What is IMS Acupuncture? Intramuscular Stimulation vs. Traditional Acupuncture

IMS stands for intramuscular stimulation and is an anatomy specific form of acupuncture performed by specially trained physiotherapists and some doctors.  It has its roots in traditional Chinese acupuncture, but is fundamentally different in many ways.  IMS uses Western medicine’s understanding of the neurophysiology of pain and Dr Chan Gunn’s assessment techniques of identifying underlying nerve irritations to treat chronic pain issues.  The technique does use acupuncture needles, but not in the way someone practicing traditional acupuncture would.  Traditional acupuncture focuses on pre-mapped out points in the body that relate to different organs and meridians of energy running through the body.  Fine acupuncture needles are then inserted into a number of these points and the person rests with them in for 10-20 minutes.  It can be very useful for the right condition, but it is not as specific or as purposeful as IMS.

To understand why IMS is performed the way it is you should have a basic understanding of how your body experiences pain.  If you haven’t already, please read the article titled Why Things Hurt: Explain Pain.

When a physiotherapist performs IMS he will first assess your basic posture and movement patterns to look for some common signs of underlying nerve irritation.  The most common one is to palpate for tender bands or knots in particular muscle groups.  He will look for restriction of movement in major joints such as your hips and shoulders and note the appearance of the skin and muscle tissue on either side of your spine.  When there is an underlying nerve irritation in an area, the skin can start to look like the rind of an orange peel, feel thickened and respond differently to light touch.  A person may develop goose bumps easily and/or have areas of coolness or hair loss.  The therapist will take all these things into account when determining where to treat you.

Can start to see all the pores in the skin around the spine on two finger test

IMS needles are typically slightly thicker than acupuncture needles, but to the lay person would look exactly the same.  Once the physiotherapist has determined all the troubled areas he will start using the needle to release them.  The needle comes in a small plastic tube that is just slightly shorter than the needle.  The plastic tube is pressed against the skin and the therapist quickly taps the end to push the fine needle through the skin with very minimal discomfort.  The plastic tube is pulled off and the practitioner will grab the end of the needle to push it further into the muscle.  Here is a big difference between IMS and acupuncture; in IMS the needle is inserted deeper into the muscle and moved in and out to hunt and peck for bands of tight muscle tissue.  The physiotherapist can feel the relative resistance to the movement of the needle and actively searches for the stiffer, thicker feeling areas; as the muscle releases, the relative resistance gets less and less.  Portions of the muscle can go from feeling like sticking a needle into a rubber eraser to more like a block of soft butter.  The needle becomes an extension of the practitioners hand to feel inside the muscle tissue.

Tube against skin, tap end of needle with finger

If you put an acupuncture needle into a happy, healthy, normal muscle, not much happens and the person doesn’t feel very much at all.  On the other hand, if you put a needle into a muscle that is in a banded state, they are by nature hypersensitive , and the stimulus will cause the muscle to contract strongly and sometimes even twitch.  This contraction feels like a strong crampy ache to the person, but the good part is that it only lasts 5-10 seconds because once the cramp is achieved the needle is pulled back out and the therapist moves on to the next point.  The patient doesn’t really feel the needle at all, it is their muscle cramping that can be the uncomfortable part.  The physiotherapist will likely treat you in areas that you were complaining hurt, but also a variety of other parts of your body that may not hurt, but are part of the root cause of your problem.  For example, most elbow problems are caused by an irritation of the C6 nerve root that extends out from the base of your neck so to fix your elbow you would likely be needled around your neck, shoulder and arm first, then the forearm muscles if the elbow still hurts.  Watch Why Elbows Hurt

IMS, compared to acupuncture, is a much more active process by the practitioner and requires a greater knowledge of anatomy, muscle balancing and biomechanics to release the right areas and restore optimal movement.  The ability to perform IMS gives a practitioner a powerful tool to help eliminate chronic pain issues, but it is the physiotherapist’s ability to assess and release things in the right order and start to reintegrate proper movement patterns in the client that make the real difference.  In other words, a client may find success with IMS with one practitioner and simply find it painful and not productive with another.  There is an art and a science to it, the practitioner has been trained to use the science, but has to develop the art with experience and the integration into rehabilitation and movement principle.

Many people either haven’t heard about IMS, or have just been told it is really painful, but works really well.  What I tell people is that everyone’s experience with IMS is different; some people do find it quite uncomfortable while others don’t mind it at all.  The difference seems to be related to both the person’s body type and his/her personality.  People that are very muscular, tight and compressed tend to find IMS the most painful (but still very effective).  People that have lower muscle tone don’t seem to be bothered by the treatment at all.  On the personality side, high strung, type A people have trouble with it because they are in a vulnerable position with involuntary muscle contraction and the lack of control stresses them out.  That being said they come back every time they hurt themselves asking for IMS even though they hate every minute of it because it works so well and they value the result over the temporary discomfort.  I find people that are scared of needles tend to do better with IMS than acupuncture because they only actually have one needle in them at a time and only for 10 seconds instead of 10 minutes.

So how does it work?

Nerves are the electrical wiring to muscles.  Muscles are a stringy, elastic tissue strung between two bones by tendons.  In a normal resting state, the nerve supplies a steady signal to the muscle to create a normal resting tone in the muscle; it is not overly contracted or totally flaccid.  When the nerve is irritated it sends an altered signal to the muscle making the muscle hyper-reactive and the result is usually bands of tension and muscle knots that are sore to the touch.  These taut muscle bands don’t allow the muscle to function properly and put way more stress on the tendons and joints when used.  If you stick a fine needle into a muscle in its normal healthy state, not much happens and the client doesn’t feel much, but if you stick a needle into a hypersensitive taut band the muscle will reflexively contract strongly or even twitch; this feels like a deep, crampy achy pressure to the client.

Normal state muscle                                                         Banded, hyper-reactive muscle

So why do you want to make a tight, sore muscle contract more?

