Acupuncture for Knee Pain
Knee pain has become a common musculoskeletal ailment world-wide.
Symptoms include dull or sharp pain, stiffness, limitation of activity, and eventually progresses into immobility/disability.
Knee pain can be an acute or chronic issue caused by injury, aging, or repeated stress to the joint. It can occur due to a sprain, which is the over-stretching or tearing of tissue fibers near the knee.
Pain often occurs when the knee is inflamed, such as tendonitis or bursitis, or after an injury such as an anterior cruciate ligament (ACL) tear. Pain can manifest above, below, on the lateral or on the medial side of the knee. It can also occur behind the knee.
Chronic knee pain is often diagnosed as arthritis, whether it be osteoarthritis, rheumatoid arthritis, or gout.
Gout is a condition considered partly genetic and partly lifestyle and diet. Uric acid crystals form in the joints, usually first presenting in the big toe.
Rheumatoid arthritis is considered an auto-immune disfunction where the body’s immune system attacks the joints, causing inflammation and pain.
Osteoarthritis is defined as the degradation of cartilage and synovial fluid in the joint space, especially of the knees. This generally affects middle-aged adults and women more than men. Western treatment includes exercise, pain relieving drugs and/or injections, or surgery.
TCM and Knee Pain
The Chinese medical diagnosis for knee pain is generally Bi syndrome (although other patterns may present as well).
Bi, meaning obstruction or blockage, indicates obstruction of Qi and Blood in the channels. This syndrome leads to symptoms such as pain, numbness, swelling, and impairment of movement.
Wind-Bi will be acute with abrupt onset, with pain moves around and has different qualities at different times of day (sharp, dull, numb, etc.).
Damp-Bi causing knee pain will present as localized pain, feeling of heaviness, numbness, and swelling, and the pain will appear slowly, gradually, and chronically. Symptoms are worse with foggy, humid, wet, overcast weather, wet environments.
Cold-Bi syndrome will present as slow movement with heavy, sharp, stabbing, and fixed pain and stiffness, with pain improved by warmth and movement.
Heat-Bi is characterized by soreness, inflammation causing pain and redness, a feeling of heat, and limited function. Heat-Bi may have an explosive effect in the superficial part of the knee.
With an understanding of the different patterns that may contribute to knee pain, a Chinese medical practitioner will know how to best treat their patient. The practitioner must be able to assess their patient physically, whether with range-of-motion tests or gently palpating tender points. With physical tests, the practitioner will determine which tissues and local areas need treatment and develop a treatment plan.
Commonly used acupuncture points for knee pain include:
Liangqiu ST-34
Dubi ST-35
Zusanli ST-36
Xiyan EX-LE5
Yinlingquan SP-9
Xuehai SP-10
Ququan LIV-8
Xiyangguan GB-33
Weizhong UB-40
Heding EX-LE2
Treatment plans for knee pain include dispelling Bi (Wind-Damp-Cold), moving Qi and Blood, unblock the channels to alleviate pain, and possibly draining Dampness. Needle moxibustion and moving moxibustion may be applied to drive out Cold.
As far as point combinations go, in Thousand Ducat Formulas, it lists Liangqiu, Ququan and Xiyangguan for contracted sinews with difficulty flexing and extending the knee and the inability to walk. In Manual of Acupuncture, it lists Liangqiu, Xuehai, Xiyan, Yanglingquan and Yinlingquan for stiffness, soreness and pain of the knee (Deadman 2016).
Clinical Acupuncture Studies for Knee Pain
Acupuncture has proved beneficial in treating knee pain in clinical studies in both the United States and China. Acupuncture and electro-stimulation are being studying for their effects on the brain and the central nervous system. Findings suggest that acupuncture may work with pain modulation pathways and the posterior medial prefrontal cortex, which has a key role in processing pain. Another study states that electro-acupuncture can relieve pain through desensitizing peripheral nociceptors, decreasing pro-inflammatory cytokines, and increasing the release of opioid neurotransmitters endomorphin and dynorphin (Lin et Al. 2019). Several studies focus on the use of acupuncture and knee pain; one found that acupuncture can help modulate cortical thickness change, which is correlated with pain sensitivity, in patients with knee osteoarthritis (Alshuft et. Al 2016).
