Sciatica that has already survived rest, injections, chiropractic, and standard physical therapy is not a simple problem. It is a mechanical problem that has not yet been addressed at its actual source. That is what Dr. Birikov does.
Dr. Maks Birikov, DPT — the first practitioner in Maryland certified in Functional Patterns and the first master-level dry needler in Baltimore.
Request a ConsultationFull-hour, one-on-one sessions in Fells Point. No assistants, no exercise circuits, no rushed appointments.
The sciatic nerve is the longest nerve in the body. It runs from the lower spine through the glute, down the back of the leg, and into the foot. When something compresses or irritates it — a disc, a tight piriformis, restricted fascia, or a nerve that has lost its ability to move freely through the surrounding tissue — you feel it as burning, shooting pain, numbness, or tingling anywhere along that path.
Most sciatica treatment focuses on the disc or the vertebral level where the nerve exits the spine. That is often the right starting point. But the nerve does not stop there. It travels through layers of muscle and connective tissue the entire length of your leg, and any of those layers can become a site of mechanical tension. If that tension is never addressed, the pain keeps returning — even after the disc heals.
This is what most patients have never been told. The nerve itself needs to be able to move. When the surrounding fascia restricts it, or when the nerve develops what clinicians call neural tension — a state where it is pulled taut and cannot glide normally — no amount of stretching or strengthening resolves it. The restriction has to be released directly.
Numbness and tingling are nerve symptoms. They mean the nerve is either compressed, chemically irritated, or mechanically restricted somewhere along its path. In the lower extremity, that is almost always sciatica — but the location of the symptom does not always match the location of the problem. Numbness in the foot can originate at the lumbar spine, in the piriformis, or anywhere along the posterior chain.
Shooting pain that travels down the leg, a burning sensation behind the knee, pins and needles in the calf or heel — these are all presentations of the same underlying nerve dysfunction. They are signals, not diagnoses. The diagnosis is where and why the nerve is being compromised.
Physica Medica also treats numbness and tingling in the upper extremity — cervical radiculopathy, thoracic outlet presentations, and nerve compression at the elbow or wrist. If your symptoms are in your hands, arms, or fingers rather than your legs, that work is available here as well.
The assessment starts with the whole posterior chain, not just the painful segment. Dr. Birikov is looking at how load moves from the foot to the spine, where fascial restriction is altering that path, and where the nerve is losing its ability to glide freely through the surrounding tissue.
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.
Learn more →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.
Learn more →No two sessions are identical. Dr. Birikov selects from the following based on what the tissue is doing that day. Most sessions draw on two or three of these approaches in combination.
Anterior hip and thoracolumbar fascia released, then the rib cage taught to rotate again. Pelvic tilt reduced and the lumbar curve settled into a shape the patient could hold without cueing.
A full hour, one-on-one with Dr. Birikov. The first fifteen to twenty minutes are assessment — movement, palpation, neural tension testing. The remainder is treatment. You leave with a clear explanation of what was found and what the plan is.
Deep manual work can be intense during the session and may leave a day or two of soreness afterward — particularly after dry needling or IASTM. This is normal tissue response. Most patients find it manageable and report that the soreness resolves into noticeable improvement.
Most sciatica patients see meaningful change within four to six sessions. Long-standing cases or those with significant neural tension may take longer — Dr. Birikov will give you an honest estimate after the first session, not before.
No referral is required. You do not need to be an existing patient. You can book directly.
Physica Medica does not bill insurance. Sessions are paid out of pocket. That is not a workaround — it is what makes full-hour, undivided appointments possible. There is no billing code that reimburses an hour of one-on-one manual therapy from a doctoral-level clinician, so the insurance model does not support this kind of work.
If you are weighing the cost against another round of standard treatment, consider what the last several rounds have returned. The question is not whether this costs more per session. It is whether it addresses something the previous treatment did not.
Describe your symptoms, how long they have been present, and what treatments you have already tried. The more specific you are, the more useful Dr. Birikov's response will be. You can reach the clinic at 443-228-8029 or through the contact form on this site. Physica Medica is located at 800 S Bond St, Baltimore, MD 21231, in Fells Point.
Dr. Birikov reads every inquiry personally and responds directly — not a front desk, not a patient coordinator.