When the muscle contracts strongly it stretches the tendons on either end that attach it to the bone.  Your tendons have little stretch receptors embedded in them called golgi tendon organs (GTO), their job is to sense stretch and protect the muscle from contracting too strongly. When they get triggered they reflexively send a signal to your spinal cord that immediately comes back saying relax, relax, relax to the muscle.  IMS effectively takes advantage of your body’s own protective feedback loops and tricks your nervous system into dampening down the tone in specific muscle groups.  People develop a love/hate relationship with it because the crampy, achy feeling can be unpleasant, but it can literally produce immediate and lasting relief from pain.

Click here for a FAQ list related to IMS provided by iSTOP the regulatory body of IMS

You will find more information about the use of IMS as it relates to specific conditions in other posts and videos on this site, but it is particularly useful in treating the following areas and conditions:

Tennis elbow, low back pain, rotator cuffs, stiff necks, headaches, TMJ issues, sprained ankles, alignment issues, IT band syndrome, patellofemoral syndrome, plantar fasciitis, Achilles tendonitis, thoracic outlet syndrome, carpal tunnel syndrome…..and many others

The above information is referencing the work of Dr. Chan Gunn.  I have integrated his work into my own clinical practice to use IMS as a part of the treatment of sub-acute to chronic pain

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71 Comments ↓
  • Bob

    Very well written article. The explanations are good and I’ve just had my 1st testament with IMS for tennis elbow. Hopefully it not only reduces pain but also contributes to long term healing of the tendonosis.

    • Brent

      The tendonosis is largely the symptom rather than the cause of tennis elbow. IMS should calm down the neuropathic irritation to the muscle that over time caused the tendon to inflame/alter it’s structure. Once the nerve irritation is calmed the body should be able to effectively repair the damaged tendon and provide a good long term outcome.

  • Lisa

    1st IMS treatment provided immediate relief however it did not last. I plan to continue and hope it relieves my lower back pain….hopeful!

    • Brent

      there is typically a cumulative effect to it…..meaning it should last longer each time and/or the physio may try new spots that can add a lasting effect. Keep going!

      • Vince

        Hi I get acupuncture treatments often and from what you describe I get the IMS. The other day I went and the therapist counts the needles she took out as she always does. She asked if I had one in my arm and said no then she said well I am one short then she said no wait I have 1 extra. I got to thinking is it possible that a needle gets absorbed into the body? I have read articles about people having acupuncture needles in them and not knowing. How can this happen? Would an extra show this?

        • Brent

          if the needles are being left in like that you are likely receiving acupuncture not IMS….that being said it is very unlikely a needle would be absorbed into the body, but yes it would show up on X-ray because they are metal

  • Donna

    I had this treatment several times and it helped me so much. I had total paralysis on my left side of my body. After 3 years of traditional physiotherapy was no success I was recommended IMS. I’m back to moving my arm and walking today. After the neck fusion at my C5 and C6 level due to spinal compression I needed additional help. I’m glad I was referred to the IMS treatments and highly recommend them.

  • Klee

    IMS is a form of Acupuncture, if you have studied TCM, you would know this technique has been used for thousands of years.

    • Brent

      IMS is a treatment technique that has its roots in TCM, but the way it is taught and utilized by physios is different than acupuncture. I live and work in Vancouver, a city with a large Chinese contingent and some very experienced TCM practitioners. Acupuncture is very mainstream here. I regularly have clients come in that have already had acupuncture or are having it regularly with their TCM as well as physio. I find the two techniques compliment each other, but are different entities and I have hundreds of clients that see me and a TCM that would attest to the same. Dr Gunn studied dry needling from what he knew about TCM, created a new technique and put it in the hands of experienced physiotherapists that have a strong background in anatomy and biomechanics. I believe the use of IMS by a trained physiotherapist allows a lot more precision, specificity, safety and better results in treating pain related problems in the body than the more systemic approach taken by most TCMs. I believe they compliment each other and are both valid, but I and thousands of my clients would attest that if they are experiencing pain, seeing a physio trained to do IMS would yield better longer lasting results than seeing a TCM for needling work. IMS practitioners are standing on the shoulders of giants and give credit to Traditional Chinese Medicine for developing acupuncture over thousands of years, but I think TCM practitioners need to stop trying to take credit for anything that is done with a fine needle going forward. As a manual therapist, the needle has become an extension of my hand that allows me to feel inside a muscle in a way that a TCM would not understand. Accept that our professions overlap and we can move forward supporting each other.

      • Harry Milstead

        I’ve been an acupuncturist for 25 years now, and I hope what you writing is more from ignorance about what acupuncture includes rather than a deliberate attempt to mislead the public. What you describe in IMS has been practiced for thousands of years as an acupuncture technique. Please learn more before educating the public.

        • Brent

          This post stemmed from the inevitable question I would get from my clients mid way through a treatment session: "so what’s the difference between this and acupuncture?" Many of them had previously had ‘acupuncture’ and were quite aware that what I was doing seemed to be different. To the best of my understanding, in language that makes sense to the general public, the above article is my explanation. I learned it as something different, they experience it as something different so I explain it as something different.
          As a physiotherapist I pull techniques from various different disciplines which helps me appreciate the value of each in a less biased way. I use needling techniques when appropriate, manual therapy techniques when appropriate, postural exercises when necessary. I have been a physio for 12 years and an IMS practitioner for 7 so my position is far from an ignorant one.
          If you choose to post again please provide a constructive, educational comment from your 25 years of wisdom with acupuncture instead of just saying no we did that, you are ignorant. Thank You

  • Sean

    I like the idea of IMS. While I do not discredit acupuncture and it’s effectiveness, I like the idea of IMS using the scientific approach that Western medicine provides. Are there any studies that measure the effectiveness of IMS side by side with the effectiveness of acupunctur e? http://www.reliefacupuncturepa.com

    • Brent

      Up to this point I do not believe there are many high level studies comparing them, but Dr Gunn has passed off his body of research to the University of British Columbia with a mandate for more in depth research and ongoing training of physiotherapists and physicians. The use of IMS in Vancouver has become much more common place in the last 5 years due to its effectiveness so I think you will see some better studies coming out in the coming years. The Kinetacore group in the States is working hard to spread the technique too so as the numbers grow, so should the academic studies.

      • Sean

        Thanks, appreciate the information!

