Gunn IMS (Intramuscular Stimulation)/Dry Needling

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Intramuscular Stimulation (IMS) is a system for the diagnosis and treatment of myofascial pain syndromes (chronic pain conditions that occur in the musculoskeletal system when there is no obvious sign of injury or inflammation). IMS 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. The treatment was developed by Dr. Chan Gunn in the 1970’s and utilizes acupuncture needles because they are the thinnest implements available that are designed to penetrate deep within the muscle tissue, specifically targeting injured muscles that have contracted and become shortened from distress.

IMS relies heavily on a thorough physical examination of the patient by a competent practitioner, trained to recognize the physical signs of neuropathic pain. This physical exam is indispensible because chronic pain is often neurological as opposed to structural, and therefore, invisible to X-rays, MRI, bone and CT scans. Failure to recognize these signs will result in an inaccurate diagnosis, and thus a poor starting point for physical therapy.

Treatment involves dry needling of the affected areas of the body without injecting any substance. The goal of treatment is to release muscle shortening, which presses on and irritates the nerve. IMS, in effect, treats the underlying neuropathic condition that causes the pain. When competently performed, IMS has a remarkable success rate, as proven by the amelioration of symptoms and signs, even for chronic back pain.

We offer IMS/dry needling as a therapeutic modality. IMS/Dry needling involves multiple advances of a fine needle into the muscle in the area of the body that produces pain and typically contains a trigger point. There is no injectable solution and the needle that is used is very thin. Positive results can be apparent in as little as one treatment session.

Intramuscular Stimulation (IMS) is an effective treatment for acute and chronic pain, rehabilitation from injury, and can assist with injury prevention with very few side-effects. This technique is beneficial in treating and eliminating neuromuscular dysfunction that leads to pain and functional deficits.

This is a customized treatment for each patient as the physiotherapist works with individuals to identify areas causing problems and then gently stimulate them with the needles.

Intramuscular Stimulation (IMS) is an effective procedure that helps patients reduce both acute and chronic pain. It is designed to reduce muscle tension, promote healing and increase your range of motion. Patients suffering from neck, back and shoulder pain, headaches, jaw pain, fibromyalgia or osteoarthritis of the joints and temporomandibular joint disorder (TMJ) benefit from Intramuscular Stimulation (IMS).

Intramuscular Stimulation, Gunn IMS

Supersensitivity and muscle shortening cannot be operated on and ‘cut away,’ while ‘painkillers’ and other analgesic pills only mask the pain (often poorly) and promote toxicity, compounding the problem. Neuropathy only responds to a physical input of energy.

Intramuscular Stimulation (IMS) is a total system for the diagnosis and treatment of myofascial pain syndromes (chronic pain conditions that occur in the musculoskeletal system when there is no obvious sign of injury or inflammation). IMS 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. It was developed by Dr. Chan Gunn while he was a physician at the Worker’s Compensation Board of British Columbia in the 70’s, where he investigated the large number of mysteriously stubborn cases after frustration with the ineffective modalities at his disposal. The treatment, which utilizes acupuncture needles because they are the thinnest implements available that are designed to penetrate deep within muscle tissue, specifically targets injured muscles that have contracted and become shortened from distress.

IMS relies heavily on a thorough physical examination of the patient by a competent practitioner, trained to recognize the physical signs of neuropathic pain. This physical examination is indispensable since chronic pain is often neurological as opposed to structural, and therefore, invisible to expensive X-rays, MRI Tests, Bone and CT Scans. Failure to recognize these signs will result in an inaccurate diagnosis, and thus, a poor starting point for physical therapy.

The treatment involves dry needling of affected areas of the body without injecting any substance. The needle sites can be at the epicenter of taut, tender muscle bands, or they can be near the spine where the nerve root may have become irritated and supersensitive. Penetration of a normal muscle is painless; however, a shortened, supersensitive muscle will ‘grasp’ the needle in what can be described as a cramping sensation. The result is threefold. One, a stretch receptor in the muscle is stimulated, producing a reflex relaxation (lengthening). Two, the needle also causes a small injury that draws blood to the area, initiating the natural healing process. Three, the treatment creates an electrical potential in the muscle to make the nerve function normally again. The needle used in IMS, by stimulating muscle spindles, essentially becomes a specific and unique tool for the diagnosis of Neuropathic Muscle Pain.

The goal of treatment is to release muscle shortening, which presses on and irritates the nerve. Supersensitive areas can be desensitized, and the persistent pull of shortened muscles can be released. IMS is very effective for releasing shortened muscles under contracture, thereby causing mechanical pain from muscle pull. IMS, in effect, treats the underlying neuropathic condition that causes the pain. When competently performed, IMS has a remarkable success rate, as proven by the amelioration of symptoms and signs, even for chronic back pain with root signs.

PAIN EDUCATION: https://www.gunnims.com/pain-education.html

What to Expect

Informed consent is a huge topic in health care and constitutes one of the most important aspects of providing care to a patient. The physiotherapist must:

Describe the treatment: You should be told the basics of the treatment including what it involves, what you should feel during and after needling, and what the expected outcome of the treatment should be.
Emphasize your role in making the decision to get treated with needling: Whether you ask about needling, or your physiotherapist suggests it as an option, you make the final decision to receive the treatment or not.
Discuss alternatives to needling: Not all patients need dry needling as a treatment. Physiotherapy can provide many alternative forms of treatment and many different avenues of care to achieve your goals.
Discuss the risks involved: There are risks with dry needling, which we discuss later in this article. You can expect that your physiotherapist will explain the risks in general and any risks unique to you.
Answering questions: You may or may not have questions depending on how well everything was explained, but you should be given the opportunity to have your questions about the treatment answered before the physiotherapist asks for your consent.
Obtain your consent: You make the final decision about receiving needling and that decision needs to be made without you feeling like you’ve been pressured or talked into anything.

