IMS

Intramuscular Stimulation

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Polyclinic Rehabilitation Institute has expanded our services to include myofascial trigger point dry needing or intramuscular manual therapy (IMT). Although IMT utilizes a solid monofilament needle, it is important to note that IMT is not acupuncture. IMT is an advanced technique based on the Western medical model.

IMT is a useful technique to decrease acute and chronic pain and facilitate the use of other physical therapy interventions, such as therapeutic exercise.

Myofascial trigger points are taut bands in skeletal muscle and fascia. Janet Travell, MD identified myofascial trigger points as being a source of referred pain. For example, sustained pressure to the trigger points in the upper trapezius muscle can elicit pain in the head, neck, and shoulder. Some people suffering from myofascial trigger points develop allodynia (painful response to a non-painful stimulus) and hyperalgesia (increased pain response). IMT is a useful technique to decrease acute and chronic pain and facilitate the use of other physical therapy interventions, such as therapeutic exercise.

IMT involves inserting a needle directly into the involved myofascial trigger points. A local twitch response occurs during IMT that increases the relaxation of the involved musculature. The patient may feel a sensation in the areas where their pain often radiates. As the patient’s soft tissue becomes more mobile, referred pain from the associated trigger point decreases or is eliminated altogether. Following IMS, soreness typically lasts a few hours to a few days.

Research has shown that IMT is an effective technique for decreasing pain and increasing function in patient populations such as cervical and lumbar radiculopathy due to herniated discs, osteoarthritis, temporomandibular disorder, fibromyalgia, whiplash, headache, and a host of other neuromusculoskeletal disorders.

 

Intramuscular Stimulation

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IMS is used to treat neuropathic pain which is caused by irritation and/or pressure on the nerves causing specific muscles to become shortened and hypersensitive. Many chronic pain conditions are caused by neuropathic pain and can occur in the absence of significant inflammation or tissue damage. Since neuropathic pain can exist without ongoing inflammation or tissue damage, painkillers and anti-inflammatory medications may provide only temporary relief or have no effect at all. In addition, x-rays, CT’s, MRI’s and other diagnostic tests may not show any visible signs of injury.

HOW IMS WORKS

IMS is able to treat this neuropathic pain by desensitizing affected nerves and muscles using acupuncture needles. It is important to note that there is no use of electricity with IMS, rather it is the mechanical simulation of the insertion of the needle into the affected muscles that provides the therapeutic effect. The needle activates a reflex causing the muscle to release and in doing so, eases the pain. Inserting the needle also creates a minor therapeutic injury to the area, stimulating the body to increase local circulation and activate its healing systems. The technique is particularly effective for deep muscles that can be difficult or impossible to reach with other forms of treatment. For example, there are some muscles around the spine and pelvis that are too deep to be treated with massage, and can only be addressed with a needle.

Length of treatment is approximately: 30min

Treatment Frequency: 1 treatment per week for 4-8 weeks for most cases

CONDITIONS THAT CAN BE TREATED BY IMS

A broad range of musculoskeletal/orthopedic problems are successfully treated using the relatively new technique of Intramuscular Stimulation (IMS). We can treat a variety of ailments using IMS including:

• Chronic Tendonitis or Bursitis
• Low back pain
• Neck pain and whiplash
• Plantar fasciitis
• Repetitive Stain Injuries
• Shin splints
• Spinal disc problems
• TMJ pain
• Arthritic conditions
• Headaches
• Myofascial Pain Syndrome
• Patellofemoral syndrome
• Recurrent or Persistent Injuries (including sports injuries)
• Sciatica/piriformis syndrome
• Shoulder injuries (including frozen shoulder)
• Tennis/Golfers elbow
• Torticollis

It is important to note that IMS is NOT EFFECTIVE for non-musculoskeletal based pain, such as the following:

• Chronic inflammatory pain (active arthritic conditions such as rheumatoid arthritis)

• Pain related to cancer

• Metabolic neuropathies (diabetes)

• Degenerative neurological conditions (Lou Gehrigs’s disease, Parkinson’s disease)

If you have one of these conditions, it is unlikely that IMS will be recommended as your best treatment option.

