Frequently Asked Questions

Most PTs follow standard protocols – same exercises for everyone with the same diagnosis. I focus time and energy figuring out why your body isn’t working well instead of just treating symptoms.

For EDS patients, I understand that your nervous system may be stuck in “fight or flight” and needs to learn how to calm down before we can progress safely with exercises. For headache patients, I consider the neck and thoracic muscles since that’s often where the real problem is. For back pain, I evaluate the whole body because your back may be a symptom generated from an issue or imbalance elsewhere.

I don’t take insurance directly, but I can provide you with a superbill that you can submit to your insurance company for reimbursement. Many of my patients get reimbursement, especially if they have out-of-network benefits. I also accept both HSA and FSA plans and work with patients after car accidents under the PIP program.

I choose not to work with insurance because working independently allows me to spend the time each patient needs instead of rushing through 15-minute appointments. Insurance companies often don’t cover the manual therapy techniques that get the best results.

Initial evaluations are 75 minutes and include treatment on your first visit. Follow-up treatments are typically 60 minutes. I don’t rush through appointments because complex conditions need time to be assessed and treated properly.

Everyone’s situation is different, but most patients start feeling some improvement within 1-3 sessions. Lasting change usually takes 7-10 sessions, sometimes more for complex cases. These sessions are often spread out over weeks or even months.

EDS patients often do well with more frequent sessions because we have to go very slowly to avoid flare-ups. Someone with chronic headaches might feel better quickly once we address the neck issues. Patients with back pain need time to retrain movement patterns/compensations.  They need to train strength and stability which may have been issues for many years.

Wear comfortable clothes that you can move in. For lower back or hip problems, shorts work best so I can see how your muscles are working. For neck and shoulder issues, a tank top or sports bra is helpful. I have gowns available if needed.

Yes, when it is the right tool for your problem. Dry needling can be very effective for releasing trigger points and restoring healthy muscle function, but it is not right for every patient or every visit, and I will always explain what I am doing and why before we start. It is a collaborative decision.
Some patients are understandably nervous about needles. If needling is not for you, there are plenty of other manual techniques that may help, including myofascial release, medical shockwave, cupping, craniosacral therapy, Active Release Technique (ART), and scraping.

No, and this is one of the biggest misunderstandings about dry needling. Many patients I work with have had it done elsewhere without meaningful results, usually because the treatment was not specific enough or the clinician was not confident with the technique.

Good dry needling is not about putting a needle where it hurts. It is about finding the true source of the problem, which is often a different muscle than the one that feels sore, and treating the whole movement system: the muscle itself along with the synergists, antagonists, and stabilizers around it. When I reach the right tissue I look for a local twitch response, which tells me I have found the trigger point and often reproduces the pain you came in with. Where it helps, I use diagnostic ultrasound to guide treatment, something most local practices do not offer. And I always pair needling with movement, because knowing when not to needle is just as important as knowing when to.

I taught this technique to other physical therapists for more than eight years through Myopain Seminars, and currently am building my own curriculum for Applied Myofascial Sciences. I have worked with professional athletes, including NFL players in the Washington Commanders, and Baltimore Ravens organizations. If dry needling has not worked for you before, it is worth trying again with a more specific approach.

While both acupuncture and trigger point dry needling use thin, solid needles, their origins, goals, and methods are different.

Acupuncture comes from Traditional Chinese Medicine (TCM) and is based on restoring the body’s energy flow, or Qi, along specific pathways called meridians. The needles are placed in precise, pre-mapped points, and the treatment often addresses not only pain but also internal health, stress, and overall balance.

Trigger Point Dry Needling (TPDN) is a modern, Western treatment based on anatomy and neuroscience. The goal is to release tight, irritable spots in muscles called trigger points, which can cause pain locally or refer pain elsewhere. By inserting a needle directly into these points, the muscle can relax, blood flow improves, and pain often decreases.

Most people feel a quick, dull ache or a brief muscle twitch when the needle reaches the trigger point, rather than sharp pain. Some muscles are more sensitive than others, so I adjust the dosage to what your body can handle, especially for sensitive or chronic pain patients.

Dry needling is very safe when it is performed by a properly trained clinician. In Maryland, the physical therapists who perform it must complete extensive post-professional training, have at least two years of clinical experience, be registered with the Maryland Board of Physical Therapy Examiners, and obtain written consent before your first treatment. I treat those rules as a floor, not a finish line. If dry needling is not appropriate for you, I will tell you and we will use a different approach.

Chiropractors mainly focus on adjusting joints. I work more on muscles, fascia, and movement patterns. Instead of just adjusting your spine, I figure out why it is out of alignment in the first place and teach you and your body to move differently.

Some patients benefit from both approaches, but many find that addressing the muscle and movement issues gives longer-lasting results than adjustments alone.

Absolutely. I see patients all the time who’ve been to other PTs without success. In most cases, they were given generic exercises, or the therapist didn’t understand their specific condition.  Many of these patients were frustrated with the limited amount of time they got to spend with their PT (usually about 15 minutes) or were handed off to other PT’s and techs. These patients are often told they have reached their “maximum improvement” and are discharged from PT even though they are still not feeling well. 

EDS patients especially have bad experiences with traditional PT because most therapists don’t know how to work with hypermobile patients safely. Same with those suffering from cervicogenic headaches – if nobody checked your neck, you probably didn’t get the correct treatment.

I work with teenagers, and occasionally younger children on a case-by-case basis. My techniques work best with patients who can understand and follow complex movement instructions.

For EDS families, I often see multiple family members since the condition runs in families. I’m comfortable working with teenage patients who have been diagnosed with EDS or chronic pain conditions.

We’ll talk about your history, what you’ve tried before, and what your daily life looks like. Then I perform a detailed movement assessment – watching how you walk, sit, and stand, and checking muscle strength and flexibility throughout your body.

I explain what I find and how it relates to your symptoms. During that first visit, we’ll start some gentle treatment, and I’ll give you a clear plan for moving forward.

Yes, but I’m picky about what I give you. Too many exercises confuse people and don’t get done. I usually start with 2-3 simple things and add more as you progress.

More importantly, I teach you how to move differently during daily activities. Fixing how you sit, stand, lift, and use your phone often matters more than formal exercises.

The easiest way to get started is to book online. You can schedule your free 20-minute consultation here, call the clinic at (410) 205-5264, or email rob@robsatriano.com if you prefer.

During the free 20-minute consultation we will talk through your situation and figure out whether I am the right fit for you. If we decide to move forward, we will get your first full appointment on the calendar.

My office is in Lutherville-Timonium, convenient to Towson, Baltimore, Cockeysville, and other nearby Maryland communities.

The address is: 1447 York Road, Suite 805, Lutherville, MD 21093.