Gunn IMS or Intramuscular Stimulation, is named for the man who developed and researched the IMS technique. Dr. Gunns research into the treatment of chronic pain began while working as a physician for the Workers Compensation Board of British Columbia. Here, he treated clients with a wide variety of chronic pain issues, who had found no relief, or would feel worse following traditional treatments including chiropractic adjustments, traditional acupuncture, massage therapy or manual physiotherapy. He found that their pain was unique in that most clients could not describe any specific injury which resulted in their pain, and those clients that could describe an injury, stated there was a delay between the time of injury and the onset of their pain. His research and subsequent development of IMS assessment and treatment has resulted in this unique needling technique that provides prompt, objective improvement, and eventual resolution in pain for clients with chronic neuropathic pain. Since that time, Dr. Gunn has helped innumerable people, and been granted the Order of Canada, our Nations highest honour, for his significant contribution to the study of neuropathic pain.
What is Neuropathic Pain?
In order to understand how IMS can help you, you first must understand Neuropathic pain. Neuropathic pain occurs when a nerve is unhealthy. All of our peripheral nerves (nerves that start at the spine and supply all of our muscles) depend on something called trophic factor for nutrition. Trophic factor provides nutrition to the nerve, is necessary to keep a nerve healthy and is so important that if a nerve was fully deprived of trophic factor it would die. Trophic factor travels along the full length of the nerve with axoplasmic flow (like fluid flowing through the nerve) and as electrical conduction travels along the nerve. Even a small amount of prolonged compression to a nerve, as seen with spondylosis (compression of the nerve at the nerve root which can happen with early OA or disc herniation) or peripheral nerve injury (which can happen following muscle injury or joint malalignment), can disrupt the axoplasmic flow and electrical conduction along a nerve and will cause the nerve to become supersensitive. When a nerve becomes supersensitive, the structures it supplies also become supersensitive and behave abnormally. It is this supersensitivity which causes neuropathic pain.
What types of disorders can be neuropathic in origin and therefore benefit from IMS treatment?
- Low Back Pain
- Neck Pain
- Shoulder Blade Pain
First of all neuropathic pain occurs in the absence of any obvious inflammatory process. Clients describe a sharp, shooting, deep, neurological type of pain which occurs with pressure which would normally be pain-free, and that the pain lasts for an extended period of time after the pressure is removed. This pain is magnified and radiates because the C Receptors (the receptors which perceive pain located in your spinal cord and brain) become supersensitized and will magnify the sensation of pain, radiate it over a larger portion of your body than it normally would, and perceive the pain for longer than normal.
A nerve which is unhealthy negatively affects the function of the structures it supplies and we see changes in the muscles, vasculature, skin, and joints with neuropathic pain. Muscles become supersensitive to acetylcholine which is the substance which causes muscles to contract. Therefore, all the muscles which are supplied by the compressed nerve will be painful on palpation and tighten until the nerve starts to function normally. The vasculature will react by vasoconstricting, which means they get narrower and are less able to bring oxygen or to carry away waste products from the muscles which will decrease the health and function in the affected muscles. The skin effect is seen as localized hair loss, increased sweating, and swelling in the superficial tissue supplied by the nerve. Joints will be affected when the muscles surrounding them tighten, which will compress or misalign the joint and may result in injury. Also, collagen production is compromised when the nerve is unhealthy which can cause degenerative changes in joints and lead to arthritis if not treated. All of these can result in debilitating pain and significantly reduced ROM and function for a client with neuropathic pain.
How does a Physiotherapist know I have Neuropathic Pain?
IMS relies heavily on a thorough physical examination of the patient by a competent practitioner, trained to recognize the physical signs of neuropathic pain. The physical examination looks for neurological, muscular, vasculature, skin, and joint changes which are specific to neuropathic pain, and will determine specifically which nerves are affected.
Dr. Gunn will only certify Physiotherapists or Physicians in IMS, and even then will only certify Physiotherapists who have completed significant post-graduate education. Thus he is able to ensure that the examination and treatment techniques will be conducted competently and that the treatments will maximize the recovery effects for clients.
How does IMS resolve Neuropathic Pain?
Once the Physiotherapist determines which nerve levels are neuropathic, IMS treatment is used to normalize the function of these nerves. IMS uses acupuncture needles (approximately the size of a hair) which are placed into the muscles which have been made tight by the unhealthy/abnormally functioning nerve. The needle is both diagnostic and therapeutic, in that if a nerve and the muscles it supplies are normal, the client will feel nothing when the needle is inserted. If a nerve and the muscle it supplies are supersensitive or neuropathic, the tightened muscle will grab the needle and produce a cramping sensation. This will result in 3 effects. First, a stretch receptor in the muscle is stimulated which results in an immediate reflex relaxation of the muscle. Second, the needle causes a microtrauma to the muscle which brings blood to the area and helps heal the muscle. Third, the treatment causes electrical current and axoplasm to flow in the nerve bringing with it trophic factor that will help heal the nerve. Increased trophic factor will normalize nerve function, rapidly allowing all the muscles the nerve supplies to relax, vasculature to flow more effectively, and the central nervous systems perception of pain to normalize. This will result in an immediate reduction in the clients muscle, skin and joint pain and increase in joint range of movement. The results are cumulative and, while improvement should occur following the first or second treatment, it will continue to improve and last longer with each appointment. Dr. Gunns research demonstrates that an overall average of 8.2 appointments is needed to permanently resolve pain with IMS.