Acupuncture, Dry Needling, and IMS - What's the difference?

For many people, their first introduction to needling happens at a physiotherapy clinic where they are most likely receiving IMS or dry needling and lately I’ve had a number of patients share their experiences with me ask me if I can do IMS. The short answer is yes, but I thought this would be a great opportunity flesh out some of the, often fuzzy, details around acupuncture, dry needling, and IMS including their similarities and differences. So lets take a moment to define each of these three needling techniques. I’ll preface these definitions by mentioning that some consider dry needling and IMS to be synonymous and I suppose that would depend on where practitioners receive their training and often times the points used in IMS will over lap with those in dry needling.

Image credit to  Physiopedia

Image credit to Physiopedia

Dry Needling - A myofascial trigger point technique using a filiform or sometimes hypodermic needle to stimulate a release of the muscles and fascia. Dry needling is used primarily for the management of pain syndromes.

IMS (Intramuscular Stimulation) - A neuromuscular technique using a filiform needle to regulate nerve innervation to a muscle and affect muscle tone. IMS can be used in the management of pain syndromes as well as the treatment of muscle inhibition and dysfunction.

Acupuncture - The insertion of filiform needles to affect multiple body systems and affect a healing response. Acupuncture can be used to manage pain, affect neuromuscular activity, regulate hormones, and affect organ function.

The one thing that all three techniques have in common is that they are using sterile, single-use needles to affect a change in the body. The vast majority of the time those needles are going to be filiform which means that they are solid and come to a fine tip that can easily puncture the skin with minimal irritation. Occasional, dry needling practitioners may choose to use a hypodermic needle, the kind used for injections, which are thicker and have a serrated tip, in order to provide a stronger stimulation. Where these techniques start to differ is on the aspect of the body they are focusing on.

Neck pain

Someone using dry needling is looking to identify and treat triggers points. A trigger point is essentially a muscle knot and they can range from the really big knots which we’ve all felt down to tiny knots the size of rice grains which take very refined palpation skills to locate. These knots are areas where muscle fibers and fascia are bunched up and are unable to release due to a variety of factors. The therapist finds these trigger points and then they insert a needle into the trigger point and stimulate the needle by either moving it in and out of the knot, twirling it in the knot, and sometimes through electrical stimulation until the muscle twitches and lets go. This techniques often provides an immediate relief of pain and tension for those suffering from muscle knots. While the immediate relief is great, there are generally some short comings. First, the stimulation needed to get that twitch response in certain areas can be quite aggressive and uncomfortable for many people. Second, since the focus is on treating the trigger point, dry needling often fails to address any underlying muscle and nerve dysfunctions which are often the root cause of the knotting and it is therefore usually a temporary solution. Despite its short comings dry needling definitely has its place in some treatment plans for that immediate relief.

IMS

In IMS the therapist is looking to affect the muscles and fascia using the connection between the nervous system and the muscles. An IMS practitioner primarily uses motor points to affect the body. A motor can be a single point in a muscles or may be multiple points in larger muscles which are highly innervated with nerves. Due to the high degree of innervation at a motor point there is typically less aggressive stimulation required to active the muscle. An IMS treatment will usually begin with the practitioner doing manual motor testing to identify which muscles are either not receiving enough information from the nervous system, causing them to under fire, or too much information, causing them to be in constant tension. The motor point for that specific muscle or group of muscles can then be used to reset the nerve supply to that muscle and promote correct muscle firing and synergistic contraction. The benefits of IMS over dry needling is that it is able to address the underlying problems in the relationship between the nervous system and muscles which often lead to the formation of chronic tension and knots. Also, while the stimulation of motor points can often still have a strong sensation it is generally not as uncomfortable as the strong stimulation required in dry needling. IMS will also usually provide a great of relief from pain and tension quite quickly.

Image credit to  Evidence Based Acupuncture

So how do dry needling and IMS fit into acupuncture? Dry needling is actually a technique which falls into the scope of acupuncture dating back to some of its earliest records. In the acupuncture classics trigger points were called ashi points which essentially translates to “ouch points”. So there is one check for acupuncture. But what about IMS? Well, interestingly enough a lot of the main acupuncture points are also motor points. Taking some points in the shoulder as an example SI 9 and 10 are the motor points for the teres muscles, SI 11 is the infraspinatous, and SI 12 is the supraspinatous. Together, these three points account for three out of four muscles in the rotator cuff. However, just because many acupuncture points are also motor points doesn’t necessarily mean that every acupuncturist knows how to use them in an IMS style. While most acupuncture programs will include a course on the treatment of musculoskeletal conditions, the approach to treatment will vary widely with some teaching more classical methods such as balancing channels while other will focus more on directly treating muscles through motor points. I was lucky enough to be in a program with two orthopedics courses, one focusing on the use of manual muscles testing for assessment and motor points for treatment and the other which approached treatment from a channel based approach. So while many acupuncturists may regularly be using the same points that and IMS therapist is using (or should I say an IMS therapist may regularly use the same points as an acupuncturist), it will be up to their training whether or not they are able to accurately identify which specific muscles are inhibited in their function and use the motor points to correct that specific muscle as opposed to a broader approach. More widely though, acupuncture isn’t just focused on the treatment of musculoskeletal and pain syndromes. Acupuncture has historically been used to treat all types of medical conditions from menstrual cramps to Parkinson’s disease, concussions, colitis, hormone imbalances, and everything in between. There are a vast array of acupuncture points and while many do correspond with motor points there are far more that do not. With the buffet of points available to an acupuncturist they are able to affect organ function, regulate the secretion of various hormones, regulate neurological pathways, and restore correct function of various body systems (including motor and pain regulation systems). Furthermore, acupuncture treatments generally does not require the stimulation of the needles to be quite as strong as the stimulation in dry needling or IMS (of course there are always some exceptions to this) making acupuncture a more relaxing and enjoyable experience.

Back Pain Acupuncture Points

The more gentle stimulation that an acupuncturist is looking for is called De Qi which means the arrival of Qi at the needle which is essentially when the body acknowledges the needle in the body. The sensation of De Qi is usually described as a heavy sensation or dull, pulsing low grade ache around the needles as opposed to the quick intense twitch with IMS or dry needling. Acupuncture also offers other options for the treatment of pain which rely on the body’s complex neural network to use reflexes to manage pain in one area of the body by treating a different area. This is why if you go to an acupuncturist with back pain they might stick pins in your hands or elbows.

To summarize all of that: dry needling can be great for short term management of pain, IMS can effectively treat pain and address the underlying neuromuscular issues which often give rise to pain, and acupuncture may include dry needling and/ or IMS in a course of treatment but also has the ability to address more complex patterns in the body. All three needling techniques are perfectly valid treatment methods and can all serve a different purpose depending on the needs of the patient. For a more complete explanation of acupuncture and some of the conditions it can treat have a read through my other article Acupuncture - What is it good for?.