You've tried everything. The pain keeps coming back.
Rest didn't fix it. Injections gave you a few weeks of relief. You did a round of PT and felt better briefly, then ended up right back where you started. That pattern isn't bad luck. It means the actual cause was never identified. I've spent 10 years and treated hundreds of back pain patients specifically to find what everyone else missed. That's what I do here.
Why Chronic Back Pain Keeps Coming Back
Most back pain treatment targets the spot that hurts. You get a massage on the low back, a heat pack, some stretches, and instructions to strengthen your core. It helps for a while. Then the pain returns, often in the exact same place, because nothing that was done addressed why that area was overloaded in the first place.
The driver is almost always somewhere other than where you feel it. A postural pattern that's been loading your lumbar spine for years. Tight fascia pulling from the hip. A nerve root that's been irritated since an old injury that never fully resolved. Scar tissue from a surgery that restricted your movement and forced compensation patterns your back is now paying for.
Finding the actual driver takes a thorough, unhurried assessment. That kind of assessment only happens when the same clinician is with you for the entire session, every session, building a picture over time rather than reading a chart in the hallway before walking in.
How Dr. Birikov Approaches Back Pain Differently
At most clinics, you see a different therapist every visit. They read the chart, run you through the protocol, and hand you off to an aide for exercises. There's no continuity, no one tracking whether the treatment is actually changing anything, and no one accountable for your outcome. I work one-on-one. Every session is with me. No assistants, no shared gym floor, no rotating staff.
That continuity matters more for back pain than almost any other condition. Back pain is layered. What you present with in session one often isn't the whole picture. I'm adjusting my approach as I learn more about how your body responds, what's improving, and what still isn't moving. That kind of clinical decision-making can't happen when a different person sees you each time.
Treatments Used for Back Pain at Physica Medica
Because I work one-on-one, I can combine several of these in a single session based on what your body needs that day. I'm not following a protocol sheet. I'm making real-time decisions about what will move the needle fastest for you.
- Dry needling: a hair-thin needle inserted directly into the muscle to release trigger points and interrupt the pain cycle driving your back spasm or nerve irritation.
- IASTM (instrument-assisted soft tissue mobilization): a stainless steel tool used to work through fascial adhesions and scar tissue that restrict your movement and keep the surrounding muscles in a constant state of guarding.
- Scar tissue mobilization: hands-on work to free post-surgical and old-injury restrictions that have been altering your movement mechanics for years without you realizing it.
- Postural correction: addressing the alignment patterns that have been chronically overloading your spine, including forward head posture, rounded shoulders, and anterior pelvic tilt.
- Neural tension release: an Italian-developed technique to calm nerve involvement when the pain radiates, refers, or comes with tingling and numbness.
- Manual therapy: direct hands-on work to restore soft tissue mobility, reduce guarding, and improve joint mechanics throughout the spine and surrounding structures.
What to Expect in Your First Session
I start by watching you move and asking what you've already tried. Knowing what hasn't worked is as important as knowing what hurts. I'm looking for the pattern behind the pain, not just the location of it. By the end of the first session, you'll know what I think is driving it, what I plan to do about it, and a realistic picture of what to expect. No vague reassurances. Straight answers.
Back Pain Conditions We Commonly Treat
Specific back pain problems I treat
Chronic Lower Back Pain
Pain that's outlasted rest, medication, and a round of standard PT. If it keeps coming back, there's a reason. Finding it is the first step.
Herniated Disc Pain
Disc-related pain, with or without radiating symptoms into the leg. Treatment focuses on reducing nerve irritation and correcting the mechanical load on the disc.
Degenerative Disc Disease
Wear-and-tear changes to the disc don't have to mean permanent pain. Restoring movement and reducing the mechanical stress on the affected segments makes a significant difference.
Post-Surgical Back Pain
Surgery changes the tissue. Scar tissue, altered movement patterns, and compensation habits that formed before the surgery all need to be addressed after it.
Muscle Spasm
Deep guarding and trigger points that lock you up and make every movement feel risky. Dry needling and manual therapy get into these faster than stretching alone.
SI Joint Dysfunction
Low, one-sided pain at the base of the spine that doesn't respond to standard back treatment. The sacroiliac joint needs targeted assessment and specific hands-on work.
Thoracic Back Pain
Mid-back pain tied to posture, breathing mechanics, and hours spent at a desk. Often overlooked as a driver of both neck and lower back problems.
Not Sure Which?
Call and describe what you're feeling. I'll tell you honestly whether it sounds like something I can help with.
Call or text →Is this worth more than a regular PT clinic?
Fair question. You're not paying for more of the same thing. You're paying for one doctor, every session, focused entirely on finding what's actually driving your pain rather than running you through a standard protocol. Most patients who come to me have already spent money on treatment that didn't work. The question isn't whether this costs more than a copay. It's whether you can afford to waste money on the same approach again.
See exactly how payment works →
What back pain patients say
A selection from 300+ verified five-star reviews on Google.
[Real patient testimonial will be placed here — verified Google review snippet.]
[Real patient testimonial will be placed here — verified Google review snippet.]
[Real patient testimonial will be placed here — verified Google review snippet.]
Rated 5.0 stars across 300+ reviews on Google.
Back pain questions, answered directly
How many physical therapy sessions does it take to fix back pain? It depends on how long it's been there and what's driving it. I won't quote you a number in session one before I understand the full picture. What I can tell you is that one-on-one sessions where the same clinician tracks your progress every visit move faster than the alternative. Most patients see meaningful change within the first few sessions. I'll give you a realistic estimate once I've assessed you.
Can physical therapy help chronic lower back pain? Yes, when it actually finds the cause. Chronic lower back pain persists because the underlying driver, whether that's a postural pattern, fascial restriction, nerve irritation, or something else, was never addressed. Generic PT that targets the symptom location without identifying the source is why so many people cycle in and out of treatment without lasting results. That's the problem I'm specifically set up to solve.
Is physical therapy better than pain medication for back pain? Medication can quiet the pain. It doesn't change what's generating it, so the pain returns when the medication stops. Physical therapy that correctly identifies and treats the root cause changes the underlying mechanics. For most back pain patients, that's the difference between managing a problem indefinitely and actually resolving it.