IMS dry needling is an increasingly popular form of treatment used by physiotherapists in Vancouver due primarily to the strong influence of local retired physician Dr Chan Gunn. He studied and refined the use of acupuncture needles specifically for treating persistent pain and ran a training and research center in Vancouver over the past thirty years. He engaged physiotherapists that had experience with manual therapy and taught them how to feel and treat inside the muscles instead of just pushing and prodding from the outside. It was a new modality that strayed from traditional acupuncture and pushed physiotherapy outside of its’ customary box. More physiotherapists in Vancouver adopted the new technique than elsewhere due to the local availability of training and the allowance of our regulatory body in British Columbia that permitted physios to puncture the skin.
Early adopters of IMS learned from Dr Gunn in the ‘90s, but relatively more and more have adopted dry needling as a staple of physiotherapy practice in the past ten years. I learned from Dr Gunn in 2008, after being exposed to the technique at Diane Lee’s physiotherapy clinic in 2006. In hindsight I am glad that I had some exposure to the dry needling technique in the hands of physios before I learned it directly from Dr Gunn because it helped me put the model that Dr Gunn was teaching in perspective. His model of intramuscular stimulation (IMS) is very valuable and the underlying principle that I apply when needling, but it is too simplistic and limited in its explanation and application. I wrote this article on my blog WhyThingsHurt.com a few years after taking the IMS course to help explain to clients what I was doing and how IMS was different than acupuncture. If you want a history lesson about acupuncture and to see how many people have different views about needling, please scroll through all the comments at the end of that article.
I have now been needling people for ten of my fifteen years as a physiotherapist in Vancouver and have seen some amazing results. I can’t claim that it helps everyone, but I have found it to be dramatically more effective than anything else that I have learned to date. To be clear, I learned the skilled use of a needle to release tension from muscles and calm down a person’s nervous system from Dr Gunn’s IMS course, but I became proficient at helping people by combining it with effective communication skills, a keen eye for postural imbalances and a detailed understanding of movement. IMS as a stand-alone treatment can be effective, but a thorough understanding of what to release with the needle and why is what makes all the difference. Dr Gunn’s explanation of why IMS works draws a lot back to irritations around the spinal cord, but the longer I have used the technique, the smaller piece of the puzzle that becomes for me.
People generate tension in their bodies for a variety of reasons, the most common being emotional stress, the second being posture and ergonomic related. We are all a product of everything that we have been through up to the given moment. Car accidents, childhood sports, anxieties, injuries and genetics all play a role in who we are, how we move and what we perceive. Pain is one of our perceptions and a reflection of how we are living in our bodies. Some people are obviously high strung and wear their heart on their sleeve, while others appear very laid back, but commonly hold their emotions in their body. I fall into the latter group, I am quite easy going and rarely feel emotionally stressed out, but I subconsciously clench my butt and jaw and create physical issues that seemingly come from nowhere. Stress comes in many forms and is commonly held in the tissues of your body, not just your mind.
Your muscles and your organs are a dumping ground for your emotions. Next time you are really stressed out, check in with your body and see how your chest feels or how nervous your stomach is; your body will turn an emotional state into a physical one. Different emotions tend to get held into different organs and different people tend to clench different muscles as a coping mechanism. Either way most people need to find some sort of steam release valve to keep their monkey brain at ease. Pain is your body’s way of telling you to pay attention to it. It doesn’t necessarily mean that any structures are injured or damaged; it just means that you need to change something like how you move or breath or think.
IMS can be an amazing steam release valve for people. It can create an immediate and reflexive relaxation of muscles that have been subconsciously guarding for weeks, years or decades. How long it will last for depends on what is creating the pressure in a person’s body; by pressure I mean what is the primary source of the irritation. It may be stress, it may be an arthritic joint, it may be horrible posture, or simply all of the above. Just because you can stand, sit, walk and breathe doesn’t mean that you do any of those things very well, but you do them day in and day out and your body has to deal with the forces that you put on it physically and the stress you are creating emotionally. Quite often the physical and the emotional collaborate to create pain.
I use dry needling as both a therapeutic AND a diagnostic tool because how a person responds to the technique tells me a lot about them both physically and emotionally. I can learn a lot about a person from how they handle the discomfort of IMS and how quickly their body will or won’t change. Some people will feel like I just waved a magic wand over them right after IMS and others will feel like they have been hit by a bus for three hours, both are useful pieces of information that can help solve the puzzle. Dr Gunn’s explanation for IMS is one of a hard wired connection from the periphery to the spinal cord that can create a reflexive inhibition from the spinal cord to the muscles. I believe and use his explanation as the reason why needling muscles can make them relax so quickly, but I propose that the reason the muscles were so tight in the first place is largely based on a person’s emotional state and functional posture.
I have found that the most effective way to use IMS is to think of the body in groups of muscles that are tug-of war buddies that effect how you stand, sit and walk. I agree that irritations to the spine create tension in the arms and legs, but I believe that the irritations in the spine are created by dysfunctional muscle balances around the pelvis, shoulders, ankles and neck. It is a chicken or the egg discussion, but my experience has shown me that freeing up a person’s hips removes strain from their back and freeing up their shoulder girdles takes pressure off their neck and arms. People will get caught in a viscous cycle of their back irritating their hips and their hips irritating their backs; IMS is a create way to help break that cycle, but the movement and posture education piece is equally important to help prevent them from reverting back to their old bracing patterns.
I like to help people understand the strategies they are using to hold themselves up and how those are contributing to the persistent tension in their bodies. You can see an illustrated explanation of basic posture and gripping strategies in my article on Why Hips Hurt. It is important that an individual see and feel how their various joints are restricted and how what they feel as normal may not be optimal, and then feel and see the difference after a physiotherapist has freed up muscle tension with IMS and manually corrected their posture. Freeing up tension will usually make things hurt less and may give you a window into what normal should feel like; it then becomes the person’s job to create some awareness of what physical or emotional forces start to make the tension or pain start to return.
I generally start by giving clients an explanation of Why Things Hurt, treat them with IMS and then give them a week to see how things feel and note if or when symptoms start to come back. I will then help teach them more about their posture to help create more accountability in the process followed by a more thorough IMS treatment that involves a broader look at their whole body. If you are dealing with a long standing issue the process is typically a three steps forward one step back journey of body awareness over three to eight weeks. It should consist of releasing tight structures, learning how to move differently and then building some strength in your new movement patterns. During the process of IMS your physio should help you understand that the different systems of your body are connected and although he is treating your muscles, it will affect your nerves, organs and very likely your emotional state. It can be used as a quick fix, but its’ real power lies in helping you understand your own anatomy and driving forces in your body.
IMS is taught as a stand-alone treatment for people experiencing chronic pain, but you will find that most good physios have integrated it with a variety of other modalities to best help their clients. It is a powerful tool, but not the answer for everything or everybody. I have found IMS to be my most effective option, but I have also learned to sometimes back off and look deeper with a hands-on osteopathic approach or a hands-off pain science approach. Every person is their own three dimensional moving puzzle and the more tools a practitioner has to help solve it the more effective he will be and the more people he will help.
For more information and stories about the use of IMS have a look at my book Why Things Hurt: Life Lessons from an Injury Prone Physical Therapist on WhyThingshurt.com