Needling Therapy

Jul 08, 2021

Dry needling? Acupuncture? Intramuscular stimulation (IMS)? Which one is right for me?

Needling therapy has become very popular among allied health professional over the last few decades, with physical therapists, chiropractors, osteopaths and many more using needles in everyday practice. It has become so popular; some people visit these professionals strictly for needle therapy. Since the emergence of this intervention there has been multiple new styles of dry needling therapy, and people often do not know the difference. In this blog I will explain the 3 most common forms of needling therapy.


Acupuncture originates back to 100 BC and has become very popular in western culture over the last 50 years. Acupuncture is based on an eastern philosophy and the concept of landmarks on the human body, known as “meridians or conduits” (figure 1), or energy-carrying channels, to alter a persons Qi, known as vital energy or lift force, which result in improvements in a range of health parameters (1). This is done by inserting very fine needles into the appropriate meridians of a person with their complaint to correct imbalance and restore health.


                                                                               (figure 1)

Acupuncture has been researched and proven to be both safe and effective in reducing pain in people with chronic low back pain, knee osteoarthritis and headaches (2) as well as other conditions, like migraines (3). The reasons as to why acupuncture is effective not well understood, but it has shown to change descending brain signals and alter the levels inflammatory mediators in the location of pain (4).


Dry needling

Dry needling, as opposed to acupuncture, uses a western philosophy and the science of anatomy and neurology as its basis of treatment. It is defined as “A skilled intervention … that uses a thin filiform needle to penetrate the skin and stimulate underlying myofascial trigger points, muscular and connective tissues for the management of neuromusculoskeletal pain and movement impairments”. (5)

The trigger points that are targeted in dry needling uses Janet Travells research, an American physician, who mapped pain referral patterns of “trigger points” of several skeletal muscles (figure 2) (6). Trigger points are “A hyperirritable spot in skeletal muscle associated with a hypersensitive nodule in a taut band” (5).

                                                                          (figure 2)

These triggers points can cause common complaints of musculoskeletal pain, and when palpated, cause characteristic referred pain, as mapped out by Travell. The goal of dry needling is to target these trigger points at the center of the muscle belly, deep to the surface of the muscle, to reduce the pain they are causing. The only similarity between acupuncture and dry needling are the needles used for treatment.

Since dry needling is a new treatment method than acupuncture, the research is not as strong or well documented. Regardless, is has also shown to reduce pain in several musculoskeletal conditions but is similar in reducing pain to other non-needle therapies (7).


Gunn Intra-muscular stimulation

Intra-muscular stimulation (IMS) was created by Dr. Chan Gunn in British Columbia in the 1970’s while working with difficult musculoskeletal cases. Dr. Gunn’s philosophy relies on both Travells work of trigger points, and the belief that most pain is neuropathic in nature, meaning it primarily originates from the nerves. His work uses the western science and concepts from the radiculopathic model of pain, which suggests pain in the extremities is derived from compressed nerves in the spine (figure 3).


                                                                        (figure 3)

The use of needles can release trigger points in muscles around the spine and reduce the pressure on these nerves, consequently reducing pain in the extremities (8).

The type of needles and technique used in IMS is very similar to dry needling, the primary difference is the reasoning and goal behind the use of the needles.


All of these different needle therapies can assist in managing pain and symptoms for several neuromusculoskeletal injuries. Which one is right for you depends on the person and several factors regarding their injury.

Active Physio Works has physiotherapists that are trained in all of these forms of needling, and each of them can guide you in the right direction for your best recovery! Call 780-458-8505 to book an appointment today!



  1. White, A., & Ernst, E. (2004). A brief history of acupuncture. Rheumatology43(5), 662-663.
  2. Xiang, A., Cheng, K., Shen, X., Xu, P., & Liu, S. (2017). The immediate analgesic effect of acupuncture for pain: a systematic review and meta-analysis. Evidence-Based Complementary and Alternative Medicine2017.
  3. Li, Y. X., Xiao, X. L., Zhong, D. L., Luo, L. J., Yang, H., Zhou, J., ... & Jin, R. J. (2020). Effectiveness and safety of acupuncture for migraine: an overview of systematic reviews. Pain Research and Management2020.
  4. Lai, H. C., Lin, Y. W., & Hsieh, C. L. (2019). Acupuncture-analgesia-mediated alleviation of central sensitization. Evidence-Based Complementary and Alternative Medicine2019.
  5. Placzek, J. D., & Boyce, D. A. (2016). Orthopaedic physical therapy secrets-E-Book. Elsevier Health Sciences.
  6. Travell, J. G., & Simons, D. G. (1983). Myofascial pain and dysfunction: the trigger point manual (Vol. 2). Lippincott Williams & Wilkins.
  7. Gattie, E., Cleland, J. A., & Snodgrass, S. (2017). The effectiveness of trigger point dry needling for musculoskeletal conditions by physical therapists: a systematic review and meta-analysis. journal of orthopaedic & sports physical therapy47(3), 133-149.



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