IMS and dry needling in Abbotsford

Two main models explain why and where practitioners place needles, and they lead to different treatment patterns.

The trigger point model. Janet Travell and David Simons described myofascial trigger points: small, hypersensitive spots within a taut band of muscle that hurt when pressed and can refer pain to other areas. A trigger point in the upper trapezius, for example, can refer pain up the side of the head. Trigger point dry needling locates these points by palpation and needles them directly. The aim is to reduce the sensitivity and tension of the band.

The Gunn IMS model. Dr. Gunn proposed that much chronic muscle pain comes from irritation of the nerve as it leaves the spine, which makes the muscles it supplies supersensitive and shortened. IMS therefore needles both the shortened muscles in the painful area and the deep muscles beside the spine at the matching segment. A person with elbow pain, under this model, may have needles placed in the forearm and in the neck.

Many physiotherapists draw on both models. The assessment decides which muscles to treat, and the treatment follows from what the physiotherapist finds rather than from a fixed recipe. Variations exist within each approach: superficial needling stays in the tissue just under the skin; deep needling reaches the muscle belly; and some practitioners attach a mild electrical current to the needles.

Needling starts with a physiotherapy assessment, because the same symptom can come from several sources and needling suits only some of them.

The assessment follows a set order:

1. History. The physiotherapist records where the pain is, how it started, what aggravates and eases it, and the patient's work, sport and goals.
2. Movement and strength. Range of motion and resisted tests show which movements are restricted and which reproduce the pain.
3. Palpation. The physiotherapist feels for taut bands, tender points and areas of guarding in the relevant muscles.
4. Nerve and spine screen. Where symptoms spread into an arm or leg, sensation, reflexes and strength are checked, and the spinal segments are examined.
5. Suitability check. The physiotherapist asks about bleeding disorders, blood-thinning medication, pregnancy, infection, a history of fainting with needles, and fear of needles.

The physiotherapist then explains what they found, whether needling fits the plan, and what it involves. Needling goes ahead only with the patient's informed consent, and the patient can decline it or stop at any point. Hands-on treatment and exercise offer alternatives for anyone who prefers not to be needled.

A needling session follows a consistent routine that prioritises safety.

• Preparation. The physiotherapist positions the patient comfortably, cleans the skin and uses single-use, sterile filament needles, which are disposed of after the session.
• Insertion. A guide tube helps the needle enter the skin quickly. Most people feel a small prick, or nothing at all.
• In the muscle. As the needle reaches a tight band, a deep ache or a cramp-like sensation is common. A brief, involuntary contraction of the muscle, called a local twitch response, often occurs. It is startling the first time but passes in a moment.
• Duration. Some techniques use quick in-and-out movements; others leave the needle in place for several minutes. Gunn IMS often uses short needle times at multiple sites.
• Afterwards. The physiotherapist rechecks movement and usually follows needling with stretching, mobility work or exercise, to make use of the change in the muscle.

Needling rarely makes up a whole session. It sits within physiotherapy treatment that also includes hands-on techniques and the home exercise program, and some sessions involve no needling at all.

Most after-effects are mild and short-lived.

• Soreness. The needled muscles commonly ache for a day or two, like after a hard workout. Gentle movement and the exercises from the session help.
• Bruising. A small bruise at a needle site is common, especially in areas with more blood vessels.
• Light-headedness. A few people feel faint during or after needling, which is why treatment is done lying down or well supported.
• Tiredness. Some people feel tired or emotional for the rest of the day.

Serious complications are rare but known. The most important is pneumothorax, an air leak around a lung, which can occur when needling near the chest wall. Certified physiotherapists learn needle depth, angle and the anatomy of each region to manage that risk. Shortness of breath or chest pain after needling near the chest needs prompt medical attention.

Precautions guide when needling is modified or avoided. They include bleeding disorders and anticoagulant medication, a weakened immune system, infection or broken skin at the site, lymphedema in the area, pregnancy (for some regions), and strong fear of needles. The suitability questions at the assessment cover each of these, and the answers can change the plan.

Dry needling by physical therapists in British Columbia is regulated through the College of Health and Care Professionals of BC. The college requires a physical therapist to be certified before performing dry needling. Certification requires practice experience as a licensed physical therapist and completion of an approved dry needling course. The certification sits on top of the physiotherapist's general licence, so not every physiotherapist performs needling.

Coverage follows the profession that provides the treatment. Dry needling performed by a physiotherapist is usually claimed as physiotherapy, so whether a plan pays for it depends on the plan's physiotherapy benefit and limits. Checking the plan wording before the first visit avoids surprises. At Altus Integrated Health, dry needling and IMS are priced differently from a standard physiotherapy session, and fees are confirmed at booking. Altus direct bills most major extended health insurers for eligible plans.

No referral is needed. Physiotherapy in BC is direct access, so a patient can book an assessment without seeing a doctor first, although some extended health plans set their own referral rules for reimbursement.