Use of Intramuscular Stimulation

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WHAT IS GUNN IMS?

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). Gunn IMS is a specialized physiotherapy service that PRI provides to our patients. It requires practitioners to have extensive physiotherapy experience before being admitted to training.

HOW DOES IMS WORK?

IMS is grounded in Western Medical Science, and uses acupuncture needles that are designed to penetrate deep within muscle tissue, specifically targeting injured muscles that have contracted and become shortened from distress.

IMS TREATMENT DESCRIPTION

IMS therapy 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.

CAN YOU SHOW ME HOW THE SPINE MAY BE INVOLVED?

The most common cause of nerve irritation and neuropathic pain is “spondylosis,” degeneration of the spine, which can result from normal wear and tear. Spondylosis irritates the nerve root and leads to neuropathy and muscle shortening.

WHAT IS THE GOAL IN USING IMS?

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.

HOW OFTEN SHOULD I HAVE IMS?

Treatments are usually once a week to allow time between treatments for the body to heal itself. The number of treatments you require will depend on several factors such as:

1. the duration and extent of your condition
2. how much scar tissue there is, (usually increased after previous surgery)
3. how quickly your body can heal depending on the condition of your nerves.

If the pain is of recent origin, one ims treatment may be all that is necessary. In published studies of patients with low back pain, the average number of IMS treatments required was 8.2.

IS IMS THE SAME AS ACUPUNCTURE?

IMS is comparable in some ways to acupuncture; however, there are a number of important differences. IMS requires a medical examination and diagnosis by a practitioner knowledgeable in anatomy, needles insertions are indicated by physical signs and not according to predefined, non-scientific meridians, while subjective and objective effects are usually experienced immediately.

If you have been injured athletically, at work or in an automobile accident and haven’t had success with traditional types of treatment, IMS may be worth trying.

Treating Whiplash-Associated Disorders with Intramuscular Stimulation

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Trauma to the neck can cause acute pain. Chronic pain and dysfunction from such injury is called “whiplash-associated disorder” (WAD). WAD is a very common complication to people who were involved in a Motor Vehicle Collision. The Quebec Task Force [QTF] classified WAD severity. The key points of QTF are as follows:

• Whiplash is the most common injury associated with motor vehicle accidents and a major cause of disability and litigation.

• Whiplash-associated disorders (WAD) can be classified by the severity of signs and symptoms from Grade 0 to 4.

• Patients usually complain of neck pain and stiffness in the acute phase, with the majority recovering within 3 months.

• Depression, anxiety, and mood disorders are common in patients with chronic whiplash.

• Reassurance, early mobilization, simple analgesic, and physiotherapy are recommended in acute whiplash (WAD I–III).

• In chronic WAD, multidisciplinary pain clinic referral followed by cognitive behavioural therapy and cervical radiofrequency neurotomy plays an important role.

Although there are many treatment approaches to a whiplash injury, one study was able to specifically demonstrate the efficacy of treatment using intramuscular stimulation therapy.

In this study Forty-three (43) people accepted intramuscular stimulation therapy. They had pain and abnormal physical signs such as allodynia, trophedema, muscle knots, and limited range of motion. With treatment, twenty-nine achieved long-term improvement.

In an IMS treatment, when the needle enters, the muscle will ‘grab’ the needle and a deep, cramping sensation is felt. Once the muscle grabs it then typically will ‘reset’ itself and begin to relax. When the tight muscle relaxes, a decrease in pain typically follows. IMS is now being recognized and used by physiotherapists and doctors around the world to treat chronic pain of musculoskeletal origin.

Conclusion

The whiplash disorder symptoms were due to abnormal function of the central nervous system. Most subjects improved subjectively and their abnormal physical signs resolved. Such direct clinical evidence of benefit is clearly meaningful.

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