Acupuncture vs. Intramuscular Stimulation (IMS): A Comprehensive Comparison
Written by: Mitch Browne and Fallon Drinkall
Acupuncture vs. Intramuscular Stimulation (IMS): A Comprehensive Comparison
In recent years, acupuncture and intramuscular stimulation (IMS) have gained significant recognition as therapeutic treatments for various musculoskeletal conditions, pain management, and improving overall well-being. While both modalities involve inserting needles into the body to address pain and dysfunction, their approaches, underlying principles, and applications are quite distinct. In this blog post, we will compare acupuncture and IMS in terms of their origins, techniques, treatment mechanisms, efficacy, and clinical uses.
Understanding Acupuncture
Historical Origins
Acupuncture is one of the oldest and most well-established forms of traditional medicine, with roots tracing back over 2,000 years in China. It is a central practice in Traditional Chinese Medicine (TCM), which views the body as an interconnected whole. TCM diagnostics use concepts like ‘qi,’ ‘yin,’ and ‘yang.’ While these terms may sound unfamiliar, they relate to physiological processes. For instance, when referring to ‘qi,’ Western medicine might use the term ‘metabolism.’ Essentially, we’re talking about the same concept, but described with different language.
TCM emphasizes the unity of mind and body, suggesting there is no separation between the two. You are equally present in both your thoughts and your physical form. This holistic approach allows for a comprehensive, systematic treatment method.
Acupuncture Technique
Acupuncture involves inserting fine needles into the body at specific points. To put this in perspective, a typical injection needle measures about 2.9mm, while acupuncture needles are a fraction of that—just 0.25mm (or smaller). While some people may feel a slight pinch during insertion, others feel little to no sensation. Once the needle is in place, the acupuncturist may gently manipulate it to provoke a specific sensation.
Pain is often viewed negatively—unpleasant and uncomfortable—but it’s important to broaden how we interpret bodily sensations. Sensations during acupuncture can be described as “dull,” “cool,” “warm,” “heavy,” “sharp,” “pulling,” or “grabbing.” These feelings may not always be painful, but they can still be intense or unusual. The goal is not to avoid discomfort but to expand our understanding of the body’s responses and embrace the experience.
When a therapist asks, “How does that feel for you?” it’s an opportunity for you to tune into your body’s signals. Similarly, the sensations you experience during acupuncture provide valuable feedback for the practitioner, so it’s important to communicate during treatment.
Acupuncture Points and Treatment
Some acupuncture points are chosen based on their proximity to a specific issue. For example, if you have shoulder pain, the acupuncturist will palpate the area to find tender spots. Once a spot is located, the needle is inserted to elicit a response that stimulates blood flow and promotes healing. When addressing muscle-specific complaints, acupuncturists often needle both the attachment and origin points of the muscle to treat it in its entirety.
Other points may be selected distally (farther from the site of pain). This is because acupuncture points throughout the body are interconnected and can address various issues. The overall goal of treatment is to target both the root cause of the condition and its symptoms, restoring balance and homeostasis.
Clinical Applications
Acupuncture has a wide range of clinical applications, including:
Muscle pain
Arthritis
Migraines
Dizziness
Fatigue
Stress
Anxiety
Depression
Digestive complaints
Infertility
Menstrual irregularities
Women’s health, including menstruation, birth preparation, and postpartum care
When addressing muscle complaints, acupuncture stimulates the body’s natural pain-relieving mechanisms, such as the release of endorphins. It also influences the nervous system to reduce muscle tension and improve blood flow. Healthy, nourished tissue is key to overall well-being.
Women’s Health and Fertility
Treatment for women’s health issues depends on the individual’s specific concerns. For menstrual issues, I often recommend tracking the entire cycle—from the first day of one bleed to the first day of the next—to understand how the body changes throughout the cycle.
Fertility treatments vary based on the cause of infertility, whether it’s unexplained or related to assisted reproductive technologies like IVF or IUI. In these cases, treatment plans may include weekly or biweekly appointments, with an increase in frequency during the follicular phase (up to two sessions per week).
Nutrition and home care are also crucial components of fertility treatment. Building up blood and qi is essential for improving outcomes and supporting overall reproductive health.
Understanding Intramuscular Stimulation (IMS)
Origins and Development
The use of solid filament needles for treatment stems from acupuncture, which may date back 5,000 years. In modern medicine, practitioners have focused on trigger points, their referral patterns, and their link to pain. This began with Gowers in the 1920s and was later expanded by Travell and Simons in the late 1970s. Today, many needling practitioners continue to emphasize trigger points.
In 1973, Dr. Chan Gunn developed the radiculopathy model and Intramuscular Stimulation (IMS) after recognizing the limitations of traditional pain treatments. His research into acupuncture’s Deqi phenomenon—a muscle twitch response to needling—led to the creation of Gunn IMS for chronic pain. Since then, various other trigger point-based needling approaches have emerged.
