Hip pain that has already survived physical therapy, chiropractic, cortisone, and rest is telling you something: the source hasn't been found yet. At Physica Medica, that is exactly where the work starts.
Dr. Maks Birikov, DPT, is a licensed physical therapist and the first master-certified dry needling practitioner in Baltimore.
Request a ConsultationFull-hour, one-on-one sessions in Fells Point. No aides. No handoffs. No exercise circuits.
You may already have a name for it. Labral tear. Hip impingement. Bursitis. Greater trochanteric pain syndrome. The imaging exists. The diagnosis is on paper. And you are still in pain.
The hip sits at the intersection of the lumbar spine, the pelvis, and the lower extremity. When something is restricted above or below it — tight thoracolumbar fascia, a locked sacroiliac joint, a compressed neural pathway from the lumbar spine — the hip absorbs that load on every step. Treating the hip in isolation leaves the driver untouched.
That is the part most patients have never been shown. It is also the reason the relief from prior treatment never lasted.
The assessment doesn't start at the hip. It starts at the foot and works up through the ankle, knee, pelvis, and lumbar spine, because restriction anywhere in that chain changes how load reaches the hip joint.
Dr. Birikov is identifying three things: where the fascia is restricted along the chain, where joint mobility is compromised, and whether any neural tension is contributing to the symptom pattern. Hip pain with groin referral, lateral thigh ache, or symptoms that travel toward the knee often have a neural component that goes unaddressed in standard care.
Once the picture is clear, the session becomes hands-on work: manual release, instrument work, dry needling, cupping, or neural mobilization, chosen for what the tissue is actually doing that day. Every session is a full hour.
No single protocol fits every presentation. Most sessions draw on two or three of the following, selected based on what the assessment finds.
Direct hands-on release of the hip capsule, iliotibial band, hip flexor complex, and surrounding fascia. Joint mobilization where the hip or sacroiliac joint is restricted. The work follows the whole posterior and lateral chain, not just the spot that hurts.
Learn more →Instrument-assisted soft tissue mobilization uses precision steel edges to locate and break down adhesion in the fascia and connective tissue around the hip. It reaches layers that hands alone cannot access and is particularly effective on chronic scar tissue from old strains or post-surgical restriction.
Learn more →A fine filament needle is placed directly into a trigger point in the deep hip musculature — the piriformis, gluteus medius, hip flexors — causing the muscle to release its sustained contraction. Dr. Birikov holds Maryland licensure for dry needling and a master-level certification. This is a clinical procedure, not acupuncture.
Learn more →Negative pressure lifts the fascia away from the layers beneath it, restoring glide between tissue planes that have become adhered. Cupping can leave temporary circular marks on the skin. They are not bruises and typically fade within a few days.
Learn more →Hip pain that radiates into the groin, lateral thigh, or down toward the knee is often partly neural. The sciatic nerve, femoral nerve, or lateral femoral cutaneous nerve can be compressed or restricted at multiple points along their path. Neural mobilization frees the nerve where it is actually being loaded, not just where the symptom appears.
Learn more →Once tissue restriction is cleared, the way the body loads the hip during standing, walking, and movement is addressed directly. Without this, the same restriction pattern returns. This is not a home exercise program — it is manual guidance of movement during the session itself.
Learn more →Standing posture and gait are assessed at intake and tracked as sessions progress. Changes in pelvic tilt, hip alignment, and movement quality are visible before pain scores fully resolve — which is often the first concrete sign that the underlying pattern is shifting, not just the symptom.
Iliotibial band and deep hip rotator restriction released over the first three sessions. Lumbar and sacroiliac contribution identified and addressed in sessions four and five. By session six, the patient reported meaningful reduction in daily pain and full return to running. Individual results depend on the duration and complexity of the presentation.
The first session is a full hour with Dr. Birikov. The first fifteen minutes or so are assessment — movement, palpation, load testing across the chain. The rest is hands-on treatment. You leave having already received care, not having scheduled it.
Deep tissue work and dry needling can be intense in the moment and may leave one to two days of soreness afterward. This is normal and expected. It is not a sign that something went wrong. Plan accordingly if you have a physically demanding day the following morning.
Most hip pain patients see meaningful change within four to six sessions. Longer-standing patterns or post-surgical presentations may require more. If your case falls into that category, Dr. Birikov will tell you that at intake rather than after six sessions.
Exercise-based PT loads a system that is still restricted. That is why pain returns when the exercises stop — the underlying tissue problem was never cleared. Manual therapy addresses the restriction first. Movement follows.
Prior treatment failure is not a sign that your case is hopeless. For most patients who come to Physica Medica, it is a sign that the right tissue was never targeted. That distinction matters.
This is an out-of-pocket practice. Sessions are not billed to insurance. The concierge model exists because doing this work properly requires time, attention, and a one-on-one structure that insurance reimbursement rates do not support.
Describe your hip pain, how long it has been present, and what treatments you have already tried. That information lets Dr. Birikov tell you before you book whether this is the right fit for your presentation.
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 office at 443-228-8029.