Arthritis changes the joint. It does not have to define how you move. Most patients who come to Physica Medica with arthritis-related pain have already been through the standard sequence: anti-inflammatories, a round of PT, maybe a cortisone injection. The pain came back. Or it never fully left. There is a reason for that, and it is not that your case is hopeless.
Dr. Maks Birikov, DPT, is a licensed physical therapist and the first practitioner in Maryland to hold a master-level dry needling credential. He works one-on-one with patients at 800 S Bond St in Fells Point, Baltimore.
Request a ConsultationEvery session is a full hour. No aides, no shared treatment tables, no exercise handouts.
The diagnosis is accurate. The joint is arthritic. But the diagnosis explains the structural finding, not why your pain is as bad as it is, or why it spreads, or why one side is so much worse than the other. Imaging shows bone and cartilage. It does not show the fascial restrictions, muscle guarding, and altered movement patterns that develop around a painful joint over months and years.
When a joint hurts, the body protects it. Surrounding muscles brace. Fascia tightens. Movement patterns shift to offload the area. Over time, those compensations become the problem. The original joint may have limited arthritis, but the soft tissue around it is locked down, the mechanics are off, and the load is being distributed badly. That is what keeps the pain cycling.
Standard treatment addresses the joint. Most of what is keeping you in pain lives outside it.
The assessment starts with how you actually move, not just where it hurts. For hip or knee arthritis, that means looking at the whole lower chain: foot mechanics, hip rotation, pelvic alignment, lumbar loading. For shoulder or cervical arthritis, it means tracing through the thoracic spine and rib cage. The arthritic joint is one piece of a larger picture.
Dr. Birikov is identifying where the fascia is restricted, where the muscles are guarding, and where the movement pattern has broken down. Those findings drive the treatment, not a protocol built around the diagnosis code.
The work is manual: hands-on fascial release, joint mobilization, dry needling into trigger points that have been compensating for years, instrument work to break up adhesion in the surrounding soft tissue. Then the movement pattern is retrained so the joint is loaded correctly going forward.
Each session draws on whatever the tissue requires that day. Most visits combine two or three of the following.
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.
Learn more →Posture and movement are documented at intake and tracked as treatment progresses. Changes in how you stand, how you rotate, and how you load the affected joint are visible before they are fully felt. That documentation is part of every patient's record.
Reduced morning stiffness. Less guarding around the joint. Movement that feels less effortful. Pain that is more localized and less constant. These changes are not about the arthritis reversing — the structural finding doesn't change. They reflect the soft tissue and movement pattern around the joint being restored.
The first session is a full hour. The first portion is assessment: movement screening, palpation, and a conversation about what you've already tried and what it did or didn't do. Treatment begins in that same visit.
Deep soft tissue work can be intense in the moment and may leave one to two days of soreness afterward, similar to what follows a hard workout. Cupping may leave visible marks. Dry needling can produce a brief muscle twitch and local achiness. These are normal responses, not signs that something went wrong.
Most patients with arthritis-related pain notice meaningful change within four to six sessions. Long-standing patterns with significant compensatory involvement take longer. After an honest assessment, Dr. Birikov can give you a realistic range for your specific situation.
If previous PT didn't hold, it is worth asking what that treatment was actually doing. Exercise-based PT loads the joint. If the surrounding soft tissue is restricted and the movement pattern is off, loading it more doesn't fix the underlying problem. That is not a criticism of PT as a field. It is a description of why a specific approach didn't work for a specific problem.
This practice does not bill insurance. Sessions are out of pocket. That model exists because one-on-one, full-hour manual therapy with a single practitioner cannot be delivered inside an insurance reimbursement structure. The cost reflects the time and the work, not a premium for the name.
If you've been told your pain is just what arthritis feels like and you'll have to manage it, that may be partly true for the joint itself. It is almost certainly not the whole story for the pain you're experiencing day to day.
Describe what you're dealing with: which joint, how long, what you've already tried, and what happened. The more specific you are, the more useful the response will be. You do not need a referral to book.
Dr. Birikov reads every inquiry personally and responds directly. Physica Medica is located at 800 S Bond St, Baltimore, MD 21231. You can also reach the practice at 443-228-8029.