Technique and Treatment Mechanism
Gunn explains that radiculopathy, or radiculopathic neuropathy, is primarily caused by nerve root compression due to spondylosis, a condition involving the loss of intervertebral height or space. This compression affects nerve roots and their pathways, leading to what is known as a dystrophic nerve. A dystrophic nerve perpetuates a cycle of compression and irritation, contributing to myofascial pain syndromes. This process places additional strain on the nervous system, further aggravating spinal nerve irritation. (Gunn 1976, 1996).
Needle Application and Its Effects
Inserting a needle into a taut band directly and reflexively stimulates the shortened muscle or trigger point, triggering a contract-relax response via the spinal reflex pathway—similar to striking a tendon with a reflex hammer. This immediate reaction causes the muscle to relax, reducing neuromuscular compression and pain while increasing range of motion (ROM). As the muscle relaxes, blood flow and circulation improve, allowing small blood vessels and lymphatic channels to open up. This helps deliver oxygen and nutrients while clearing waste, promoting healing both at the treatment site and throughout the body. Because these changes happen so quickly, it suggests that the nervous system plays a key role in the process.
Current of Injury
An injury increases sensory feedback in the body, including mechanical, chemical, and temperature-related signals, which are processed through the nervous system. When a needle is inserted, it creates a tiny, controlled injury that triggers inflammation and shifts in cellular activity. This produces a small electrical current at the site, lasting until the tissue heals. This "current of injury" is thought to help release healing chemicals, aiding in nerve and tissue recovery. The nervous system plays a key role in this process, potentially reducing nerve sensitivity and abnormal muscle activity. (Abramson, 1927; Oschman, 1994).
Clinical Applications
IMS is primarily used for the treatment of musculoskeletal pain locally, or via addressing a neuropathically driven issue, particularly pain that is related to muscle tightness and trigger points. It is commonly used to treat conditions such as:
Chronic back and neck pain or stiffness
Headaches and migraines
Myofascial pain syndrome
Sports injuries
Sciatica
Tendonitis and bursitis
While IMS is often effective for acute injuries, it is most beneficial for individuals who experience chronic pain that has not responded to other therapies. It is typically used in conjunction with other physical therapy interventions, such as stretching, strengthening exercises, and manual therapy, to help optimize the results (Gunn, 2007).
Comparing Acupuncture and IMS
Philosophical Foundations
The most fundamental difference between acupuncture and IMS lies in their philosophical foundations. Acupuncture is based on the principles of Traditional Chinese Medicine, which centers around the concept of Qi and the belief that health results from the balance of energy within the body. This ancient system views the body holistically and treats conditions by addressing imbalances in energy flow (Vickers et al., 2018).
IMS, on the other hand, is grounded in Western medical principles, focusing on the neuromuscular system and trigger points within the muscles. It is based on modern anatomy, physiology, and neurology and does not incorporate the concept of Qi or energy flow (Gunn, 2007).
Techniques and Needle Insertion
Both acupuncture and IMS involve the use of needles, but the techniques and reasons for insertion differ significantly. In acupuncture, the needles are inserted into predetermined points along the body's meridians. These points may be located far from the area of pain or dysfunction, and the focus is on influencing the overall balance of the body, not just treating the local area (Haas et al., 2014).
In contrast, IMS involves inserting needles directly into muscles that have developed trigger points. These are typically deep, tight, and painful areas that can refer pain to other parts of the body. The goal of IMS is not just to stimulate the nervous system, but to deactivate these trigger points and relieve muscle tension (Gunn, 2007).
Needle characteristics vary slightly, with traditional acupuncture needles ranging from 0.12-0.20mm in thickness, whereas IMS needles tend to be thicker depending on the practitioner and area of needling ranging from 0.22 up to 0.35mm thickness. Furthermore, the application of the needle may differ where acupuncture points apply the needle, and it can remain in place for a period of time. In IMS, the needle may be manipulated or inserted deeper into the tissue, and it will typically be removed once the twitch phenomenon is achieved.
Pain and Sensations During Treatment
The sensation experienced during acupuncture can vary depending on the person, the location of the needle, and the style of acupuncture used. Many patients report feeling a mild sensation, such as a dull ache or a slight "tingling" when the needle is inserted. Some forms of acupuncture, such as dry needling, can also produce stronger sensations (Vickers et al., 2018).
In IMS, patients may experience a brief muscle twitch or a "cramping" sensation when the needle stimulates the trigger point. While some individuals find this sensation slightly uncomfortable, it is generally short-lived and leads to relief as the muscle relaxes. The overall sensation is often more intense than acupuncture, as it is targeting muscle tissue specifically (Cummings & White, 2001).
Effectiveness and Scientific Backing
Acupuncture has been studied extensively, and there is a growing body of evidence supporting its effectiveness for certain conditions, particularly chronic pain and stress-related disorders. The World Health Organization (WHO) has recognized acupuncture as a valid treatment for a variety of conditions, including chronic pain, musculoskeletal pain, and nausea (Lee et al., 2013). However, acupuncture’s efficacy remains a topic of debate in scientific circles, as some studies report mixed results, particularly in terms of its effectiveness compared to placebo treatments (Vickers et al., 2018).