Once the physiotherapist has taken you through the steps above and you feel comfortable receiving treatment, then they may present you with a consent form to sign or ask for your verbal consent. You should only sign this form or grant consent after they have addressed everything in points 1-6 to your satisfaction.

Importantly, consent needs to be ongoing. Each time you see your physiotherapist, the physiotherapist MUST ask if you wish to continue with needling. They may not have to go through all the initial details they did in the first session, but they should be constantly checking in to see how you are doing, if you have any questions, if there are any changes that could affect the treatment’s safety or effectiveness, and if you are willing to continue.

It is also important to note that consent can be revoked at any time. Just because you agreed to something at the start, does not mean you have to continue with it if you have changed your mind. Many things can alter your opinion on whether you wish to receive a treatment, but you are able to withdraw from one part or from all treatment at any time. You can expect that your physiotherapist:

“Respects the autonomy of clients to question, decline options, refuse, and/or withdraw from services at any time.” Consent Standard of Practice

Potential Risks

Potential risks associated with dry needling from the more common “minor” issues to the more serious adverse events, however this is not an exhaustive list.

Some of the more common (and typically minor) incidents that you can experience when being treated with a form of dry needling include bruising, bleeding, and discomfort.

When a needle penetrates the skin and goes past the level of the dermis, it may encounter blood vessels on the way to the targeted site. If the needle pierces the blood vessel, there can be a droplet or two of blood that comes after the needle is removed. Generally, the blood clots quickly due to the small gauge of the needle and your blood’s ability to clot. However, usually after a blood vessel has been hit, a small bruise may form and can be anywhere from smaller than a dime, to as large as a loonie depending on the type of needling performed, the gauge of the needle, and your body’s ability to clot quickly. Bruising is what occurs when blood vessels are damaged and small amounts of blood pool under the skin.

Discomfort or sharp pain can occur during and after needling treatments. These types of reactions are reported more frequently and can be a normal reaction to having acupuncture needles inserted into the muscles and tissue of the body. Some patients feel better immediately, while others may be sore for an hour or two, and up to a day or two. It is typically mild discomfort, but if you are concerned that there may be something wrong, contact your physiotherapist to discuss your response, or follow the plan your physiotherapist discussed with you if concerns arise following your departure from the clinic.

On the spectrum of risks associated with dry needling, we will move onto the slightly more concerning vaso-vagal response. The vaso-vagal response is experienced by most people as feeling faint or light-headed. Reports of dizziness, sweating, nausea, increased heart rate or a drop in blood pressure are rare, occurring in 0.2-7% of patients receiving treatment. Most often, patients recognize that they have had these reactions before to the sight of blood, or their own personal experience with immunizations, drawing blood for testing, or from previous treatments involving acupuncture needles.

Recovery from this response usually takes 20-30 minutes and is helped with a little snack and some water or juice. There are no long-term issues with having a vaso-vagal response, but if it does occur, it is usually a good idea to follow-up with your family doctor to make sure nothing else is going on that may have triggered this response.

Infection and pneumothorax are two of the more significant adverse events when it comes to having a physiotherapist insert a needle into your body. Bacterial infections after needling are rare but if they do occur, it is usually because of microorganisms on the surface of the skin. Symptoms would include pain, redness, swelling, and heat in the area of the infection. Most infections can be easily treated with a visit to a doctor.

The last and rarest of potential adverse events we will talk about is a pneumothorax. A pneumothorax is also known as a collapsed lung and occurs when an abnormal collection of air forms in the space between the lung and the chest wall. A pneumothorax can occur during dry needling if a needle enters the lung tissue, but thankfully this is quite rare, occurring in approximately one out of a million treatments. While shortness of breath is often thought of as the main symptom, other symptoms may include anxiety, cough and chest pain increasing while taking a deep breath in. Although quite rare in occurrence, if you do have these symptoms, please go straight to the emergency department as an x-ray is needed for diagnosis and you will require medical treatment.

If any of these occur while you are receiving treatment

1. Your physiotherapist should be told of any symptoms you are experiencing so they can guide you through the situation.

2. Symptoms you experience once you have left the clinic, such as pain, dizziness, or shortness of breath, warrant a phone call to your physiotherapist so they can advise you on steps to take, if any.

3. Your physiotherapist should walk you through a plan involving any necessary immediate care required of the adverse event and follow up to ensure concerns have been addressed.

The use of needles in practice should be presented to you in a way that weighs the potential benefits and risks of the treatment, as well as why the physiotherapist thinks it would be an appropriate treatment option. The potential risks should be explained thoroughly in a way that you understand, and your questions should be answered to your satisfaction. Your consent must be voluntary and ongoing. Trust is built over time, and it is okay to tell your physiotherapist that you might not be ready for needling treatments. As a professional, they should respect your decision and provide alternatives to treatment. Physiotherapy should never be a one-treatment-for-everyone practice, so expect your physiotherapist to provide you with alternatives that you are comfortable with.

SOURCE:

UBC: https://sportsmedicine.med.ubc.ca/services-sport-and-exercise-physician-sport-medicine-treatment-health/gunn-ims/

What is Gunn IMS? https://www.gunnims.com/what-is-gunn-ims-dry-needling.html

Consent: Understanding Dry Needling Risks and Consent — College of Physiotherapists of Alberta (cpta.ab.ca)