Many people with chronic pain have attempted numerous medications, therapy and even surgery, often without a lasting pain relief. Fairway Physiotherapy is pleased to announce an exciting new service for Thunder Bay. While Western acupuncture is a service that continues to be proven to be very beneficial for many of our patients, we are now able to provide you with further advancements in the assessment and treatment for chronic muscle and joint pain – Intramuscular Stimulation (IMS).
What is Intramuscular Stimulation (IMS)?
IMS in an exciting and effective form of treatment for chronic pain. This form of acupuncture was developed by Dr. Chan Gunn (medical doctor) in the 1970s. Among Dr. Gunn’s recognized contributions to pain management, he has received both The Order of British Columbia, as well as the Order of Canada for his development and use of IMS. IMS training is currently offered to physiotherapists, medical doctors, including orthopaedic and neurological specialists, at a post-graduate level.
IMS is adapted from traditional acupuncture, and based on scientific principles, helping us better understand and treat chronic pain. One principle universal to chronic muscle pain is muscle shortening. Through the insertion of thin acupuncture needles into predetermined muscle bands or “trigger points,” it allows the muscle to relax, providing relief to both the muscle and the joints. Typically, a muscle cramp sensation accompanies the needle insertion, which confirms the positive effect of IMS. Unlike acupuncture, these needles are typically not left in, but withdrawn once the cramp sensation is felt.
So how can this help my chronic pain?
IMS theory is more than simply treating a tight area of the muscle, and is not “trigger point therapy” or “dry needling therapy” but instead takes into consideration the underlying health of the muscles’ nerves. This is based on the concept of neuropathic pain. More commonly we refer to this in the health care as radiculopathic pain (i.e. sciatica). Rather than simply needling the tight and painful muscle, it is usually necessary to improve the health of its nerve first. This is often done by removing the muscle tightness around the nerve and/or joint. If you consider the analogy of a light bulb that has stopped working, our most human reaction is to change the bulb in order to fix the problem. Unfortunately, this does not always work, as the problem can often occur at the fuse box (i.e. the spine), or anywhere along its wiring (i.e. the nerve). This is true for this type of chronic pain. The underlying problem usually occurs because when nerves malfunction, for example in arthritis of the neck or back, they become supersensitive. This means that previously harmless signals to the nerve, like a light touch or a cool breeze, are enough to cause the supersensitive nerve to communicate actual pain. Many patients find it comforting to have this explanation for why something as normal as the feeling of one’s shirt against their back actually can cause their pain! This is a real physical problem and completely legitimate.
Additionally, the muscles that the nerves travel to become shortened and painful themselves. This causes parts of the muscle to contract. This is different than a spasm. This is much more common than we previously thought, but has recently received some renewed attention. So which makes the most sense to try and treat…the tight and sensitive muscle, or treating the nerve at the source of the problem?
Unfortunately, the longer shortened muscle exists, the more chance there are of other conditions developing. This is commonly seen in patients who develop tendonitis, osteoarthritis ordisc bulges in their spine. Patients with this type of pain, often do not present with osteoarthritis on x-ray, as the irritation to the nerve is often present before the bone actually changes; this is referred to as prespondylosis. Whereas, actual osteoarthritis is referred to as spondylosis. However, once that irritation is present, it may cause the muscles around the joint to tighten, further irritating the nerve, which further tightens the muscles – this accelerates both the breakdown to the nerve and wear and tear to the joints.
How is this IMS treatment different from acupuncture?
In reality the needles used are often the same as you would expect with acupuncture. They are a sterile, one-time use needle, which is typically small enough to fit 3-4 in the centre of a typical needle you would receive from a doctor. They are also solid, not hollow, with a rounded tip, rather than a bevelled tip, minimizing trauma to the tissue. In typical acupuncture, needles are inserted based on the concept of meridians, or energy channels, throughout the body. While this has proven to be a very effective treatment for some conditions, the rationale for where the needles are placed as well as the reason for needling (i.e. the diagnosis) is quite different when compared to IMS theory. Needles are typically not left in with IMS, but merely inserted to the point where the muscle cramps and then are withdrawn. IMS needles are often inserted deeper than traditional acupuncture points in order to access deeper muscles in our body.
As such, IMS needles are inserted based on our knowledge of human anatomy, physiology and neuroanatomy, with a contemporary medical diagnosis guiding the selection of points to needle.
IMS is a skilled medical procedure in which:
- A medical examination is necessary
- A medical diagnosis is required
- Needle points are based on physical signs
- Knowledge of anatomy is essential
- Typically immediate pain improvement and/or physical improvement is experienced
What type of conditions can be helped by IMS?
Any musculoskeletal condition that is caused by, or contributed to by, nerve irritation typically can respond. This often includes:
- Back pain & sciatica
- Neck pain
- Tennis elbow
- Carpal tunnel
- Shoulder or Achilles’ tendonitis
- Frozen shoulder
- Groin or hip pain
- Plantar fasciitis
- “Myofascial pain syndromes” (i.e. fibromyalgia)
What type of conditions should not be treated with IMS?
IMS cannot improve neurological conditions that involve the brain or spinal cord directly. As such, conditions such as stroke, Parkinson’s or Multiple Sclerosis are not treatable with IMS. However, research has shown that these conditions can respond in many cases to focused physiotherapy using other tools at our disposal, in conjunction with your normal medical care.
IMS is not appropriate in patients who have had an acute injury (within the past week or often month) or have swelling that is associated with it. However, often chronic swelling can be improved with IMS, depending on the underlying cause. Again, there are plenty of other extremely effective tools that physiotherapists use for acute injuries in order to prevent them from becoming chronic.
IMS is also not appropriate in women who are currently pregnant, regardless of the stage of pregnancy.
The role of the initial assessment with an IMS-trained physiotherapist is not only to determine if you are a candidate for IMS, but also to determine if you are not, and if you would benefit more from other forms of medical care.
Who is qualified to perform IMS acupuncture?
Physiotherapists and medical doctors who have received post-graduate training in GunnIMS are able to provide detailed IMS assessment and treatment. These practitioners can be identified by the term CGIMS or Cert. Gunn IMS as part of their credentials. Again, IMS is not the same as trigger point needling. A list of current IMS practitioners in your area can be found under the Members section (Practitioners link) at . Further reading related to the background of IMS can be found here under the Research link.
Is there evidence to support IMS acupuncture?