Acupuncture for knee pain is one that is very well-known amongst patients, researchers, and acupuncturists alike. It is one of the top issues people visit a physician for according to the American Academy of Orthopedic Surgeons, 11 million people each year for knee or knee-related problems to be exact. It is a common complaint that affects people of all ages, and many, especially those who are older, are looking for less harmful alternatives to treating their pain rather than turning to prescription painkillers.
Knee pain can originate from a variety of causes and can impact patients both old and young.
Some of the signs & symptoms of knee pain include:
- Redness & warmth to the touch
- Popping or crunching noises at the knee joint
- Inability to fully extend the knee
- Weakness or instability
- Swelling & stiffness
These symptoms can arise from any number of things. They may be the result of an injury such as a ruptured ligament or torn cartilage, or it could be from medical conditions like arthritis, gout, and infections. Another possibility is simply overuse or improper use which is common amongst athletes and/or runners (we’ve all heard of “runner’s knee” right?), and mechanical problems such as natural deterioration that comes with aging.
Common Knee Injuries:
- ACL tear – a tear of the anterior cruciate ligament (ACL) which is one of four ligaments that connect the thigh bone to the shinbone. This is a very common injury amongst athletes such as basketball players, soccer players, or any other sport that requires a sudden change of direction.
- Torn Meniscus – this acts as the shock absorber between the shin and thigh bone, and the tear happens when one suddenly twists their knee while bearing weight on it.
- Knee bursitis – an injury caused by inflammation in the bursae which are small sacs of fluid that cushion the knee joint so that tendons and ligaments glide smoothly over the joint.
- Fracture – when bones of the knee can be broken during a motor vehicle accident or falls. There are some that have weakened knee bones from osteoporosis, and can even fracture the bones in the knee just by stepping incorrectly.
- Patellar tendinitis – inflammation and irritation of the patellar tendon which connects the quadriceps to the shinbone.
- Dislocation – often the result of trauma
Mechanical Problems of the Knee:
- Dislocated kneecap – occurs when the patella slips out of place, most commonly to the outside of the knee. There are some cases where the dislocation can even be seen.
- Foot or hip pain – if your patient has hip or foot pain this can change the way they are walking to feel less pain in those areas. However, this altered way of walking can place more stress on the knee, therefore potentially causing the knee pain.
- Loose bone/cartilage– sometimes injury or natural degeneration of the bone or cartilage can cause a piece of bone or cartilage to break off and float in the joint space. This can create issues if the loose piece interferes with knee joint movement.
- Iliotibial band syndrome – this happens when the iliotibial band (the tough band of tissue extending from the outside of the hip to the outside of the knee) becomes tight and rubs against the femur. Cyclists and runners are typically susceptible to this.
Knee pain may be experienced as temporary or chronic. Chronic knee pain is long-term pain, swelling, and sensitivity in one or both knees. Temporary knee pain may be caused by an injury or accident, and will often go away after treatment or on its own. However, with chronic knee pain, it rarely goes away without intervention and its most often in reference to another condition/s the patient may have. The symptoms for chronic knee pain are usually constant aches, sharp pain when in use, and burning discomfort.
Physical conditions that can cause chronic knee pain:
- Osteoarthritis – joint degeneration & deterioration which causes pain and inflammation
- Chondromalacia patella – cartilage that is damaged under the kneecap
- Gout – a buildup of uric acid which causes arthritis
- Pseudogout – caused by calcium-containing crystals which develop in the joint fluid, and is often mistaken for gout. Knees are the most commonly affected by this condition.
- Baker’s cyst – a buildup of synovial fluid behind the knee
- Rheumatoid Arthritis – an autoimmune inflammatory disorder causing painful swelling which can lead to joint deformity & bone erosion.
- Bone tumors – osteosarcoma (bone cancer) which usually occurs in the knee
- Septic arthritis – causes swelling, pain, & redness, and often occurs with a fever. Usually there is no trauma before pain onset.
