stated before you book.

Question 15

Can I get reimbursed by my insurer?

Accepted Answer

I provide documentation suitable for out-of-network reimbursement claims. Whether your plan reimburses depends on your out-of-network benefits — your insurer can tell you before your first visit.

Question 16

Is this worth the higher cost compared to insurance-based PT?

Accepted Answer

Consider total cost, not per-session cost. One-on-one sessions with a DPT who treats the root cause typically require fewer total visits than fifteen-minute rotations through a high-volume clinic. You are paying for undivided clinical attention — which is what changes outcomes.

Question 17

Is Dr. Birikov qualified to treat my specific condition?

Accepted Answer

The DPT scope of practice covers musculoskeletal, neurological, and post-surgical conditions — from rotator cuff injuries to chronic back pain to post-operative recovery. The additional certifications (Pancafit, Wim Hof Method, advanced manual therapy) add specialized capability on top. Full credentials are on the about page.

Question 18

Does he treat patients directly or supervise other therapists?

Accepted Answer

Directly. Every session, always. There are no other therapists, aides, or technicians at Physica Medica — the person who assesses you is the person who treats you.

Question 19

What makes Physica Medica different from a standard PT clinic?

Accepted Answer

Structure, not slogans: a named provider who delivers every minute of care, exclusive modalities including the only Pancafit class in the United States, and a root-cause methodology aimed at why your pain persists — not just where it hurts.

Question 20

What is Pancafit, and why is it only available here?

Accepted Answer

Pancafit is an Italian method of global postural realignment — guided decompensated stretching that releases the fascial chains pulling posture out of line. I certified in it in Europe, and I am the only practitioner offering Pancafit classes in the United States.

Question 21

What do Wim Hof Method workshops involve?

Accepted Answer

Structured breathing training, graduated cold exposure, and focus work, taught by the first certified WHM instructor in Baltimore. Clinically, the tools apply to pain modulation, recovery, and nervous system regulation.

Question 22

Is non-surgical scoliosis correction real?

Accepted Answer

For many curves, yes. The program combines Pancafit realignment, fascial work, and targeted strengthening — without surgery, braces, or drugs. Candidacy depends on the curve and age; the assessment determines whether you are one.

Question 23

What does therapy for singers treat?

Accepted Answer

Voice strain, breathing mechanics, and the postural load of performance — the neck, jaw, ribcage, and diaphragm system that voice production depends on. I have found no other US practice offering it as a dedicated program.

Questions, Answered Directly

About Dry Needling

About Myofascial Cupping

About Treatment & What to Expect

Cost, Insurance & Payment

About Dr. Birikov & Physica Medica

Specialty Services

Ask me the rest directly.

Questions, Answered Directly

About Dry Needling

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About Myofascial Cupping

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About Treatment & What to Expect

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Cost, Insurance & Payment

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About Dr. Birikov & Physica Medica

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Specialty Services

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Ask me the rest directly.