As a practitioner certified in pain management by the Blatman International Myofascial Academy, and also a registered Doctor of Traditional Chinese Medicine, I am frequently asked how IMS (Intramuscular stimulation) differs from acupuncture. Both systems have proven themselves to be very effective in pain relief, but make no mistake, IMS is acupuncture. Let me explain the similarities and differences. Again, I reiterate that both systems have shown remarkable ability in the treatment of pain.
EDUCATION and TRAINING
Let’s start with education. In BC, a fully qualified doctor of TCM has undergone a minimum of 3250 hours of training over a 5 year program. The program includes more than 260 hours of Western Medical Sciences, including anatomy, physiology, pharmacology, and pathology. By contrast, the Western medical training of a physician or physiotherapist far exceeds that of a TCM practitioner. The Dr. TCM program includes more than 800 hours of clinical practice time, including needling (acupuncture), cupping, moxibustion, and tuina. By contrast, the needling training that physicians and physiotherapists undertake to learn IMS is done over several weekends.
There seems to be some suggestion that TCM practitioners do not make their diagnoses based on any understanding of anatomy, and that the selection of the acupuncture points is predetermined and on the basis of “unscientific meridians” rather than physical signs. This is flat out false.
TCM diagnosis for a typical pain pathology involves an understanding of the anatomy, the dermatomes, the meridians, as well as the patient’s physical signs and symptoms. A TCM practitioner will then palpate the area or areas in question. Typical physical findings include:
- Touch tenderness – this can be in one or multiple areas depending on the degree of “stagnation” (in TCM terminology). Multiple areas of pain typically indicate more severe stagnation. Western medicine often calls this “fibromyalgia”.
- Circulation deficiencies – painful areas can be either hot or cold to the touch. Again, in TCM theory this is due to stagnation of qi (vital energy), and blood. The affected area may feel sweaty or clammy as well.
- Changes in the appearance of the skin in the area. This will give a TCM practitioner an indication of meridian and possibly organ involvement. In TCM theory, all the meridian have a particular relationship with a specific organ. Much like the concept in Western medicine that the peripheral nerves all innervate the internal organs.
- Muscle contraction, shortening, pulling – often seen as referred pain where the area that the person “feels” the pain is not actually the source of the pain. A contracted muscle can actually mimic joint pain, and cause tendinopathies. These are the most common features of “neuropathic pain” in Western medicine.
POINT SELECTION (PRESCRIPTION)
After careful assessment of all of the above, a TCM practitioner will select his acupuncture prescription. As a practitioner who is certified in pain management, I will select points according to classic TCM theory, and combine these with deep needling of the very tender areas in the muscle. In classic TCM literature these tender points have been called “a-shi” points. The literal meaning is “that’s it” (i.e. that’s where it hurts). These points will often generate a strong twitch or muscle release when stimulated with the needle, producing a very obvious subjective and objective effect that is felt almost immediately. These points have been named “trigger points” in other schools of thought, and they are often the points needled in an IMS treatment. Where a TCM treatment really differs from the IMS treatment, lies in the selection of the accompanying acupuncture points. TCM practitioners have extensive knowledge in meridian distribution and we will always select accompanying points based on the meridians involved. In fact, a proper TCM point prescription will always include local (a-shi) points combined with other points elsewhere on the body. This is the basis of acupuncture. Needling the local points only will never yield the same results as when combined with the distal points. For example, if the pain is in the anterior portion of the shoulder on the TCM yang ming (large intestine) channel, we might select points on the distal portion of the yang ming channel of the lower leg. Or, if the qi and blood stagnation is severe, we might use accompanying point combinations that help to stimulate the systemic circulation.
So, the differences between IMS and acupuncture really come down to training, and point selection. In my clinic, I always combine aspects of classic TCM theory and point prescription, with aspects of deep needling of the affected (painful) area.