  • Kass

    I have recently been to a physiotherapist due to lower back, hip and shoulder pain caused by a vehicle accident. My therapist has used IMS the last 2 visits.. Mainly in my hip and back.
    What he did different from what I’ve read in your article is he attached an electrical current to the needles to stimulate the muscles to twitch… He also left the needles in, with the electrical pulses continuing for the next 10 minutes. Although not painful, it does leave my hip achy for a day or 2 after, but ultimately it is feeling better.
    My question to you is, is an electrical stimulant as good as, better or worse than moving them manually as described by you as an extension of your hands?

    • Brent

      I have never used the electrical stimulation in needling people although I know some do. It was not taught by Dr Gunn as part of the IMS training although I am sure he experimented with it. Many people that do IMS have also trained to do acupuncture and treat people with a hybrid of both. Many people that are trained to do acupuncture also claim they are doing IMS. It sounds like you may be seeing someone that is trained in both.

      I cannot truthfully say that using current is better or not because I have not tried it, but as a manual therapist I find that I get a lot of feedback from feeling the tissues through the needle that helps guide my treatment that I just wouldn’t get by using current. I also don’t think that you need to get a full twitch out of some of the muscles to be effective. Some muscles will twitch while others will create a slow deep cramp before relaxing….if you make these muscles twitch by means of current it is likely to lead to more post treatment soreness.

      Long story short, electrical stimulation to the needle is not what I would consider pure Gunn IMS as I know it, but it may still be quite effective.

  • Deborah

    I live in Ontario and received my first IMS treatment today to my lower back and both achilles. I am a sprinter and the therapist said that I could not do any form of exercise for 3 weeks while I was getting the treatment. He also said that I could not go back to sprinting for 6-8 weeks. However when I have read info on the web its says that its ok to exercise after treatment. I am confused. I don’t want to stop sprinting if I don’t have to. I am ok with a week or two off but 8 weeks!! Any info on this would be appreciated.

    • Brent

      that is extremely conservative advice. I usually tell people to not exercise the day of treatment, but the next day is usually OK. If you still have a lot of pain or stiffness post treatment in the following days you are best to let that resolve before doing anything heavy. If your Achilles are really inflamed the therapist may want to give the tendonitis time to calm down, but if they are only irritated you should be able to exercise during treatment. I treat dancers, Ironman triathletes, MMA fighters, and tennis players that all go out and compete the next day. I haven’t seen or assessed you so I cannot give you advice and your therapist must have some reasoning for suggesting such a long time off, but that type of rest is not a regular part of IMS treatment.

      Hope that helps

  • Deborah

    Thanks! I really appreciate the information. The therapist said that my body was breaking down, lower back pain, knee pain, hamstring pain due to scar tissue and achilles pain due to past trauma. Maybe that is why he suggested no activity except for walking for the next 3 weeks. Just one other thing, the therapist also said that I should not do any other form of treatment in conjunction with IMS. So no massage, acupuncture, shock wave, no stretching. Is this so the therapist can gauge whether the IMS is working for me?

    • Brent

      you should ask the therapist why he/she suggested that. IMS is a powerful tool so it typically isn’t necessary to all the other things too. There is such thing as too much treatment. I think certain exercises are important during treatment. I usually preach less is more when you first start IMS treatment and then start layering in exercise, occasionally massage. I typically find acupuncture compliments it. shockwave is probably not a great idea. You are better to be systematic in the approach so you know what is helping and what is not. One thing at a time helps with that, but it is not always necessary to say don’t do anything else at the same time. Don’t have massage RIGHT after IMS, or do lots of stretching right after.

  • Linda M

    There is a current debate throughout North America about who can use acupuncture needles in their scope of practice. IMS is no different than classical acupuncture which included the treatment of muscle as one of the layers of treatment- among others. It is simply a rebranding by Physiotherapist. Another example is ‘Graston’ technique which is also a chinese medicine practice called gua sha.

    Many states are stating that it is illegal for physiotherapist to practice ‘dry needling’ as it is not within their scope. This is similar to RMT’s that can not legally use "cupping" which is also the domain of Chinese medicine. Washington state has recently banned physiotherapist from using acupuncture needles.
    http://forwardthinkingpt.com/2014/10/16/washington-counts-ban-physical-therapists-from-practicing-dry-needling/

    I personally have little issue with physiotherapist using the benefits of acupuncture but I would like to see them more trained and refrain from publicly saying IMS is something other than acupuncture when this is simply not the case. Currently I believe they are only required to have 30hours of training, compare that to more than 1500 hours an acupuncturist trains you might see how something might have been left out.

    • Brent

      thanks for your comments Linda, although I don’t agree with some of them this is a forum for people to learn about needling techniques and the ‘debate’ that is going on so I am happy you shared. I did hear about the Washington State ruling and I think it is one that did the people of Washington a real disservice. It is also important to know for people that what was ruled in Washington is not true of all the States, only closer to half. You can look at the Kinetacore website for which States are and aren’t allowed to have PTs needle http://www.kinetacore.com/physical-therapy/Dry-Needling-Scope-of-Practice/page63.html

      I am in no way affiliated with Kinetacore. I live and practice in Canada where IMS originated and physiotherapists are allowed to ultilize both IMS and/or acupuncture across the country as part of their scope of practice as long as they have completed the appropriate training. In order to even qualify for the IMS course a practitioner must be a medical physician or a physiotherapist with minimum 3 years experience, and have already been certified in acupuncture, or taken the extensive manual therapy diploma program here. So IMS practitioners typically have at least 4-6 years of University training in health/anatomy experience and over three years working with their hands on people before they even touch a needle. The IMS course is then held at the University of British Columbia where further research into ‘dry needling’ is being done. So in Canada we have taken the approach of more training and help building physiotherapists scope of practice in a safe way so you cannot discredit it on a ‘matter of public safety.’ In America you would be wise to push for more stringent training requirements by Kinetacore instead of trying to limit health professionals ability to help someone.

