Traditional Acupuncture is based on Eastern Chinese medicine principles of meridians and energy flows. The body has 12 different meridians or channels which stem from the inner organs and manifest along different parts of our body. Energy, or Qi (pronounced “chi”), flows freely along the meridians in a healthy body. When there is a blockage of energy along one or more of these meridians, we can develop symptoms or problems. This could be pain, inflammation, muscle stiffness or it could affect the immune system or organs. Along these meridians are many acupuncture points which serve different purposes. We have pain points, inflammation points, healing points, relaxation points, muscle/tendon points to name but a mere few. A physiotherapist will select which points to use based on what area is injured in your body and what we are trying to achieve with treatment (decrease pain, increase mobility, promote healing etc). With Acupuncture, we may use points that aren’t even close to your injury site because we want to restore energy flow to the whole meridian. The needles are inserted just through the skin, not very deep, and they are typically left in for 15-20 minutes depending on what is indicated. You generally do not feel anything specific and a lot of patients report feeling very relaxed after treatment. Acupuncture is usually not painful.

It is important to mention that physiotherapists who do acupuncture are licensed to use the technique to treat musculoskeletal problems whereas an Acupuncturist is licensed/trained to treat for all body problems.

IMS is physiologically and scientifically based. You might think of it as a western acupuncture approach. As discussed in the two previous blogs, the acupuncture needle is inserted deeper into the tight bands of the muscle to elicit a cramp or twitch response and then removed immediately once the muscle relaxes. The needles do not stay in like they do in traditional Acupuncture – get in and get out! We select our treatment points based on which muscles are tight/shortened, which areas are displaying signs of neuropathic changes, and based on the nerve pathway that supplies the injured area. When talking about the nervous system, we always treat around the spine because our nerves originate off the spinal cord. For example, if you have an Achilles tendonitis caused by the calf muscle being shortened/tight, we would needle not only the calf muscles, but also the muscles which are supplied by the same nerve roots. In our example, this would be the L5-S1 nerves which include the hamstrings, glute muscles and the paraspinal muscles around L5-S1 vertebrae in the spine. The cramping effect we feel in the muscle with IMS is uncomfortable and some might say a little painful, but this discomfort is short lived. After an IMS treatment, you feel a little achy and stiff from the lactic acid that is released as part of the natural healing process in the body but often the original pain for which you came in feels better.

Both Acupuncture and IMS can be very effective, so ask your physiotherapist which treatment is better suited for your injury – maybe it’s both!
Everyone likes a good combo meal deal!

Ingrid Witt, BScPT, CPMA, GunnIMS
Registered Senior Physiotherapist
ingrid@motionworxphysio.com

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What is neuropathy?

Neuropathy is the description of what happens when there is pain that shows no sign of tissue damage or inflammation. This occurs when the nerves malfunction. Nerves become extremely sensitive and cause innocent, harmless signals to be exaggerated and misunderstood as painful ones. The result of this supersensitivity is pain, even when extensive medical testing shows there is “nothing wrong” (e.g. headaches, whiplash, backache, tennis elbow, frozen shoulder).

Treating neuropathic pain

Supersensitivity and muscle shortening cannot be operated on or cut away. Pain killers will only mask the pain. The goal of IMS treatment is to release shortened muscles which press on and irritate nerves. Supersensitive areas can be desensitized and the persistent pull of the shortened muscle can be released.

Three effects will happen with the IMS treatment:

1. A stretch receptor in the muscle is stimulated, producing a reflex relaxation (lengthening).
2. The needle also causes a small injury that draws blood and your body’s natural chemicals to the area, initiating the natural healing process.
3. The treatment creates an electrical potential in the muscle to make the nerve function normally again.

What is a shortened muscle?

The important factor in neuropathic pain is muscle shortening, caused by muscle spasm and contracture. Muscle shortening produces pain by pulling tendons, straining them, as well as distressing the joints they move. The tendons will thicken over time, medically termed an enthesopathy. Muscle shortening also increases wear and tear and contributes to degenerative conditions such as “tendonitis” and “osteoarthritis”.

How often do I need treatment?

Treatments are usually once per week to allow time between treatments for the body to heal itself. The number of treatments you will require will depend on several factors such as the duration and extent of your condition, how much scar tissue there is, and how quickly your body can heal. The rate of healing depends on the condition of your nerves, as younger people usually heal more quickly. Pain of recent origin requires less treatment. The effects of IMS are cumulative as the needling will stimulate a certain amount of healing. Generally, relief will last longer after each subsequent treatment.

Is this safe?

Your physiotherapist will take a detailed history during your assessment to determine if IMS is an appropriate treatment for your condition. IMS relies heavily on a thorough physical examination of the patient by a competent practitioner, trained to recognize the physical signs of neuropathic pain. If you have positive signs of neuropathic pain, they will screen you for any contraindications and you will be required to sign a consent form which includes the risks of treatment. Given the proper screening is done, this procedure is very safe.

Ingrid Witt, BScPT, CPMA, GunnIMS
Registered Senior Physiotherapist
ingrid@motionworxphysio.com

The post The Nitty Gritty Science of IMS appeared first on MotionWorx Physiotherapy.

Intramuscular Stimulation was developed by Dr. Chan Gunn in the 1970’s, a chronic pain physician in Vancouver, BC. It uses an acupuncture needle to release shortened or tight bands in the muscle. When a muscle has been tight for a long time, the fibers can shorten. This then causes pulling on the tendon and bone and can restrict movement and cause inflammatory pain in tendons. Not cool.

Now some of you might be saying, “Woah, woah, woah! A needle?!”? Fear not, the acupuncture needle is very thin and fine so you should not feel the needle itself. It differs from the needle used to deliver a vaccine or take blood – those needles are thicker and contain a hollow tube to inject liquid or draw blood. An acupuncture needle is more like an extremely thin sewing needle. The needle is swiftly inserted into the tight muscle causing a cramping sensation. This reaction can be uncomfortable, best described as a very brief Charlie horse in the muscle, but most people report this is a tolerable sensation and sometimes a good type of pain. The needle does not stay in like acupuncture but is taken out as soon as the muscle contraction and reflex relaxation has occurred. So, the whole treatment process is usually quick, and you don’t lie on the treatment bed looking like a porcupine.

Now here’s the fascinating part of IMS – once we get those muscles jumping from the weird little cramps, the body takes over with healing. You can think of the needle causing a micro trauma in the muscle to wake up the body’s natural defense system. The body rushes its natural healing chemicals not only to the site of your injury, but throughout the whole body. Research has shown those healing chemicals stick around for a whole 5-7 days, so your body continues to heal itself for an entire week after one treatment! Lactic acid gets released as part of the healing which is the same chemical that gets released after you have a good work out in the gym, hence the feeling of a “good pain”. That muscle soreness generally only lingers for a few hours or a day. But it is good to remember that everyone’s body is different in terms of how sensitive it might be or how it perceives pain.

Most people feel some relief from their very first treatment, but should see improvements in pain, movement or function within the first 2-3 sessions. The benefits from treatment are cumulative, so each session provides increased results. Treatment usually starts with once a week and then as your good days last longer we taper the frequency until your body can keep itself happy with a home exercise routine.

Stay tuned for the next blog which will dive a bit deeper into the ins and outs of IMS for those of you who need a better nerd fix

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