In addition to these conditions there are things that can make chronic knee pain worse such as overuse, infection, bad posture or form when doing physical activity, improper stretching, and sprains & strains. Additionally, there are a number of factors that increase a patient’s risk for chronic knee pain, and should be discussed with them during treatment. Things like excess weight, certain sports or occupations, lack of muscle flexibility & strength, or previous injuries can all put someone at a higher risk of developing knee pain.
Typical western treatments usually include keeping the pain at bay with over-the-counter anti-inflammatory drugs like ibuprofen or prescription painkillers. If the knee pain is chronic, and other treatments have not worked or the knee pain is prohibiting a patient from doing daily tasks, a western physician may also recommend surgery. Knee pain from osteoarthritis, will likely be permanent unless surgery or another extensive treatment is done. All in all, the goal of treating knee pain involves managing pain, preventing future flare-ups, and working to reduce irritation in the knee. Acupuncture, as we know, can do all of these things and more.
Acupuncture & Knee Pain
The pain relieving and anti-inflammatory effects of acupuncture for knee pain have not gone unnoticed by the medical community and patients alike. It can relieve day to day knee pain, ease the discomfort patients feel while waiting for surgery, and many times may be considered an alternative to the surgery itself. Acupuncture decreases the pain & stiffness levels, and at the same time increases muscle strength and flexion in the knee. It is no secret why the majority of patients come in for pain related issues…it works!
Does acupuncture work for knee pain?
- Acupuncture increases the circulation to the knee, thereby helping the knee to heal. When the blood flow increases, the toxins & fluids that are built up from the inflammation of the knee are able to be removed more quickly. This will help the swelling to decrease more rapidly which will reduce the painful friction from the swollen tissues rubbing together. Additionally, the improved circulation supplies the painful knee with an increased amount of nutrient-rich blood speeding up tissue repair.
- It relaxes painful trigger points and knots that develop in the muscles of the knee. Acupuncture works by deactivating these trigger points, and unknotting the sore areas to allow for the relaxation of unnatural tension which develop in the muscle fibers as a result of a knee injury.
- Lastly, as we know, acupuncture works with the body’s own healing mechanism, and natural pain relieving processes to resolve the underlying issue. The release of endorphins and serotonin during acupuncture treatment is not one to take lightly as these are the keys to the pain relief success of acupuncture.
A well placed needle sets off a series of events which encourage the flow of chemical & electrical information through the body therefore moderating the perception of pain. Acupuncture has also been shown to inhibit proteins that increase inflammation, and increases production of cortisol which controls it.
Acupuncture Points & Herbs for Knee Pain
As we know, there are many possible treatment plans including acupuncture points and herbs in regards to knee pain. However, there are some points that are definitely ones to revisit when taking a look at your particular patient circumstances surrounding their knee pain.
Acupuncture points for knee pain:
- SP9 – Yin Mound Spring – Yinlinquan – located on the medial aspect of the lower leg in the depression of the lower border of the medial condyle of the tibia. Used for knee pain.
- ST3 – Great Bone-Hole – Juliao – located directly below the pupil of the eye in a depression at the level of the border of the ala nasi. Used specifically for swelling of the knee.
- ST31 – Thigh Joint – Biguan – located on the anterior aspect of the thigh, on the line connecting the anterior superior iliac spine and the lower lateral border of the patella, and level with the lower border of the symphysis pubis in a depression with the thigh flexed lateral to the sartorius muscle. Used for knee pain.
- UB24 – Sea of Qi Shu – Qi Hai Shu – located 1.5 cun lateral to GV line level with L3. Used for low back and knee pain.
- UB39 – Bend Yang – Wei Yang – lateral to UB40 on the medial border of the tendon of biceps femoris. This is a local point for knee issues.
