A few years ago I posted this article (What is IMS acupuncture? Intramuscular Stimulation vs Traditional Acupuncture) on my blog largely as a resource for my clients, because inevitably, about three needles into treatment, clients would ask “how is this different from acupuncture again?” What started as a patient education piece turned into a learning experience for me, in that I discovered how different groups of people had strong and differing opinions about the technique I was using and how I chose to explain it. I had entered the turf war of dry needling. Some acupuncturists were telling me that IMS simply was acupuncture, while others were telling me that my explanation was ‘just bollocks,’ and I should stop misleading people. Meanwhile a retired physician and an aging physiotherapist were telling me that dry needling had been ‘debunked years ago,’ but local physicians and hundreds of previous clients were actively referring patients and friends to me specifically for IMS treatment. It is an interesting time in the world of treating people’s pain!
I learned to perform IMS (intramuscular stimulation) from its’ originator and guru in his field, retired physician, Dr. Chan Gunn in 2008. At the time, I did not know the history of dry needling or the fact that Dr. Gunn had been praised for his work by some and criticized by others, but in my mind, the innovators that stir the pot of the status quo are the ones worth following. I happened to live and work in Vancouver, the city that Dr. Gunn ran his training center called iSTOP (Institute for the Study & Treatment of Pain) which resulted in Vancouver having the most IMS practitioners than anywhere in the world simply due to the ease of access of training. It wasn’t research articles validating the effects of IMS that drew me to iSTOP, it was working in a renowned physiotherapy clinic alongside experienced therapists that were using IMS every day with great results that made me sign up as soon as I met iSTOP’s prerequisites.
In 2006, I branched out on my own and started Envision Physiotherapy in a private room within a personal training facility. I had been a physiotherapist for three years and was slowly building my caseload until I learned IMS in 2008. Dr. Gunn handed me a super power that made my caseload take off because my client outcomes improved dramatically. I started using IMS more and more because people were coming in specifically asking for it; word of mouth drove my business and subsequently developed my skill at the technique. I should mention that Dr. Gunn’s model of dry needling is the platform that I work from, but I have been influenced by Diane Lee’s use of needling and my own take on muscle balancing that may make my approach somewhat different than what I was originally taught. Like all practitioners should, I have made the technique my own through years of experience.
The practice of using IMS every day for eight years has taught me an enormous amount about the body and human nature that I could not have learned from any school or research paper. My experiences and my clients’ stories are what make me take issue with healthcare practitioners that claim IMS is the same as acupuncture, has been debunked, or that the results are more based on the clients’ expectations than the method of treatment I am using. I like to learn by experience and then supplement that by reading on a topic and I encourage others to do so before they make a strong opinion one way or the other on something. I would argue that if you found one hundred skeptical older men that were scared of needles and believed that no one could help them and sent them to an experienced acupuncturist and then to an experienced physiotherapist trained to do IMS that a few things would happen. First, I believe the resounding majority of them would agree that the two forms of needling treatment they received were vastly different and deserve to be differentiated from each other by name and explanation. Second, I believe that many of the men would likely benefit from both forms of treatment, but the majority would report that IMS provided more immediate, more profound and more lasting results than acupuncture. Finally, I would argue the outcomes would be based more on the method used than the practitioner because I know many physiotherapists that have been trained to use both techniques and the resounding majority tend to use the IMS approach over the acupuncture methods when treating pain because of the better outcomes.
The three assumptions above are based on my eight years of experience with dry needling, working in a multidisciplinary clinic, in a city full of experienced acupuncturists, physical therapists, physicians and active people endlessly hurting themselves. We service an educated group of patients that have a lot of choice and have seen numerous health professionals and I am continually told that IMS has been the game changer for them. It has become hard to ignore the growing demand for IMS in Vancouver in the absence of any commercial marketing and easier for me to push back against the critics even in the absence of strong researched evidence backing IMS. I value research, but at the end of the day I am a clinician and my clinical reasoning continually draws me to use IMS as my best available option to help my clients. Below I share with you a series of stories about IMS that may give you more insight into the world of poking needles into people all day. You will see that everybody has a different experience and tolerance for the process of IMS, but most find the results are worth the journey.
Sally the screamer and the tattooed baby
Sally was a tennis player in her mid-forties with a chronically bad neck and back, I would describe her personality as high maintenance to be kind. She wanted her pain gone yesterday and was quite whiny about everything surrounding it. Her friends referred her to see me, but hadn’t told her much about what I do. Sally had tried massage and was scared of chiropractors, but was open to trying physiotherapy if her friends thought it would help. Her notion of what physiotherapy was differed dramatically from what I proposed to do with her.
