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Acupuncture vs. Dry Needling and IMS: who rules Needleville?

I often get asked about the difference between traditional acupuncture and dry needling or Intramuscular Stimulation (IMS). Understandably, people can confuse these modalities as one and the same. Alternately, they may segregate them to opposite ends of the spectrum believing they are completely different treatment approaches. As it is with many things, the answer lies somewhere in the middle. 

Let's start with some similarities of the treatments. Each involves puncturing the skin with fine needles for a therapeutic purpose, namely pain relief in this comparison. They all utilize single-use, pre-sterilized filiform needles, meaning the needle is solid and does not inject any substance into the body. Each technique, at minimum, is stimulating the body's nervous system in one way or another as well as influencing the hormone and neurotransmitter chemical balance of our internal pharmacy.

Dry needling is more of a general term describing a relatively recent development in biomedical clinical practices that solely aims to reduce muscle pain and tension. This is done by inserting needles into tight or knotted muscle areas often referred to as trigger points. A single needle or several needles may be used, and they may only be left in for a few seconds or up to several minutes. Most healthcare practitioners (medical doctor, chiropractor, massage therapist, etc.) are allowed to take a two-weekend course with an online component to become certified in dry needling. Though more in depth study opportunities do exist. 

Intramuscular Stimulation (IMS) is a particular systematized approach to dry needling with a theoretical model focusing on neuropathic pain. IMS practitioners (medical doctors and physiotherapists primarily) may test and treat at the painful muscle area or at the correlated spinal nerve roots. The roots are important gateways that receive and feed nerve signals to the affected area.

Again, the IMS treatments are usually more brief with only one needle used at a time. These needles tend to be a bit thicker in order to withstand stronger needle manipulation used to elicit a grabbing-twitch response that aims to relax the muscles afterwards. This type of stimulation can produce a noticeable soreness during treatment and 24-48 hours afterwards before the benefits of muscle release are realized. 


Traditional acupuncture is based on theoretical and clinical practice with a history of over 2000 years. The traditional theory developed around ideas of the flow of Qi ("chee") energy in our bodies. Acupuncture needles were used to access and manipulate this Qi flow in order to maintain or correct multiple states of health, including pain conditions. Specific meridians or channels that carried the Qi were mapped out, and the best access areas for stimulation became the acupuncture points. 

Today, most traditional acupuncture practitioners incorporate knowledge and respect of modern anatomy, physiology, and medical diagnostics into our daily practices. In fact, as part of a three to four year education program, registered acupuncturists are required to pass hundreds of hours in the Western medical sciences in order to be eligible for our licensing exam. This allows us to safely assess and more easily communicate to patients what is going on in their bodies and how acupuncture may help. It also provides traditional acupuncturists the unique ability to approach a patient's concerns through two lenses: one modern, objective and scientific; the other time-tested, intuitive and holistic. 

With traditional acupuncture, we will often use several needles, anywhere from two or three up to twenty or thirty needles in a session. Though it depends on the practitioner, traditional acupuncture tends to be gentler in its needling techniques, often promoting deep relaxation or sleep during the 20-30 minute rest time on the treatment table. 

Now, to be clear and fair, I absolutely appreciate the benefits of dry needling and IMS. All techniques, modern and traditional help people in pain and that is a good thing and most important in the end. Yet, for the purpose of accuracy and out of respect to the countless practitioners who developed the art I practice today, I want to affirm the foundation from which these modern westernized practices evolved and make clear where traditional acupuncture stands uniquely apart.  


Most of the concepts within dry needling existed for millenia as part of traditional acupuncture. For instance, the majority of common trigger points found in dry needling exist already as charted acupuncture points. Traditional acupuncture is not limited to using only the charted points, however. In practice, we also feel for tight, knotted and painful trigger points in the muscles and the fascial membranes that group together and stabilize the muscles. We call these spots "Ashi" points, translated as "Ah, yes! (...that's where the pain is)," or, "Ah, sh*t!" points if you're speaking to an occasionally irreverent acupuncture student. 

Traditional acupuncture theory also involves the spinal nerve roots similar to the IMS needling approach. We will often combine the "Ashi" points with the correlated spinal nerve root points known as Hua Tuo Jia Ji points, named after the famous physician who discovered their use in the second century, A.D. 

Treatment plans for both dry needling and traditional acupuncture tend to follow similar trajectories. A patient may get quick relief after one or two sessions of either style of treatment. However, depending on the condition and how long it has been around, both methods will often take six to ten treatments to achieve more sustainable results. 

What I also appreciate about traditional acupuncture is its added focus on the patient's entire experience of health. How is sleep going? What are stress levels like and the emotional balance in general? How's diet and digestion going? It is standard procedure in a traditional acupuncture office to understand and treat these cofactors of health in order to improve both the pain condition as well as the patient's overall state of well being.

This is not an exhaustive exploration of the similarities and differences of dry needling and traditional acupuncture. Hopefully it at least brings a new level of clarity on how the practices relate. Naturally, as my writing shows, I am a bit biased towards the work I do, though I've tried to be fair in the information shared. Ultimately, as my patients know, I just want them to feel better. Whether the help comes from traditional acupuncture, dry needling, or through a combination of various therapies, what matters most is engaging the healthcare system with perseverance to find what actually works for you. If I get to be a part of your success directly, well that's just icing on the cake.  If you have further questions about this topic, don't hesitate to contact me directly. Ready to take action on your pain condition or other health concern? Give us a call at 403-455-0880 to schedule your appointment. Or, try out our handy Online Booking system to set up a visit.


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