Acupuncture Treatment of Knee Pain

Treatment of knee pain with acupuncture modalities commonly involves use of acupuncture with electro-stimulation at the injury sites. Electro-acupuncture has been shown to reduce pain, muscle tension, swelling, and inflammation, increase soft tissue mobility and joint range-of-motion, and normalize local blood flow and lymphatic drainage.
Gua sha friction massage can be used to break up adhesions and stretch and mobilize the iliotibial band, quadriceps and hamstring muscles.
Knee exercises to strengthen and stretch the quadriceps, gluteal muscles, and hamstrings can help to treat knee pain and prevent re-injury.
For pain around the knee-cap, or at the iliotibial band where it inserts to the lateral knee, sports taping techniques may also be employed to restore normal tracking of the patella.

In the terminology of Traditional Chinese Medicine, the treatment principles of acupuncture for knee pain are to move qi and blood, drain dampness, dispel bi (painful obstruction syndrome), and promote the healing of injured tissues.

Evidence Basis for Acupuncture for Knee Pain

Acupuncture appears to be effective in relieving pain and improving function for osteoarthritis, particularly in the area of knee pain. In fact, knee osteoarthritis is among the conditions for which the most research has been performed regarding acupuncture efficacy. For example, according the National Center for Complementary and Alternative Health Care:

[A} landmark study published in the Annals of Internal Medicine, funded in part by NCCAM and the National Institute of Arthritis and Musculoskeletal and Skin Diseases, was conducted across three sites and is the longest and largest clinical trial of acupuncture to date.

The researchers enrolled 570 patients with osteoarthritis of the knee, aged 50 and older, to receive one of three treatments: acupuncture, simulated acupuncture (procedures that mimic acupuncture, sometimes also referred to as "placebo" or "sham"), or participation in a control group. The control group followed the Arthritis Foundation's self-help course for managing their condition over 12 weeks. Participants in the actual and simulated acupuncture groups received 23 treatment sessions over 26 weeks. All study participants continued to receive standard medical care from their primary physicians, including anti-inflammatory medications and opioid pain relievers.

At the start of the study, participants' pain and knee function were assessed using standard arthritis research survey instruments and measurement tools; their progress was assessed at 4, 8, 14, and 26 weeks. By week 8, participants receiving actual acupuncture showed a significant increase in function and by week 14 a significant decrease in pain, compared with the simulated and control groups. These results sustained through week 26. Overall, participants in the acupuncture group had a 40 percent decrease in pain and a nearly 40 percent improvement in function compared to their assessments at the start of the study.

Pain outside the knee joint, such as patello-femoral tendonitis or iliotibial band pain, has not been studied as much with regard to acupuncture outcomes. Nonetheless, two clinical trials of acupuncture for anterior knee pain have found evidence of efficacy:

http://www.ncbi.nlm.nih.gov/pubmed/10630346

http://www.ncbi.nlm.nih.gov/pubmed/12392239

My Clinical Experience With Acupuncture For Knee Pain

My experience comes from using acupuncture modalities to treat over 150 cases of knee pain.

Pain in the muscles and tendons that cross the knee joint, as well as osteoarthritis of the knee, generally respond favorably to acupuncture modalities, with symptom relief often evident from the very first treatment, and stable improvements in function and pain evident with continued treatment.
Injuries to the medial or collateral ligaments may also respond well to acupuncture except in the case of full-thickness tears, which I generally refer to orthopedic physicians for further evaluation (while continuing to manage pain with acupuncture).
Injuries to the cruciate ligaments inside the joint (ACL, PCL) or menisci can respond well if the trauma is mild or recent, but for old or full-thickness tears I generally refer to orthopedic physicians for further evaluation (while continuing to manage pain with acupuncture).

The relative safety of acupuncture for knee pain makes it worthy of trying in almost all cases.

Knee Pain Causes And Anatomy

Most knee pain originates from either inside the knee joint, or from the muscles and tendons that cross the joint outside its capsule. (Exceptions include pain that is referred from elsewhere, such as the hip joint or lumbar spine).

Knee pain inside the joint generally arises from injury to the ligaments and/or cartilage that forms the joint. The most common knee joint injuries occur at the medial (inside) aspect of the joint, and include some combination of the medial collateral, anterior cruciate, or coronary ligaments, and the medial meniscus. Less common are injuries to the lateral (outside) collateral ligament and/or meniscus, or other cartilaginous structures in the joint.

