What is IMS? – Dalen Friesen

Mark: Hi, it's Mark from TLR. I'm here with Dalen Friesen and he's a physiotherapist at North Vancouver's best physiotherapy clinic, Body Works. And we're going to talk today about IMS, intra muscular stimulation. Dalen, what is IMS? 

 Dalen: Hi Mark.  It's a pleasure to be with you. As you just stated, IMS stands for intramuscular stimulation. We usually refer to it as a form of dry needling. Dry needling is simply a term, an umbrella term that refers to different forms of needling, which does not involve injecting anything. We use thin filament acupuncture type needles to identify contracted muscle bands. Which usually are a result of what's referred to as neuropathy or I like to think of it as a hyperactive nervous system.

And we use the needles simply as a probe to identify these muscles and then get them to release the muscle. It's a feedback loop that we're trying to break between that hyperactive nervous system and the tightened muscle or contracted muscle. So it's a bit of a chicken or the egg, you know, what's come first, but the two of them seem to feed back loop on one another.

And I sometimes explain it to patients as we're going to look at the nervous system near the spine as well, or the electrical panel outlet. And then you've got the muscle or perhaps the chandelier with flickering and burning out light bulbs. And instead of just simply looking at a muscle that may be presenting to them as being tight. Okay, perhaps, but maybe there's something more at a neurological level as well. So this is a form of treatment that looks to identify and release or reset that whole neural muscular system. And it's been a system that's been very, very effective. 

Mark: All right. So you mentioned, this is like it's similar that the needles are like acupuncture. Is this like acupuncture? 

Dalen: Well, and often people will ask how is this different? And I often say that the quicker conversation is how is it similar? And it's simply the needle, quite frankly. With intramuscular stimulation, we use different lengths of needles because we are identifying specific muscles or targeting specific muscles.

So we need to understand the anatomy. And the different layering of these muscle systems, unlike acupuncture, which would be using more energy meridians, predetermined anatomical points. And so from that standpoint, very different. The similarity being the type of needle that's being utilized. 

Mark: So what's the history and origin of IMS. This seems like a crazy kind of idea. Sticking needles into your muscles will make them relax. Where did this come from? 

 Dalen: Well, interestingly enough Mark it was founded here in Vancouver by a physician named Dr. Chan Gunn. And it was back in the 1970s. He was with the workers' compensation board and they were doing some studies with chronic low back pain. And they believed that their control group was a group that were not going to be injected with anything, but they were still needling them. And this was using hypodermic needles. I presume it was cortisone that they were using with the chronic low back pain patients and their control group were patients who were not receiving the cortisone. But of course were still getting the needle. 

And as they followed them, discovered that both groups were getting better and wondered well why would that be happening? And so that began their study and investigation of what became known to be neuropathic signs and symptoms within these chronic low back pain patients.

And Dr. Gun's Malaysian background, although I believe he was Oxford medicine trained, but with his background from Malaysia, decided why don't we try acupuncture type needles and will we get the same results? Of course, being able to utilize many more points, probably less discomfort associated with the treatment and lo and behold discovered that it worked very similarity. So that continued their investigation and research into this. 

And I completed my training approximately 13 years ago. At the time Dr. Guns program there was called The Institute For The Study And Treatment Of Pain, or ISTOP. And it's subsequently now part of the UBC Faculty of Medicine Program and all ongoing training and research is being completed on campus there at UBC. It's open to physicians and physiotherapists for training. So that's kind of the history. 

And interestingly too, he has been recognized worldwide for this and received the Order of Canada, the Order of BC for his discovery in this area. And it's really taken on particularly over the last 10, 15 years. I know at the beginning, when I started, most of my conversations were first time conversations with patients or physicians, and now it comprises upwards of 90% of my caseload and many people seeking it. Perhaps have even had it done before. And of course, I would point out Mark, with anything that has maybe accelerated or become a little bit more mainstream and known like that. There are a lot of different forms of it now, which has made it a little bit confusing for people. 

Gun IMS would be Dr. Chan Gun's form of it. And there are a few different types out there. Only a couple of them that are currently being regulated and certified by the college of physiotherapy here at BC. 

Mark: So let's get to the real nub of the thing. I've got pain in part of my body, how does IMS actually help me? What's the protocol? Is there a specific body parts that it works better for? What's the scope here? 

Dalen: Okay.  It's a very encouraging answer, I would say to that because there's a lot of different treatments that we can use or incorporate for acute new injury type conditions. IMS works particularly well for chronic conditions. Sometimes we'll refer to them as chronic myofascial.

And so a very common type example would be Mark, if you came in to see me complaining of. Low back pain. It's the time of the year you're starting to get out and golf again, perhaps you didn't do a whole lot during the year, and you've had episodes of this in the past and you come and see me with complaints of tightness and pain, let's say in the right lower part of your back. And maybe there's some pain extending down into the buttocks or hip area. Perhaps it's even a little bit further down the leg. It's impacting, you know how you're moving around. You're sitting in your office for extended periods of time, then trying to go out and golf and finding it really difficult.

So someone like you would come in. We would do an assessment. Identify any red flags perhaps that might be indicating that there's something more significant that we need to look at. But very often IMS will help a whole wide range of that from that, which is more serious to, that was just simply, we've got some muscle tightness and stiffness in here.

And after going through that exam, explaining a little bit of how that can feel, which is typically a little bit of soreness during the appointment or a little bit afterward. That's very common and it's a very unique sensation I think a lot of times people will describe. Pain is a very personal experience.

Many will say that it's not painful, but rather this cramping grasping type sensation. And others will say, no, no it's definitely uncomfortable. What I often say to people though, with that is that where we experienced that sensation. That's where our hope lies. In the sense that that's where the relief can come from. A normal muscle with a normal nerve innervation at rest, as the person is lying there, the muscles shouldn't really react at all.

 And so that's a normal response and we're looking for these muscle responses that are much more reactive. And by that, I mean, they'll tighten around the introduction of the needle. So again, I sometimes say, it's not me Mark, it's you. In other words, it's not so much the needle that you're feeling. If it's introduced quickly through the skin, it's not really even uncomfortable being that it's such a thin filament, but it's the muscle response that you feel. And that can be abrupt. It can be a quick twitch release, more of a quick reflex, or it can be a little bit more sustained. And in the low back example, like we're talking about, it can be a little bit more sustained depending on how pronounced the condition is. But what we look for then is that release of the muscle. That will improve your joint mechanics, your movements, including into the hips should be improved. 

Again you could be a little bit sore that day. But by the next day, we would anticipate that that would have disappeared and your movement again, should be better. Do we look for improvement after one session? It can happen. And certainly that is very encouraging when it does. The sessions are cumulative. We often do them about a week apart and like our stock portfolio, Mark, I say we'd like to have a strong trend after a few of those. 

 Mark: If you're looking to get rid of some pain, the guy to see is Dalen Friesen. You can reach him at Body Works Physiotherapy in North Vancouver. You can call to book at 604-983-6616. Or their website is body-works.ca. You can book online right there. Get in there and see him. A little bit of pain through some IMS, cause it is for me, I'm one of those guys is on the pain side of that, but it feels a heck of a lot better afterwards and it's nice to be able to move well again. Thanks Dalen. 

Dalen: Thank you, Mark.