      As for IMS being acupuncture….I still think this is completely misleading for the public. As you say acupuncture has many layers to what it can be used for, not all of them being pain. Dr Gunn studied traditional acupuncture and tried to filter out what was useful and what was not for chronic pain issues. He wanted to know why some of the ashi points worked. He experimented with various different uses of the needling techniques and found what he thought worked the best. Yes the body of work he started with was acupuncture, but he refined it to be specific, precise and safe, where traditional acupuncture was not. There are some acupuncture points that just don’t respect the dangers of some important anatomical structures and I would hope an acupuncturist had throusands of hours of experience before considering them. Dr Gunn cut those out and started teaching a refined techique to very qualified and competent health care professionals. There has been little to no ‘branding’ around IMS. Kinetacore has started that in America in the last few years which sparked this debate, but IMS and Dr. Gunn’s work dates back to the 1970s. The technique has grown organically in Vancouver, Canada and somewhat the world based on its merit, but there hasn’t been any branding at all.

      So yes IMS comes from acupuncture, but no IMS is NOT acupuncture.

      • Sheila

        Linda is correct. Please- stop saying you know what an acupuncturist does. "ashi" acupuncture or trigger point acupuncture, or local acupuncture are all terms that have been in use for thousands of years and ARE THE SAME thing as "dry needling" and "IMS". What these "modern day" terms are- a re-branded shaved version of what acu’s have been doing for centuries. Please stop saying what the acu profession does- who are you to define it? Perhaps this would not be turf war if PT’s stopped insisting that they can redefine an entire profession that isn’t even their own. Gua sha, cupping, and now needling (WITH ACUPUNCTURE NEEDLES NO LESS) is indeed invading/borrowing and appropriating a whole other medicine and craft. Quit calling it something else. Clearly- there is a strong lack of boundaries- there is also talk of PT’s taking this "non acupuncture class that’s using acupuncture needles and employing acupuncture techniques but insists it’s not acupuncture despite they actually have no idea what acupuncture is" are now reappropriating acupuncture points to call them "reflexive points" which are meridian distal points. Stop it. Have some self respect.

        • Jay

          What Brent has been doing here is invaluable, it’s called educating on the similarities and differences between what is now know as IMS and an age-old treatment system known as Acupuncture. There are differences, especially in theory and philosophy. To deny that is disingenuous. Contrast Brent’s approach with the hostility from various acupuncturists here and notice the difference is quite stark. I really don’t think acupuncturists should feel threatened at all, and especially not because IMS is quickly becoming a popular and invaluable treatment approach to those in musculoskeletal pain.

          IMS works clinically and that is important. IMS is seeking scientific validation in areas which have not been provided by acupuncture as well. That’s not to say one is better than the other, rather to point out where one might be more effective than the other is a matter of understanding what the therapist is after.

          Instead of attacking Brent and the hard work he’s obviously put into this article and his site, wouldn’t it be better to add constructive input that builds confidence in patients with respect to the use of the needle itself.

          Let’s stop the attack based responses.

          • Brent

            thank you Jay

      • Carmen

        Physiotherapists are required to be certified in ANATOMICAL ACUPUNCTURE through the organization known as Acupuncture Canada. This organization teaches anatomical acupuncture where acupuncture points are utilized to treat muscle/nerve and tendon dysfunctions as defined by a Physiotherapy Assessment. There is no TCM diagnosis and No application of TCM. The certification through Acupuncture Canada is given after 2 courses utilizing 6 weeks on online education and then a 2 or 3 day hands on workshop to learn to locate 90 points. There is a written and practical exam after the second course and, if successful, the participant is "certified" by Acupuncture Canada. They ARE NOT certified acupuncturists in the sense of Traditional Chinese Medicine.
        Chan Gunn IMS is very similar to "AH SHI" treatment. In this TCM technique, tender points are treated as part of the entire Syndrome Differentiation Diagnosis. It is believed that these tender points are the result of other body imbalances. These imbalances must be treated IN CONJUNCTION with treated the Ah Shi (ouch points) so that the painful points can be treated successfully.
        In IMS the underlying muscle dysfunction/ neuropathic pain source has to be treated in order to treat the trigger points successfully.
        While very well versed in anatomy and physiology, I don’t thing Physios are certified in Acupuncture— they has merely been taught to handle needles prior to taking your course. ( I know I teach with Acupuncture Canada, have practiced Medicine for 35 years, practiced GTT and Anatomical Acupuncture and Trigger point injection for 20 years. I am currently completing a 3 year TCM acupuncture program for Licensing as a TCM acupuncturist in British Columbia)

        • Brent

          thank you for your insight Carmen….that is helpful!

  • Linda M

    Quote from article:

    “This is a major victory for public safety. There’s a reason Washington law requires 500 hours of supervised clinical training before people are allowed to practice acupuncture” says Dan Dingle, a board member of SSAA, an Olympia-based organization that promotes education and patient safety. “When physical therapists take weekend workshops of only 27 hours and then start needling as deep as 4 inches into their patients, it’s only a matter of time before someone is seriously injured in Washington, as they have been elsewhere.“

    • Jay

      Linda,

      Do you have statistics on patients injured by either IMS or Acupuncture, rather than a political statement that seems more like it’s designed to instill fear than provide facts?

  • Linda M
  • Kristie

    I have started seeing a physiotherapist and I thought he was doing IMS treatments. The question Im wondering about is that when he puts the needle in I can kinda feel as well here a big spark! What is that? I have never seen him hook anything up to them. It’s just the needle. And some times he puts the needle in and leaves it for 5 minutes or so and other times he puts them in and it sparks and he moves it around until I have the pulling effect or shock sensation and then takes it out and goes onto the next one. And sometimes when he inserts the next one I can feel a jolt of pain from the one he is working on and a spark on the one way across the other side of it. Just so seeing if this is a different technique? And when I leave I have more pain then when I went in with
    Thanks

    • Brent

      just ask him if he did his training through iSTOP (Institute for the Study and Treatment of Pain) with Dr Gunn or the new facility at UBC in Vancouver…if not he is not technically doing IMS but may be the same principle. I never leave points in for more than 10-15 seconds and am almost always holding onto any needle that is in the body. As for the spark feeling, it may be that he hit a nerve, although that is usually felt like a prickly feeling further away from where he put it in. Sometimes the needle can feel sharp going in if it doesn’t go through the skin really quickly. Post treatment soreness can be normal but it should be accompanied by some relief too, if not right then, likely the next day. Hope that helps