Knee joint injuries can occur as a result of abrupt trauma, or, as we age, from degeneration of the knee menisci (shock-absorbing, motion-controlling discs sandwiched between the femur (thigh bone) and tibia (calf bone)), and/or the cartilage surfaces at the ends of the femur and tibia.

Knee pain can also arise from injuries to the muscles and tendons that cross the joint at any of is aspects, but most commonly, at the lateral (outside) aspect and at the front of the joint, around the kneecap (patella). Knee muscle/tendon injuries are most commonly from repetitive strain which can occur from a wide variety of causes, including biomechanical faults from other hip/leg/foot problems (including injuries inside the knee joint), excessive or inappropriate training or use, poor footwear choices, etc. The injured structures can include the patellar or quadriceps tendons, the ilio-tibial (IT) band, the pes anserine tendon at the medial knee, and the hamstring tendons in the rear of the knee.

Knee Pain Acupuncture Diagnosis

Acupuncture diagnosis of knee pain involves determining whether the onset of the pain is acute or chronic and whether from trauma, degeneration, or repetitive strain. Identifying the location of the pain and the structures inside and/or outside the joint that are injured or causing the pain precisely as possible is important to treatment success.
Pain at the medial knee frequently involves the three leg yin acupuncture meridians (Kidney, Liver, and Spleen/pancreas) as well as the Stomach tendino-muscular meridian which wraps around both the medial and lateral aspects of the knee-cap.
Pain at the lateral knee typically involves the Stomach and Gallbladder meridians. Pain at the Posterior knee typically involves the Urinary Bladder and/or Kidney meridians.
The primary pathomechanism for acute pain and injuries is stagnation of qi and blood in the affected meridians. With time, repeated injury, or inadequate treatment, the condition can progress to a "bi" (wind-damp painful obstruction) syndrome (roughly equivalent to the Western medical concept of degenerative joint disease or osteoarthrosis).

Knee Pain: Mind-Body Relationships

The relationship between the mind and the knee is less immediate and direct than with some other body regions (the neck, for example often responds immediately and directly to stress, anger and other negative emotions).

As with any chronic or severely disabling injury, people may experience depression, frustration, sadness or worry about a knee injury. Chronic stress causes excess secretion of the hormone cortisol, which can break down muscle and connective tissue, adversely affecting the knee. Chronic feelings of fatigue, depression or being overwhelmed can lead to chronically slouching posture and reduced physical activity which over time have adverse affects on knee health.

In Traditional Chinese Medicine (TCM), weak painful knees can be a symptom of underlying deficiency of the Kidney/Adrenal complex. Fear, despair, pessimism and apathetic depression are negative emotions often associated with Kidney/Adrenal weakness in TCM. In my own experience, another common emotional disharmony of anger and impatience combined with worry and low self-esteem ("Wood/Earth" disharmony, or Gallbladder qi stagnation with Spleen/Pancreas deficiency in TCM) can also manifest as an imbalance between a weak, flaccid medial quadriceps and a painfully tight, hypertonic lateral quadriceps and IT band.

Knee Pain Self-Care

Pain from muscles and tendons outside the knee joint can respond favorably to therapeutic exercises, stretching and self-massage techniques.
Taiji (tai chi) may benefit knee pain and is generally safe for the elderly.
Local application of cold (20 minutes on, 2 hours off) can also help with acute swelling and pain, but is less often useful for chronic pain.
Avoidance of painful activities is usually important with knee injuries.

Any acute knee injury with severe pain or swelling, instability, buckling, or locking, should be examined by a physician on a urgent basis.

Risks Of Delayed Or Non-Treatment Of Knee Pain

Untreated or under-treated knee sprain/strains can involve or lead to complete tears of knee ligaments and/or menisci. Pain and disability may become chronic and hasten the onset of degenerative joint disease (knee osteoarthritis).
Untreated or under-treated pain in the muscles and tendons that cross the knee joint can lead to chronic pain and disability, and lead to osteoarthritis of the undersurface of the kneecap.
Knee injuries sufficient to limit walking, running, and other sports and recreational activities raises the risk of weight gain and associated cardiovascular, metabolic (diabetic) and organ conditions.