Sally had some degenerative change around her spine and a lot of global muscular and fascial tension in her body both from having a high strung personality and being an active athlete. Her joints were under an increased compressive load and her anxiety was holding it all in their strongly, she had the combination of factors that make some people find IMS quite uncomfortable. I explained my assessment findings to her and the premise of IMS and why I thought it was her best option. She reluctantly agreed and decided to give it a try.
I started with her upper traps, the big muscle that connected her neck to her shoulder. It can be one of the strongest, most uncomfortable muscles to needle because it tends to contract strongly and pull on your neck and head. Sally screamed and yelled so that everyone in the clinic could hear her clearly. The needle was in her for a grand total of five seconds, but a memorable five seconds it was. As soon as I took the needle out, she was completely fine and apologetic of how loud she was, but just amazed at how intense her muscle tightened up. I let her know that that reaction was totally normal and that we should try a few more points if we were going to help her neck and back. Some people can only tolerate four needles in a session and others can take forty. The art of doing IMS well relies on the practitioner’s ability to read how much a person can tolerate physically and emotionally. My goal with Sally was four muscles and most likely four loud screams.
After a few minutes of reassuring, Sally agreed to three more points, one in her other trap and one on the side of each hip. Each time she yelled as loud as the last. She started sweating and ended up feeling like I kicked her in the butt and gave her whiplash. She wasn’t sure what just happened, but it definitely was something. I don’t know how you could create a placebo treatment to measure IMS against because the experience is a very tangible physical and emotional event for many people. In the span of thirty minutes, Sally went from screaming, to talking, to laughing and back to screaming four times and then felt like she had been hit by a truck. I told her not to worry, to go home and put some heat on it and come see me again in a week.
Sally and I opened the door and walked back out to the front desk where I met a six foot five tattooed deer in the headlights, named Carl, as my next client. His girlfriend loved IMS, found the process quite comfortable and claimed that it was the only thing she had found that helped her pain related to her scoliosis. He came in excited, with high expectations that got crushed moments before he met me, listening to Sally scream, but I managed to talk him off the ledge and guide him through the process. Carl was a big dude with full tattooed sleeves and a bad back related to a car accident a few years earlier. He had tried massage, physiotherapy, acupuncture and a chiropractor in the previous year without much success, but he was nervously game to give IMS a try. He flinched and grimaced with the first few needles in his hips, but calmed down once he could wrap his brain around the feeling and at the end felt a bit sore, but actually much better. Five sessions of IMS created more lasting change in Carl’s back than a full year of multiple other therapies (an occurrence I see on a regular basis).Sally came back a week later feeling somewhat better, but brought her sister in for moral support during the next few sessions. She progressively learned to control her screaming and actually asked for needling instead of me having to convince her. Her chronic issues took much longer to help, but she recognized the value of the IMS treatment even though she hated every minute of it. It’s hard to say the technique doesn’t work when you can quasi-torture someone for thirty minutes and they will send you all of their friends and relatives to you because of the outcome they got from it.
I have dramatically helped Ironman triathletes and sprinters improve their performance and decrease their injuries with dry needling. I have helped ninety year old stroke victims release the tone in their shoulders and neck to alleviate long standing pain. I have eliminated back pain in one session from an eight year old baseball player with four needle points. On a weekly basis someone comes into my office with a long history of tennis elbow or plantar fasciitis that hasn’t gotten better from traditional therapies and finds a fifty percent change in their symptoms after one session of IMS. It is a remarkably effective technique that should be widely embraced by physical therapists around the world and more thoroughly studied by researchers.
I am not interested in participating in the dry needling turf war that is happening in America between acupuncturists and physical therapists, but I am interested in furthering our collective knowledge. The current body of research surrounding dry needling is of relatively poor quality, but clinically therapists are finding great results as demonstrated by the ever growing number of therapists learning the technique and patients seeking it out. I believe that if we learn from each other across disciplines and create some more standardized approaches to dry needling that we will start seeing better quality studies that demonstrate more positive results for the technique than currently exists.
I will be putting together an online course this year open to any health professional that is legally allowed to needle their clients. Acupuncturists, physical therapists, physicians are all welcome to enroll and learn to refine their techniques and their thinking. I am not interested in a turf war. I am interested in helping people in pain and learning from others and hopefully contributing to an improved quality of research going forward. If you are interested in future dry needling courses on line and/or in person, please enter your email below and you will be notified as soon as the course becomes available.
Online Dry Needling Course Updates
I'm sure some of you agree with me and some of you don't. I am interested to hear and learn from both groups. Please be respectful and leave your comments in the space below.
Yours in health,
Brent Stevenson, Physiotherapist