Intramuscular Simulation / Dry Needling

This technique is based on the insertion of acupuncture needles into trigger points of affected muscles. IMS is not an eastern form of treatment based on meridians or Chinese acupuncture points.

It is a conventional method based on muscle anatomy and function as well as nerve supply and the interaction of these together. To practise it, one requires a very good knowledge of anatomy in order to insert the needles into the appropriate places.

Some links on IMS are:

  • Medical Media (in Hebrew)
  • Wikipedia

Left untreated, trigger points (TPs) can continue to contract for months to years, causing local ischemia within the muscle, inefficient muscle activity, weakness within the muscle and most importantly of all, severe pain. As explained in detail in the section on pain arising from muscles, these trigger points result from either injury or from prolonged strain such as poor posture, ergonomics, lifting techniques, and sleep hygiene. Trigger points can develop both within weak and stretched or shortened and relatively overactive muscles. All of these cases can be needled successfully.

The IMS method of treatment uses acupuncture needles, which, if inserted correctly, stop the vicious cycle, and ‘resets’ the trigger point within minutes or even seconds. This method actually has a similar effect on the muscles as does massage, however the results with IMS needling are much more long-lasting.

In contrast to the Eastern acupuncture method in which needles are left for 20 minutes, in IMS the needles are left in for seconds to a few minutes at the very most. However, they continue to affect the trigger points for 48 hours after being taken out giving rise to much more long-lasting results. The longer the condition has lingered on for, the more muscles will need to be needled and the more treatment sessions will be required. Usually 2-5 treatment sessions are sufficient however this depends on the compliance of the patient in adopting healthier postures and doing the appropriate exercises.

Several studies have been done comparing dry needling with trigger point injections of various solutions: corticosteroids, local anaesthetic, saline, sterile water and Botox, all of which showed that dry needle was not inferior to TP injections (Cummings and Baldry 2007). The advantage of IMS is that one can be more thorough and treat the musculoskeletal system as a whole, without being concerned about the overdosing of the medication being injected. One can then address the neighbouring areas, which, according to the musculoskeletal physician, must also be addressed in order to lead to longer lasting effects.

Common conditions in which IMS works very well:

  • Back and neck strains and sprains, whiplash injuries
  • Back pain (see figure 1)
  • Neck pain (see figure 2)
  • Some types of frozen shoulder
  • Many cases of neck pain referring to the arm
  • Elbow pain, tennis elbow
  • ‘Hip bursitis’

Some dramatic examples where IMS works almost miraculously are:

  • treatment of back sprains commonly associated with trigger points in one or more of the following muscles: Quadratus lumborum (see photo), Gluteus medius, Multifidus
  • nerve entrapments of the ulnar nerve (see photo top of page) and entrapment of the brachial plexus
  • acute to sub-acute whiplash injury