  • Ross

    IMS is Acupuncture, but very basic acupuncture! Call a rose by another name it smell just as sweet

  • Rick

    Wow, when something works well you can always count on entrepreneurs looking to make a profit by tweaking something…. and in WESTERN WORLD MEDICINE… this idea of stating that "ALLEGEDLY" IMS is BETTER than acupuncture … IT’s BS to just remove pain is comparable to saying to a person…"Tell me what you feel, but wait a minute … let me stick this sock in your mouth" Pain is the body’s way of saying something is wrong… and to just REMOVE the pain is SOOOOOO like all allopathic medicine… cut it out, remove the symptom and NEVER looking at how to change things & determining WHY things are out of balance….. ACUPUNCTURE on the other hand IS LARGELY better than IMS because it let’s the body do what’s natural… rebalance, stimulate the flow of energy so things can heal….. our body’s will know better than some IMS "specialist" who’s playing God & removing a signal that something is out of balance without letting the body resolve it’s issue… THUMBS DOWN for IMS…. Just another medical PLOY to capitalize on an EFFECTIVE healing practice… and let’s face it…. the Western world medical profession doesn’t EVER promote HEALTH… what is HEALTH? what do doctors know about health ? They know how to prescribe drugs that don’t do anything but remove symptoms & then ADD additional SEVER SIDE EFFECTS to prompt MORE drugs… all about the money… keep those patients coming back for more drugs… if they get healthy you’re out of business if you’re an MD>….. An HONEST MD once asked me, " You know what MD means don’t you? " I questioned
    What? his comment was MORE DRUGS…. now THAT"S the truth….
    Acupuncture isn’t learned in an intensive couple of week training session like your IMS therapists likely attend…. AMERICA is terribly sick and the "medical" profession is at the core…. never EVER really dealing with HEALTH care… should be called SICK CARE… Just give the client some NEW drug (get your kickback ) and have ’em come back next week for another drug to counter the side effects…. AMA is as corrupt as our federal gov’t… passing & approving of drugs & products that are PROVEN to have SERIOUS side effects & NO proof that they work… other than what the "COMPANY" says in their own biased research… WTF who’s shittin’ who? The regular guy who TRUSTS the AMA & doctors IS getting screwed… just look at all the stats of how Americans are getting sicker & worse than EVER in American history… Research to fine cures? HA… why would they want to find a cure for cancer, when they’re making BILLIONS of dollars of of every fool that surrenders to some doctors options that STATISTICALLY DON"T WORK well at ALL….. Three cheers for Acupuncture… THUMBS DOWN for IMS

    • Brent

      Thank you for your rant Rick, but you’re having trouble staying on topic and obviously haven’t read anything else on my website. I am not a doctor, I am a physiotherapist as are most therapists that do IMS. A good portion of this website is dedicated to educating the public on how to be preventative in their health and how to stay out of the medical system as much as they can. Acupuncture is a great tool that can be utilized for a broad array issues in attempt to balance the body. IMS is more basic in its principle and purpose. Dr Gunn carved away a lot of the aspects of acupuncture that weren’t necessary for treating neuropathic pain and taught a simplified and refined version to a group of healthcare practitioners that understand the biomechanics of movement, alignment and pain better than most. It is a powerful too in the right hands. To call it acupuncture is misleading to the public because the experience is quite different from traditional acupuncture. Yes it is derived from acupuncture but I have no agenda in trying to tell you it is different beyond trying to help people understand. If you go see a TCM for a pain issue and he uses acupuncture and then you go to a physio and he uses IMS you will not come out of those two visits thinking you just had the same form of treatment. They are both useful, but IMS works better at alleviating pain most of the time.

    • Jay

      I got five sentences in and then couldn’t read any more of this. Too loaded and emotional for my likes.

  • Kristin

    Hello…

    I was so happy to find your article today. I have been seeing a wonderful physiotherapist since a car accident in late June. In the last two weeks we have decided to attempt IMS. My last that was done at the base my neck and about 1" down on my shoulder seemed fine…although the typical pain etc. It seems to be helping the muscles relax on one side of the body better than the other so she can do her job. It seems that she has to spend a lot of time loosening me knotted muscles. By the time she does this, there is little time left to deal with the soft tissue injuries. When I was hit my car was at a stand still and I was slightly turned in my seat, I was driving and did have my seat belt on. I was waiting for a green arrow on the Willingdon overpass to go onto the freeway. I am writing to you today, because on Friday she did IMS on my lower back, because she only wants to do IMS on my shouders/neck and lower back once a week, and I see her twice a week. As of Friday I have been so exhausted and with a massive headache, that is not a typical headache for me. It is definitely muscular and running up the left side of my neck to just above my ear. I have had headaches in my life but nothing like this. I thought I was going to have to go to the hospital last night. Today, I only had minimal work I had to do, and the pain is so bad, when I sit or stand, that there are tears in my eyes, and no amount of Tylenol will take the pain away. I mentioned this to someone I know and they told me that I should be careful because only chiropractors are licensed to administer IMS. Is this true? If so I think I will back away from IMS (although it seems to have helped my right shoulder), but I’m a little leary about having someone who is not licensed do it, if that is indeed the case. I look forward to your response, and thank you for your article…it helped a lot to define what the difference is between acupuncture and IMS.

    • Brent

      no chiropractors are not able to do IMS, you have to be a physio or a physician, it is about 95% physios that practice IMS and 5% doctors. Post treatment soreness is normal, but if you were in that much pain you should talk to your physio and/or doctor about it. hope that helps

      • Kristin

        Thank you Brent, will be seeing my physio tomorrow…..trust me, we WILL be having a long talk, I’m still in as much pain today. I appreciate you taking the time to read and respond to my post.

