If you've been looking for treatment for pain, muscle tension, or restricted movement, you've probably come across terms like IMS, dry needling, acupuncture, and cupping.
They can sound similar, especially when several are offered at the same clinic, but they aren't the same thing.
Dry needling is performed by a registered physiotherapist and targets specific muscles. IMS is a specific type of dry needling.
Acupuncture is performed by a registered acupuncturist and follows a different framework, with points selected across the body. Cupping uses suction rather than needles.
So, which one is right for you?
You don't necessarily have to figure that out before you book. Choosing the appropriate approach is part of the assessment. But understanding the differences can make the decision a little easier.
The quick comparison
| IMS | Dry needling | Acupuncture | Cupping | |
|---|---|---|---|---|
What is used | Fine, solid filament needle (nothing injected) | Fine, solid filament needle (nothing injected) | Fine, solid filament needle (nothing injected) | Suction cups, no needles |
Who provides it | Registered Physiotherapist with with IMS training and regulatory authorization | Registered Physiotherapist with additional training and regulatory authorization | Registered Acupuncturist | Registered Acupuncturists, registered physiotherapists, RMTs, and other trained practitioners |
What is targeted | Tight muscles linked to nerve irritation, often including muscles near the spine | A specific muscle or trigger point | Points selected across the body by a registered acupuncturist, local to the symptom or elsewhere | An area of tissue that feels tight, heavy or restricted |
The framework behind it | Western neurophysiology | Western anatomy and musculoskeletal assessment | Traditional Chinese Medicine | Traditional medicine origins; also used with a modern soft-tissue approach |
Usually part of | A physiotherapy treatment plan | A physiotherapy treatment plan | An acupuncture treatment plan | An acupuncture, massage, or physiotherapy treatment plan |
What it often feels like | A brief twitch or cramping sensation, instant, short-lived | A brief twitch or cramping sensation, instant, short-lived | Usually, a dull ache or heaviness at the point | Pulling or tightness; temporary marks that usually fade within days to a week |
How it's usually billed | Physiotherapy | Physiotherapy | Acupuncture | Depends on the practitioner |
What is used
Fine, solid filament needle (nothing injected)
Fine, solid filament needle (nothing injected)
Fine, solid filament needle (nothing injected)
Suction cups, no needles
Who provides it
Registered Physiotherapist with with IMS training and regulatory authorization
Registered Physiotherapist with additional training and regulatory authorization
Registered Acupuncturist
Registered Acupuncturists, registered physiotherapists, RMTs, and other trained practitioners
What is targeted
Tight muscles linked to nerve irritation, often including muscles near the spine
A specific muscle or trigger point
Points selected across the body by a registered acupuncturist, local to the symptom or elsewhere
An area of tissue that feels tight, heavy or restricted
The framework behind it
Western neurophysiology
Western anatomy and musculoskeletal assessment
Traditional Chinese Medicine
Traditional medicine origins; also used with a modern soft-tissue approach
Usually part of
A physiotherapy treatment plan
A physiotherapy treatment plan
An acupuncture treatment plan
An acupuncture, massage, or physiotherapy treatment plan
What it often feels like
A brief twitch or cramping sensation, instant, short-lived
A brief twitch or cramping sensation, instant, short-lived
Usually, a dull ache or heaviness at the point
Pulling or tightness; temporary marks that usually fade within days to a week
How it's usually billed
Physiotherapy
Physiotherapy
Acupuncture
Depends on the practitioner
What is dry needling?
Dry needling is a technique used by registered physiotherapists as part of a broader treatment plan.
Dry needling uses a thin needle inserted into a specific area of muscle, often one that feels tight, ropey or tender, with the goal of changing how that tissue is behaving.
It is called dry needling because nothing is injected. The needle itself is the treatment.
The sensation can surprise people. When the needle reaches the intended area, you may feel a quick twitch or brief cramping sensation. Some people notice that the area feels looser oftentimes immediately afterwards, although the response varies depending on the underlying problem.
Some soreness for a day or two is also common.
Several of our registered physiotherapists are certified to provide dry needling, and it is rarely used on its own. The needle may help change how a muscle feels, but treatment also needs to address the reason the muscle became tight or irritated in the first place.
Research supports dry needling as one tool that can help manage musculoskeletal pain. A 2021 systematic review and meta-analysis published in Physical Therapy found that dry needling applied by physiotherapists reduced pain in people with musculoskeletal conditions compared with placebo and other treatments, at time points ranging from 72 hours to six months. The authors rated the quality of the evidence as low to moderate, with considerable variation between studies. This is one reason dry needling is generally used as part of a broader treatment plan rather than as a standalone solution.
Learn more about IMS/Dry Needling
Where does IMS fit in?
IMS stands for intramuscular stimulation, and it is a type of dry needling rather than a separate category.
The simplest way to think about it is: All IMS is dry needling, but not all dry needling is IMS.
What makes IMS distinct is the reasoning behind the treatment. IMS works from the idea that persistent muscle tightness can be driven by irritation of the nerve supplying that muscle. Because of this, treatment may address the area near the spine as well as the muscle where you feel the problem.
A review in the Journal of the American Board of Family Medicine describes two models behind dry needling: the radiculopathy model, which IMS follows, and the trigger point model, which targets a sensitive spot in the muscle more directly.
Both approaches use an acupuncture needle, but they are based on Western medical reasoning rather than traditional meridian theory.
