Intra-Muscular Stimulation (IMS)
What is Dry needling?
Dry needling is primarily directed at trigger points. A Trigger Point (TrP) is a hyper-irritable spot, a palpable nodule in the taut bands of the skeletal muscles’ fascia. Dry needling involves insertion of an acupuncture needle into these trigger points to release the muscle tightness.
What is Gunn Intra-Muscular Stimulation (IMS)?
IMS is a total system for the diagnosis and treatment of chronic pain of a neuropathic origin. Neuropathic pain occurs when nerves malfunction following injury or tissue irritation. Nerve endings become overly sensitive and begin to interpret normal sensations as pain. Distressed or injured muscles can become contracted and shortened.
The IMS practitioner uses thin acupuncture needles to target deep inside these muscles in the periphery, or they can be near the spine where the nerve root may have become irritated and supersensitive, causing problems in other parts of the body.
Many causes of pain and chronic problems might not show up on imaging such as MRI scans. This is because the pain is often neuropathic as opposed to structural. For more information on signs of neuropathy please read Appendix 1.
Examples of some musculoskeletal conditions that can be treated using IMS:
- Back ache (sciatic pain)
- Neck Pain
- Tennis elbow
- Frozen shoulder
- Shoulder Pain
Is IMS the same as acupuncture?
IMS uses acupuncture needles because they are the thinnest implements available but it is grounded in Western Medical Science, and has a solid foundation in its radiculopathic model of pain, which is now supported by many experts in the field. To view Paul Frawley’s qualifications in dry needling and IMS please read Appendix 2:
What to expect with IMS?
Generally only one needle is inserted at a time and stays in for only a few seconds; multiple muscles may be treated in one session. A shortened, supersensitive muscle may ‘grasp’ the needle in what can be described as a cramping sensation or you may experience an involuntary local twitch response (LTR). An LTR is an involuntary spinal cord reflex contraction of the muscle fibres in a taut band.
This type of needling creates some muscle soreness during treatment and may last for a few hours to a day or two. This temporary discomfort is generally followed by significant muscle relaxation, improved mobility and reduction of pain.
How does IMS work?
Inserting an acupuncture needling deep inside a distressed or injured muscle causes a small injury to that site that draws blood to the area, initiating the natural healing process. Secondly the treatment creates an electrical potential in the muscle to make the nerve function normally again. Thirdly a stretch receptor in the muscle is stimulated (LTR) leading to reflex relaxation of the muscle (lengthening).
Dry Needling (Gunn Intramuscular Stimulation)
Initial Consultation 60 mins£68There will be an assessment of your presenting problems as well as an look at your medical history.
Follow Up 50 mins£63Paul will check on your progress and maybe look at certain aspects in greater detail, especially if you have many conditions that need treating simultaneously.
Signs of Neuropathy
Neuropathic pain can be confirmed by demonstrating physical signs and symptoms; features of nerve dysfunction in the painful area, as well as at the corresponding spinal level. Neuropathic conditions may present with or without a history of injury, will be treatment resistant, and last longer than the period of normal tissue healing.
The IMS Radiculopathy Model outlines these neuropathic features below:
The most important and widespread features of neuropathic pain.
- Changes within muscle can be extremely painful (supersensitive nerve receptors in muscle).
- Shortened muscles can produce mechanical pain by pulling on tendons and joints.
- Supersensitivity and muscle shortening cannot be operated on and ‘cut away,’ while ‘painkillers’ and other analgesic pills only mask the pain.
- The most crucial shortening occurs in paraspinal muscles across a joint space, compressing the disc and sometimes the nerve root (see image-spinal pain). The significance: neuropathy becomes the primary condition, and the ‘root signs’ are secondary results.
- The painful area is tender to finger pressure (supersensitive).
- Sometimes multiple tender points occur when more than one spinal segment is involved, which is known as fibromyalgia.
- Tenderness can also be located in the spinal muscles.
- The painful part is usually colder (from vasoconstriction).
- The painful area may exhibit excess perspiration.
- There may be Goosebumps over the painful area.
- Often there is excess fluid in the subcutaneous tissues, as in Trophedema.
Peripheral nerves innervate internal organs. Neuropathy in these autonomic nerves often go unsuspected and undetected. The following conditions give strong indications of neuropathic origin: irritable bowel syndrome and adult respiratory distress syndrome.
Trophic Changes (due to reduced neural stimulation):
- Localised hair loss
- Brittle Nails
- Psoriasis (Abnormal skin)
Summary of Paul Frawley’s qualifications for Dry Needling and IMS:
- 2004 Jan/Feb – A ACP*: Introduction to Acupuncture.
- 2010 October – Myofascial Dry Needling (Modules 1-3).
- 2011 October – Myofascial Dry Needling (Modules 4-5).
- 2013 April – Gunn IMS Dry Needling Course Part 1.
- 2013 August – Gunn IMS Dry Needling Follow up/Exam.
- 2014 April – Gunn IMS Dry Needling Course: Part 2
* Acupuncture Association of Chartered Physiotherapists.