  • Beril

    Hi, I’ve been receiving IMS treatment for sometime but my lower back pain still troubles me. I wanted to find out how often I should be seeing My physiotherapist as she wants to see me almost every week? She said that between two appointment there should be no more then two weeks gap. Plus how do I know my physiotherapist is experienced? We are new to the city and have no idea how to find an experienced physio. Thanks

    • Brent

      for IMS treatments it is typical to have about 1 week between treatments and then progressively wean you away. As for how to know if they are experienced….I would start by reading their bio on their website….if a physio has IMS certification they have probably been a physio for at least three years….I believe the istop.org website has a list of practitioners on it that lists the year they did the course and where they are (it is only the people that paid the $100 to be on the list so it is not exhaustive)

  • Irene

    Hi, Brent. I live in Victoria just across the pond from you. I have something called adhesive capsulitis of the right hip also known as frozen hip since May. I had my first IMS treatment 1 week ago and was feeling very little pain during the week. Now the effects are wearing off and the muscle tenderness and spasm is slowly returning. I have booked another treatment for a week from now. I am told that my condition will eventually clear up on its own after about a year and that the IMS likely will not improve my condition — it can only help with pain relief. In your opinion does IMS do anything therapeutically to help the muscles to stretch and to heal? Or is its only purpose to relieve the pain? I just want to be realistic about what I can reasonably expect.

    • Brent

      I would try the IMS at least 8 times spaced out by about a week…the effect can be cumulative with longer lasting results each time….freeing the muscles up should allow the hip to sit deep in the socket and move better which should help loosen up the hip capsule. I would agree with what you said for frozen shoulder but not for the hip…..it should help with more than the pain

      • Irene Rau

        Thanks for your feedback. I did end up trying the IMS treatments for 6 consecutive weeks and it was great for pain relief and for helping my hip to feel somewhat normal again. I did discontinue it so I could see if I’d made any progress. Now I am not in as much pain and I seem to be making slow progress primarily with targeted exercises and Pilates. A new phase I’m going through now is that I am awakened from my sleep after about 3-4 hours with painful muscle spasms in my glutes and hip flexors. So painful and then hard to get back to sleep again. Any thoughts? I’m assuming this is just a phase I’m going through til my muscles have stretched sufficiently and lengthened. I do take about 300 mg of magnesium before bed but it doesn’t seem to help much.

        • Brent

          I would consider looking for someone that can do neural and visceral manipulation….that type of pain can come from a cranial torsion and/or a referral from one of your pelvic organs http://www.iahp.com/pages/search/index.php

          you can read my article on visceral manipulation on this blog….I haven’t posted about neural manipulation yet….it will be in my book, but it is similar to craniosacral therapy

  • LA

    Anyone who has read Chan Gunn or Yun-Tao Ma will note that they both deliberately state their intention of "de chinsese’ing" acupuncture to make it more "acceptable" to a Western audience. However, biomedical acupuncture which is based on French Energetics Acupuncture has been used consistently by Western physicians since George Soilé de Morant’s ‘L’acupuncture Chinoise” was published in 1941. Prior to de Morant, Sir William Osler, considered the father of modern medicine and a co-founder of John Hopkin’s, used what he called "acupuncture" to treat sciatica and low back pain (lumbago). His application of acupuncture to address referred pain patterns is no different to IMS. The notion that acupuncture has been or continues to be taught or used with only Chinese theories or points on meridians is false and intentionally misleading. The Western world has been using the word "acupuncture" universally to describe therapeutic use of needles since 1683, when the Dutch physician and botanist, Willem Ten Rijke published: ‘Dissertatio de Arthritide: Mantissa Schematica: De Acupunctura: Et Orationes Tres’. There’s so much to the 330+ years of history of acupuncture in the West and it’s uses w/o Chinese terminology. The ultimate challenge for any modern practitioner of medicine is: are you determined enough to learn acupuncture from its beginnings or rather opt of a short form and miss out on the all the "goodies"?

    • Brent

      thanks for the background!

  • perry mason

    extremely interesting discussion … first day of research to precede a procedure by a physician to perform ims on my 80 year old mother who suffers from chronic degenerative spinal problems that include multiple bulging herniated and ruptured disc … multiple spurred and/or touching vertebra and most likely miss alignments and some curvature due to inactiveness and little if any exercise her entire life … third site to visit and probably the most informative … this guy knows his business … extremely interesting article and i am very interested to read his comments on the remaining guestions / comments since his last … i have a question concerning the practitioner’s initial examination … when should this be done and how extensive?

    • Brent

      the process of doing IMS for your mother would be partly therapeutic and partly diagnostic to see how much of her pain is a result of muscular compression on the joints. The doc/physio will look at her posture and movement, should feel the mobility of her hip joints and then feel the muscles tissue on either side of her spine in prone with his two fingers. There may be a handful of other tests too, but an 80 yo with an Xray like that will likely benefit from her deep hip muscles being released and the deep spinal stabilizers called her multifidus….many times is is the tension in these muscles as a result of the degenerated spine that causes most of the pain and immobility. She will likely find it helpful but will likely have to do it as maintenance every month to keep her back happy because the degeneration in her spine will likely cause the tension to regenerate over time.

      hope that helps

      • perry mason

        i appreciate it

  • Doris Jones

    I have a friend who rec I try IMS therapy for sciatica and low back chronic pain. 20 years ongoing now. I have stabbing nerve pain into my heels and toes everyday to some degree and nerve pain down the sides of my legs in both legs that last from 10 minutes to several days, heat or hot spots a lot. I’ve been told it could be coming from several places in the spine. I’m not sure I can handle the thought of someone searching for muscle points 4" down into my body. Terrifying really. Although I think I would prefer it over all those needles in my body unattended or with some electro stimulation attached to the needles …….. The other thing about acupuncture was they kept hitting what seemed like major nerves and it was very painful. Some of the needles after putting them in the pain in the nerve did not subside. I tried to buck up, I tried 3 visits and could not manage that kind of pain. Perhaps it was the therapist or a combination of things. Are the muscle spasms or grabbing worse would you say when penetrating the muscle, then the spasms I get from sciatica or muscle spasms from tightness. I have arthritis in my L4, 5 and SI joint, a herniation in the same area. Over time has been making it increasingly difficult to bend, and when I do I get such terrible knee pain. I have no quality of life like this. I have not been able to squat since 2005 which likely did not help the rest of the body. I have fibromyalgia throughout my body to varying degrees, and arthritis in my neck from my last two car accidents, it seemed to acerbate the neck trouble. I don’t want to feel worse than I do already. Brent I read almost every post and there was so much negative feed back, that it’s scary. The area is so hypersensitive sometimes, the act of getting a bath triggers sciatica on many occassions. I can go to bed feeling normal and wake up with the same. I’m desperate. I’ve spent months doing physio each time when it seriously goes out and been off work. I’ve collasped from sciatica pain on a number of occassions. Would you recommend IMS and how many visit do you think I would need. Everyone is different I realize.