The approach was developed in Vancouver, which is part of why the term is used here more than in most places. Practitioners take specific additional certification to provide it.
What is acupuncture?
Acupuncture comes from Traditional Chinese Medicine (TCM) and follows a different framework from physiotherapy-based needling.
Points are selected as part of an individual assessment and are not necessarily limited to where you feel your symptoms.
For example, someone experiencing shoulder tension may have acupuncture points selected on their hand or leg. That can seem surprising if you are used to thinking about pain primarily through muscles and movement, but point selection follows a different framework.
The two approaches use a similar tool - a fine needle - but the reasoning behind how and where the needles are used is different.
Research also supports acupuncture for several chronic pain conditions. The largest analysis of acupuncture for chronic pain, an individual patient data meta-analysis of around 20,000 people published in The Journal of Pain, found acupuncture to be more effective than no treatment, and modestly more effective than sham acupuncture, for chronic musculoskeletal pain, headache, and osteoarthritis.
The effects held up over time, although the benefit one year after treatment was smaller. The difference between acupuncture and sham acupuncture was also small, suggesting that treatment context and other non-specific factors may contribute to the overall effect.
The sensation is usually gentler than dry needling. You may feel a dull heaviness or mild ache at that point, and the needles are often left in place while you rest. HealthLink BC, the province's health information service, notes that acupuncture is safe when done by a registered provider using sterile, single-use needles.
Acupuncturists in British Columbia are regulated by the College of Complementary Health Professionals of BC, which sets the standard of training and registration behind the title.
Where does cupping fit in?
Cupping uses cups placed on the skin to create suction, lifting the tissue rather than pressing into it.
It is generally applied over an area that feels tight, heavy or restricted and is often used alongside other treatments rather than on its own. At Therapy X, cupping sits within our acupuncture service as part of a treatment plan rather than as a standalone appointment.
A 2024 systematic review and meta-analysis published in Complementary Therapies in Medicine found that cupping improved pain and disability in people with low back pain. The authors also noted considerable variation between studies and that the outcomes measured were self-reported.
In other words, it is reasonable to say that cupping helps some people with tight, painful areas. It is not reasonable to promise that it will work for everyone.
One practical thing to know before booking: cupping commonly leaves circular marks on the skin. These typically fade over several days. If you have an event coming up or simply don't want visible marks, mention this before your appointment.
So, which one should you book?
These are all techniques, not diagnoses or treatments in isolation. What determines whether one is appropriate for you is the assessment that comes first.
As a general starting point:
Consider physiotherapy if...
Your symptoms are connected to a specific movement, injury, activity, or physical load. Dry needling or IMS may then be used as part of your broader physiotherapy treatment plan.
Consider acupuncture if...
Your symptoms feel more diffuse or persistent, for example, ongoing tension or pain that hasn't settled, or physical symptoms that seem to be affected by stress or disrupted sleep.
Cupping can also be used within an acupuncture treatment plan.
Not sure?
You don't have to figure it out yourself before you book.
Book whichever assessment is easiest for you to access and tell your practitioner what you're experiencing. Working out the right starting point is part of the first visit. Your practitioner will direct you accordingly based on their findings after a thorough assessment during your first visit
Frequently Asked Questions
Is dry needling the same as acupuncture?
No. They use a similar type of needle, but that's where much of the overlap ends. They involve different training, different frameworks, and different treatment approaches.
Is IMS the same as dry needling?
IMS is a type of dry needling. The distinction is primarily in the clinical reasoning behind how the needling is applied. IMS focuses on the relationship between nerve irritation and persistent muscle tightness.
Is cupping the same as acupuncture?
No. Acupuncture uses fine needles at points selected during an assessment. Cupping uses suction and no needles.
Both sit within our acupuncture service and may be used together, which is why they can be easy to confuse.
Does dry needling hurt?
Dry needling and IMS can produce a brief twitch or cramping sensation. IMS can sometimes feel more intense than standard dry needling. Some soreness for a day or two can also occur. Many people report dry needling to be very tolerable.
Acupuncture is usually gentler and may feel like a dull ache or heaviness at that point.
Most importantly, tell your practitioner during the session if something feels more uncomfortable than you want to tolerate. The technique can often be adjusted.
References
- Sánchez-Infante, J., Navarro-Santana, M. J., Bravo-Sánchez, A., Jiménez-Díaz, F., & Abián-Vicén, J. (2021). Is dry needling applied by physical therapists effective for pain in musculoskeletal conditions? A systematic review and meta-analysis. Physical Therapy, 101(3), pzab070. Link
- Kalichman, L., & Vulfsons, S. (2010). Dry needling in the management of musculoskeletal pain. Journal of the American Board of Family Medicine, 23(5), 640–646. Link
- Vickers, A. J., Vertosick, E. A., Lewith, G., MacPherson, H., Foster, N. E., Sherman, K. J., Irnich, D., Witt, C. M., & Linde, K. (2018). Acupuncture for chronic pain: Update of an individual patient data meta-analysis. The Journal of Pain, 19(5), 455–474. Link
- Zhang, Z., Pasapula, M., Wang, Z., Edwards, K., & Norrish, A. (2024). The effectiveness of cupping therapy on low back pain: A systematic review and meta-analysis of randomized control trials. Complementary Therapies in Medicine, 80, 103013. Link
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Therapy X is a multidisciplinary movement therapy clinic in South Granville, Vancouver.
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