On the other hand, IMS has a more established scientific basis. Research into IMS and its effects on myofascial pain syndrome and chronic musculoskeletal pain has shown promising results. Studies suggest that IMS can lead to significant improvements in pain levels, muscle function, and range of motion, particularly in individuals with conditions like sciatica, back pain, and myofascial pain syndrome (Gunn, 2007). However, as with any medical treatment, individual outcomes can vary, and more research is needed to explore the full extent of IMS’s benefits (Gunn, 2002).
Side Effects and Safety
Both acupuncture and IMS are generally considered safe when performed by trained professionals. In acupuncture, the most common side effects are mild, including bruising, soreness, or dizziness after treatment. Serious side effects are rare and typically occur when the procedure is not performed correctly (Wang & Kim, 2015).
For IMS, side effects can include temporary soreness at the needle insertion site, muscle tenderness, or mild bruising. In some cases, patients may experience a brief flare-up of symptoms after treatment, followed by relief. Severe adverse effects are extremely rare, and IMS is typically well tolerated (Cummings & White, 2001).
Cost and Accessibility
Acupuncture is widely available in many parts of the world and is often covered by insurance, particularly in countries with a strong emphasis on integrative or alternative medicine. In countries like China, acupuncture is a common treatment modality and is often provided alongside conventional medical care (Haas et al., 2014).
IMS, while gaining recognition, may be less widely available than acupuncture. It is typically offered by physiotherapists and healthcare providers specializing in musculoskeletal pain. IMS treatment may be covered by insurance depending on the provider, and it is often included in physical therapy regimens for pain management (Gunn, 2007).
Which Treatment is Right for You?
Ultimately, the choice between acupuncture and IMS depends on the nature of your condition, your treatment preferences, and your individual response to these therapies. If you are seeking a holistic, energy-based approach to pain management or overall wellness, acupuncture may be the better option for you. It offers a broad array of benefits beyond just pain relief, such as stress reduction and immune system support (Lee et al., 2013).
However, if you are dealing with chronic musculoskeletal pain, muscle tension, or myofascial pain, IMS may provide more targeted relief. The use of trigger point therapy and the direct influence on the neuromuscular system makes IMS particularly effective for treating conditions such as sciatica, tension headaches, and chronic back pain (Gunn, 2007).
Both acupuncture and IMS have shown to be effective therapies for managing pain and improving function. Consulting with a healthcare provider to determine which therapy best suits your needs is a key step toward achieving optimal results.
References
Abramson, D. I. (1927). Electrotherapeutic Techniques in Rehabilitation Medicine. New York: Academic Press.
Cummings, T. M., & White, A. R. (2001). Needling therapies in the management of myofascial trigger point pain: A systematic review. Archives of Physical Medicine and Rehabilitation, 82(7), 986-992.
Gunn, C. C. (1976). The Gunn approach to the treatment of chronic pain: Intramuscular Stimulation for Myofascial Pain Syndromes of Radiculopathic Origin. Journal of Musculoskeletal Pain, 4(1), 1-27.
Gunn, C. C. (1996). Radiculopathic pain: Mechanisms, diagnosis, and treatment. Journal of Musculoskeletal Pain, 4(2), 123-134.
Gunn, C. C. (2002). The Gunn approach to the treatment of chronic pain: Intramuscular Stimulation for Myofascial Pain Syndromes of Radiculopathic Origin. Churchill Livingstone.
Gunn, C. C. (2007). The Gunn approach to the treatment of chronic pain: Intramuscular Stimulation for Myofascial Pain Syndromes. Journal of Orthopaedic & Sports Physical Therapy, 37(7), 425-432.
Haas, M., Spearman-McCarthy, E. V., & Peterson, D. (2014). Acupuncture for chronic pain: An update and critical overview. Journal of Alternative and Complementary Medicine, 20(5), 351-356.
Lee, J. H., Choi, T. Y., Lee, M. S., Lee, H., Shin, B. C., & Ernst, E. (2013). Acupuncture for acute low back pain: A systematic review. The Clinical Journal of Pain, 29(2), 172-185.
Oschman, J. L. (1994). The role of bioelectric fields in healing and regeneration. Journal of Bodywork and Movement Therapies, 1(2), 117-127.
Vickers, A. J., Vertosick, E. A., Lewith, G., MacPherson, H., Foster, N. E., Sherman, K. J., ... & Linde, K. (2018). Acupuncture for chronic pain: Update of an individual patient data meta-analysis. Journal of Pain, 19(5), 455-474.
Wang, S. M., & Kim, J. H. (2015). Acupuncture analgesia: Evidence, efficacy, and clinical applications. Anesthesia & Analgesia, 120(2), 511-524.