    • Brent

      Hi Doris

      IMS would likely be helpful, but you would have to endure some discomfort with it. The pressurey crramp that comes with it is quite short lived, but it can make you sore for a few days after, but it is typically worth it. As for how many sessions, I would guess 3-8 but don’t put too much weight into that because I have not seen you. You would likely need someone to treat your neck, hips and back. If it seems too aggressive for your pain level, I would consider finding a physio, osteopath or massage therapist to try some visceral and cranial work on you first…..look up my post on visceral manipulation.

      Best of luck

  • Doris Jones

    BTW – this was the clearest and most truthful article I have read this morning in what to expect, and what IMS is. I will leave it to the rest of you to deliberate the fine details of the two treatments. When really all of us are seriously suffering just want help. Rather than taking over the counter meds excessively and not being able to function because of the side effects.

  • Rick

    Hi, I see the usual debate going on here as in the US. I am a physical therapist (PT) in North Carolina. Unfortunately acupuncturists always trot out the public safety argument when in reality it’s a turf war. But what is it in reality that puts the public safety at risk? PTs have 2300 -2600 hours of education and more importantly, cadaver dissection. Acupucturists have cadaver dissection as well (I believe). Placing the needle into the body is the very easy part. The skilled part is knowing where and more importantly, where not to place the needle. Acupuncturists are no more trained at this skill than PTs. Acupuncturists like to say they have thousands of hours of training, but I believe this includes all courses in their curriculum, not only needling. If that were the case, they’d be in school for 6 years. (Incidentally, the risk of adverse effects of dry needling (DN) is 0.04 %. Taking Advil is 14%). Additionally, DN is one of many tools I use to get my patients back to function in addition to modalities, manual treatment, exercise and education. I rarely only do DN. Acupuncturists only do needling and several variations and that’s it. They’re not trained to do manual work or prescribe exercises and honestly I don’t believe they’re intertested. Additionally, my lab partner at my last course was…you guessed…an acupuncturist. So my question is if this is commonly taught in the acupuncture curriculum and commonly practiced by acupuncturists, why are they taking DN courses? I believe the fact is that most do not do Ashi points and mostly perform superficial needling into meridians. I believe this is something the acupuncture community likes to mention is part of their profession, but very few actually do it. And if you do do it, do you know what impact it has on the body? How is it affecting alpha and gamma receptors? Do you know how trigger points form and the chemical processes that occur which lead to pain? And do you know what process is set in motion once the muscle twitches to decrease pain? Do you know what a muscle twitch is? I’m sure if I ask any acupuncturists who have gone only through an acupuncture program those questions, they’d have no idea what I was talking about. Yes the chemical process and goal of dry needling (to change the biochemical milieu) is very different from the process and goals of traditional acupuncture. That’s why when my patients ask what’s the difference between DN and acupuncture, I tell them the only similarity is placing the needle into the skin. From that point on, the process and goals are very different. And yes I do send my patients to several acupuncturists in my area. As a side, I notice no mention of Janet Travell who pioneered this work in the US back in the seventies.

    • Brent

      thanks Rick….I agree it is more of a turf war than anything.

  • Holly

    Hi – I have had needling done for several years and it has been great. Most recent session something new happened and curious to get your thoughts. The dr. was working on my neck and inserted needles. One made my body jump involuntarily and it felt like a shock or like something burst in my neck. The dr. said that she hit a spot of stagnate energy and it released. The area on my neck has been very sore for 10 days but is getting better. Is this normal? Thanks

    • Brent

      no that is not normal….some muscles are prone to twitching especially your upper traps ( the bigger muscle from your shoulder up to your neck), but that doesn’t sound like what you are describing.. I have seen people’s whole body jump from needles in the mid back when I hit a big strong area of tension that they weren’t expecting, but pain lasting 10 days is not good or normal…I would challenge your doctor on her explanation and be careful with your neck

      • Holly

        Thanks for your speedy reply.I definitely appreciate it. I have experienced the twitch and this was not that. It felt like something burst in my neck and my body and legs convulsed for a split second. I will follow up with my dr. tomorrow. I have been researching on line and it seems like may be she hit a nerve. Not sure how serious it might be though since it still is sensitive on the side of my neck. Thanks again for your input.

  • Val

    I really love IMS therapy but some IMS treatments really sting. It seems to be when certain therapists do it over others. The more experienced therapists are slick and it doesn’t sting at all. Is it due to the therapists technique? Is it due to the therapist swabbing with alcohol and not allowing to dry before the needle insertion?Just curious.

    • Brent

      the occasional sharp feeling with IMS is typically partly the technique of the practitioner, partly the area they are treating and partly the state you are in that day. Certain areas of the body have more sharp pain receptors in the skin and can be more sensitive. I find if women are on their period they are more sensitive and if a person is just getting sick they tend to perceive more sharpness. Also once you have had one sharp needle and are anxiously anticipating the next one, it heightens your nervous system and you are much more likely to feel the next few needles as sharp. I tell people it is like throwing a penny at a chain link fence….it is 90 percent air but sometimes you ding right off the metal and hit a pain receptor. As you get more experienced at doing it you learn better entry techniques and get better at dealing with people’s anxieties about needles and both bring down the likelihood of feeling the sharp stingy feeling.

  • Chocolate

    Brent – Love the site. A bit of background info: I was a competitive dancer for 5 years and also lifted moderately heavy weights (300lb deadlift, 225 squat) for 3 years. My ‘injury’ occurred when I was excessively hyperextended while doing pull ups. MRI and nerve conduction tests were normal and I’ve been through multiple specialists and physios without much relief. I’ve had shooting pain since 2013 and I am super intolerant to any extension / rotation.