Other acupuncture points that are great for knee pain are ST32, ST33, ST34, ST35, ST45, UB40, SP10, and GB34. Additionally, there are some great herbal formulas for aiding knee pain, and there is one in particular that has been used specifically for knee issues that has been successful.
Du Huo Ji Sheng Tang for knee pain:
- This herbal formula disperses wind dampness, scatters cold, stops Bi pain, tonifies the Kidneys and Liver, tonifies Qi, and nourishes the blood.
- Used in a study of 68 patients with knee osteoarthritis which showed reduced pain and stiffness & improved physical functioning. It was also used in another study of a rabbit with osteoarthritis and the use of this herb in cartilage degradation. This study concluded that Du Huo Ji Sheng Tang showed significant therapeutic effects on osteoarthritis in rabbits.
- It has also been shown to help other pain issues a great deal such as low back pain, shown in a study done in 2018 on Du Huo Ji Sheng Tang inhibiting SDF-1 induced inflammation & matrix degradation.
- Contraindicated for Bi syndrome marked by strong Excess or Damp-Heat as well as by Liver and Kidney Yin Deficiencies. It must also be used with caution if the patient is pregnant.
No matter which points are chosen for the treatment plan of your patient, it is important to always do a full analysis, and consultation before prescribing any herbs so as not to interfere with other medicines they may be already taking.
Acupuncture Research for Knee Pain
Acupuncture Modulates Cortical Thickness & Functional Connectivity in Knee Osteoarthritis Patients:
- This study investigated the cortical thickness and functional connectivity across longitudinal acupuncture treatments in patients with knee osteoarthritis.
- It involved 30 patients over a period of 4 weeks consisting of 6 treatments, and researchers collected fMRI scans before their first, third, and sixth treatments.
- Results show that “acupuncture may achieve its therapeutic effect of knee OA pain by preventing cortical thinning and decreases in functional connectivity in major pain related areas, therefore modulating pain in the descending pain modulatory pathway.”
The Effects of Acupuncture on Chronic Knee Pain Due to Osteoarthritis:
- This meta-analysis was performed with the goal of evaluating the temporal effects of acupuncture on chronic knee pain due to knee osteoarthritis.
- Several databases were searched for studies published through March 2015, and the researchers ended up with 10 randomized controlled trials which met the criteria. All acupuncture groups showed superior improvement in pain and physical function.
- The meta-analysis concluded that these studies demonstrated that acupuncture can improve both short and long-term physical function, but mostly short-term pain relief in patients with chronic knee pain from osteoarthritis.
The Effectiveness & Safety of Acupuncture for Knee Osteoarthritis:
- The goal of this overview conducted in 2019 was to provide more reliable evidence-based medical references for the effectiveness & safety of acupuncture.
- Several databases and digital journals were searched, and a total of 12 systematic reviews were used that met the criteria. All of them were published in the last 12 years from 2006-2017.
- This review concluded that according to the high quality evidence, acupuncture may have some advantages in treating knee osteoarthritis.
Acupuncture & Knee Pain
The knee is the largest joint in the body, made up of the lower end of the femur rotating on the upper end of the tibia, and the kneecap. Not to mention it contains several muscles which straighten & bend the leg, tendons attaching the muscles to the bones, ligaments to help control the motion of the bones, and cartilage for shock absorption. Obviously, because of its complex structure and size, it is one of the most frequently injured, and therefore treated joints. Joint pain increases with age, and among the 63.1 million people reporting chronic joint pain, knee pain was the most frequently cited with an astounding 40 million people.
The research studies out there for acupuncture for knee pain are plenty, and ongoing. While regular acupuncture treatments may be beneficial for individuals with knee pain, it’s important to emphasize continuing good habits outside the office. Losing weight, low impact exercises, sticking to paved surfaces as opposed to rough roads or walkways, good shoe support, and a healthful diet are all ways to help reduce pain and inflammation. Not all knee pain can be prevented, but acupuncture has been shown to be helpful in treating this condition.
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