Dry Needling Places A Thin Filament Needle Into Tight Or Sensitive Muscle

The needle used in dry needling is solid, very fine and single-use. It goes into a taut band, trigger point or shortened muscle identified at the assessment. Nothing is injected; the treatment relies on the needle's effect on the muscle and the nervous system.

IMS Is A Form Of Dry Needling Developed In Vancouver

Dr. C. Chan Gunn developed intramuscular stimulation in Vancouver. IMS treats muscle pain as a sign of irritated nerves and therefore needles both the painful area and the muscles beside the spine at the matching nerve level. The approach has been taught to physiotherapists in BC for decades.

Physiotherapists In BC Need Certification To Perform Dry Needling

The College of Health and Care Professionals of BC requires physical therapists to hold certification before performing dry needling. Certification follows practice experience and an approved course. At Altus Integrated Health, three physiotherapists provide IMS and dry needling: An Luu, Harmanjeet Singh and Nikkie Brar.

Dry Needling Is Not Acupuncture

Dry needling and acupuncture use similar needles but rest on different foundations. Dry needling follows a musculoskeletal assessment and targets muscle and nerve-related tension. Acupuncture follows traditional Chinese medicine's meridians and points, and in BC is provided by registered acupuncturists and others with their own authorization. Altus Integrated Health offers dry needling and IMS, but not acupuncture.

Needling Works Best As One Part Of An Active Treatment Plan

Needling can reduce tension and sensitivity in a muscle for a period of time. That window is most useful when movement and exercise follow, rebuilding the strength and control that keep the change. A plan that relies on needling alone leaves the cause of the problem in place.

Misconception: Dry Needling Is The Same Thing As Acupuncture

The two share the needle, not the reasoning. Dry needling follows a musculoskeletal assessment of muscles, joints and nerves; acupuncture follows traditional Chinese medicine's meridian system. They involve separate training and, in BC, separate authorization.

Misconception: Needling Injects Something Into The Muscle

"Dry" means no substance is injected. The needle is solid rather than hollow. This distinguishes dry needling from trigger point injections, which a physician performs with medication.

Misconception: Dry Needling Replaces The Need For Exercise

Needling can ease a tight, sensitive muscle in the short term. Exercise and movement afterwards build the capacity that holds that change. Skipping the exercise part leaves the original weakness or overload in place.

Misconception: More Needles And More Sessions Always Mean Better Results

The number of needles and sessions follows the assessment and the response to each treatment. A physiotherapist adjusts the plan, or stops needling, when it isn't adding to progress. More needling is not automatically better care.

Misconception: Anyone Who Treats Muscles Can Perform Dry Needling

In BC, a physiotherapist needs certification from the college, after approved training, before performing dry needling. It is not something a practitioner adds to their care without that step.

Strength of the evidence. Supporters point to studies reporting short-term reductions in muscle pain and sensitivity, particularly in the neck, shoulder and lower back. Sceptics note that many trials are small or short and call for stronger long-term evidence before needling is treated as a first-line approach.

Trigger points or nerves. Clinicians who follow the trigger point model needle where the taut bands and tender points are. Those who follow Gunn's model argue the nerve root is the driver and needle at the spine as well. Many practitioners combine the two, and the debate shapes where needles go.

The twitch response. Some practitioners aim for a local twitch response, believing it signals that the needle has reached the right tissue. Others argue the twitch is not necessary and favour gentler techniques that avoid it.

Dry needling and acupuncture. Physiotherapists and acupuncturists continue to debate where one practice ends and the other begins, since both insert filament needles. The debate mostly concerns training, terminology and regulation rather than the needle itself.

When to needle. Some clinicians use needling early to reduce pain so that exercise is easier. Others reserve it for problems that have not responded to exercise and manual therapy. Most agree it belongs inside a plan rather than on its own.

A dry needling treatment assembles from parts that depend on one another. The physiotherapy assessment forms the first component, deciding whether needling suits the problem and which muscles to target. Informed consent forms a component of every needling session, renewed whenever the plan changes. Within the muscle, the taut band forms a component of a myofascial trigger point, which is why palpation guides the needle. Under the Gunn model, the spinal segment forms a component of the assessment, linking the painful muscles to the nerve that supplies them. Exercise after needling forms a component of the session itself, using the change in the muscle to restore movement. Removing any of these parts, most often the exercise, weakens the treatment as a whole.

Dry needling places a thin, solid filament needle into tight or sensitive muscle; IMS, developed by Dr. C. Chan Gunn in Vancouver, applies the same tool to both the painful area and the muscles near the spine. Physiotherapists in British Columbia need certification from their college before performing it, and they use it within a plan that starts with assessment and continues with hands-on treatment and exercise. Common after-effects are short-lived soreness and bruising, and precautions guide when needling is modified or avoided. Dry needling is not acupuncture. At Altus Integrated Health, IMS and dry needling are provided by physiotherapists An Luu, Harmanjeet Singh and Nikkie Brar, with fees confirmed at booking.