    I recently started seeing a physio who characterized my pain as neuropathic and started giving me IMS treatments. So far, my range of motion has increased quite a bit (much to my surprise!), but the flare ups still remain. I have three questions:

    1) For a super neuropathic person, how many sessions does it typically take to realize pain relief? iStop mentioned it takes about 8 sessions for ‘normal’ cases. Am I expecting 20? 50?
    2) Does the effect of IMS saturate where further sessions yield no benefit?
    3) Is the effect of IMS temporary or does it cause a permanent change to the neurophysiology?
    4) Have you used / heard of folks doing IMS + nerve blocks?

    -C

    • Brent

      1) For a super neuropathic person, how many sessions does it typically take to realize pain relief? iStop mentioned it takes about 8 sessions for ‘normal’ cases. Am I expecting 20? 50?
      -no I would say about 8 sessions spaced out by about a week would be typical and if you aren’t noticing pain relief by that time, the physio should start expanding to treating other areas of the body/and or using other techniques in conjunction with IMS. There is a cumulative affect to it, but if you haven’t experienced any pain relief by 5-8 sessions start considering something else.
      2) Does the effect of IMS saturate where further sessions yield no benefit?
      I haven’t had that experience No…..it seems to work no matter how many times you have done it in the past
      3) Is the effect of IMS temporary or does it cause a permanent change to the neurophysiology?
      Can be both depending on what the root cause that is facilitating the nerve irritation. For example you may have an arthritic joint that creates inflammation and irritates the nerves and muscles around it. IMS will calm the muscles and nerves down around it and make the joint less painful, but the arthritic joint is still degenerated and will slowly start the process again and likely bring the pain back over time. On the other hand, if the origin of the pain is not coming from a structural problem and is more just an irritation of the nervous system from a past injury or jarring force then yes IMS can and does have a permanent affect on the physiology. I have slowly turned around a lady with Complex Regional Pain Syndrome and seen visible changes in her skin and legs over a period of two years…..she took 30+ sessions, but it did make a significant and permanent change
      4) Have you used / heard of folks doing IMS + nerve blocks?
      Yes, I work with a pain specialist that does blocks and then sends people to me for IMS all the time. Many times I have found IMS to work better than the block, but they can work well together

      • Chocolate

        Brent – Thanks for answering my questions!

        1) There is definitely radicular pain relief right after the needling session. My ROM also feels ‘free’; almost to pre-injury ROM! However, my propensity to get flare-ups has not decreased. My physio is expanding out to hamstrings, upper back and other related areas besides just the lower back / glutes.

        3) Regarding nerve irritation: the ‘injury’ seems quite innocuous to me. Hyperextended lower back while doing pull ups doesn’t seem excess weight to me. Even if I suppose there exists an arthritic joint, it’s pretty crazy how intolerant my movements have become now post injury because pre-injury I was quite mobile and had no history of any back pain whatsoever. I find it hard to understand that the current nerve irritation is coming from an arthritic joint.

        Very happy to hear about IMS working for a tough case. Have you treated super neuropathic athletes who’ve recovered enough to ‘play’ again? I’m trying to manage my expectations and understand what’s realistic!

        • Brent

          yes I have treated lots of neuropathic athletes and got them back playing, You’re right in that it doesn’t sound like it is coming from an arthritic joint, but you can sprain the ligaments around the joint and/or effectively bruise the facet joints by overly compressing them together which may persist for 6 weeks or so and continue to annoy the nerves around it. It can be tough treating athletes with IMS in the acute stage, because you can really free them up and improve their pain, but if the body still needs time to heal something, the pain and stiffness can come back and the athlete gets frustrated. It is still worth doing and typically gets you there faster, but for competitive athletes it is never fast enough!

          The other thing that can facilitate and irritate nerve roots is the fascial pull of the organs that attach to the front of the spine. If something inside isn’t moving well, it can be the driving force behind your flare ups. I have found that using what is called visceral manipulation in conjunction with IMS is the best way to help people that are only getting temporary relief with IMS….I was quite cynical about it, but as I get better at it, it can be the magic bullet that people need.

          Best of luck

  • Sometimes the better to simply take a stride back as well as recognize that not everybody gives your own beliefs

  • Thanks for the information about IMS treatment, very well explained. But it should not be involving Acupuncture in a negative way. if we understand the both treatments, both complements each other. According to my knolwdge IMS treatment& Acupuncture treatment if performed properly (as you mentioned depends upon the practitioners)works same.Because Acupuncture for sports medicine work same as IMS by stimulating the Trigger points for very short period of time almost just insert the Acupuncture needle very fast and remove it or keep just for a minute. This is called reducing action for pain management according to chinese Medicine.I am practicing Chinese Medicine & acupuncture for 10 years and receiving great results in acute/ chronic pain managenent/ healing and same time for interal medicine.I belive in integrated medicine & my main focus is giving my patient quality care. I am big fan of Acupuncture , Dry needling and same time IMS. But definately depends upon the practitioners Knowledge and art of their needle technique. Sarabjit Romana R.TCMP

  • we all are well aware of the truth abouth IMS, acupuncture & Dry needling that the root is chinese medicine.Our main job is to reduce the pain of our Patients. So please focus on your work and help each other for the betterment of our patients.

  • Carmen

    What is the difference between IMS and Dry Needling?

    • IMS is a form of dry needling, as is acupuncture. It is an umbrella term for techniques that use a needle but don’t actually inject any substance into the body. There are a number of different types of ‘dry needling’ that use the same tool (needle) but may have a different approach. IMS is the process developed by Dr Chan Gunn in Vancouver

  • I believe that physios are not allowed to needle in California unless I am mistaken. It is different in every state. IMS is a form of dry needling. you can an international list of practitioners on their site here http://istop.wildapricot.org/Directory but it is not a complete list….only the people that remembered to pay the $100 annual fee which I forget every other year!

  • G

    I find that after IMS to a certain muscle, that the muscle jump repeatedly days after the treatment, almost like when it was being needled. This usually happens when I am in a bad posture position, and when the muscle is in a shortened position or with no tension going through it at the time(to support posture). Is this twitching the muscle tightening back up/regressing? Sometimes there is pain too and it usually feels less supple/flexible afterwards(doesn’t fire as well).

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