In one study, the following five local points were to be used for every treatment session on the affected knee: Dubi ST-35, Neixiyan EX-LE5, Ququan LIV-8, Xiyangguan GB-33 and an ah-shi point. The inserted needles were stimulated for approximately ten seconds to achieve “de qi” sensation. Electro-stimulation was applied at Ququan LIV-8 and Xiyangguan GB-33 along with two other customized points, depending on which channel the pain was occurring in. If the patient had pain in the anterior aspect of the knee, then Yang-Ming Stomach channel points were selected such as Liangqiu ST-34, Zusanli ST-36, Futu ST-32, Fenglong ST-40 and Heding. Fengshi GB-31, Yanglingquan GB-34, Waiqiu GB-36, Xuanzhong GB-39 and Zulinqi GB-41 were used for pain at the lateral aspect of the knee, using points of the Shao-Yang Gallbladder channel (Lin et. Al 2019).
In the same study, Weiyang UB-39, Weizhong UB-40, Chengshan UB-57 and Kunlun UB-60 were used for pain at the back of the knees, indicating pain along the Tai-Yang Urinary Bladder meridian. If the patient has pain in the medial aspect of the knee, then points from the Three Yin meridians were selected such as Xiguan LIV-7, Yinlingquan SP-9, Xuehai SP-10, Yingu KI-10, Gongsun SP-4, Sanyinjiao SP-6, Taichong LIV-3 and Taixi KI-3. Using the WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index), pain levels were measured at weeks 4, 8, and 16. Of a scale from 0-20, pain reduction was noted as clinically improved if points dropped by at least 6 (Lin et. Al 2019).
This study showed that frequency plays a factor in overall improvement of pain and physical function. Patients that came for three or more sessions per week fared a much better outcome, with patients reporting milder and less frequent pain after their third or fourth visits. Patients that had one or no acupuncture treatments a week had no improvement in pain. These studies also suggested that a treatment every day or every other day may be reasonable for chronic knee pain. Unfortunately, these treatments seemed to only provide short term benefits that dissipated over time, with pain returning over four to eight months.
Acupuncture can be enhanced with electrical stimulation to strongly benefit against knee pain. The more often a patient comes in for treatment, the better the results. Using acupuncture for knee pain can provide observable results and most importantly, reduction of pain.
Do you suffer from knee pain on Maui? Have you considered giving acupuncture a try?
Book a free 15-minute consultation to see how I can help.
Mahalo,
Meghane Hernandez - licensed Hawaii acupuncturist and herbalist
References
Alshuft, H. M., Condon, L. A., Dineen, R. A., & Auer, D. P. (2016, September 22). Cerebral cortical thickness in chronic pain due to knee osteoarthritis: The effect of pain duration and pain sensitization. PloS one. Retrieved October 20, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5033394/
Chen, X., Spaeth, R. B., Retzepi, K., Ott, D., & Kong, J. (2014, September 26). Acupuncture modulates cortical thickness and functional connectivity in knee osteoarthritis patients. Nature News. Retrieved October 20, 2022, from https://www.nature.com/articles/srep06482
Deadman, P., Al-Khafaji, M., & Baker, K. (2016). A Manual of Acupuncture. Journal of Chinese Medicine Publications.
Dorr, S. D. / C. (n.d.). Introduction. An Analysis of Chinese Herb Prescriptions for Rheumatoid Arthritis. Retrieved October 20, 2022, from http://www.itmonline.org/arts/arthritis.htm
Korostyshevskiy, V. (2020, October 1). Possible improvements of acupuncture for knee-pain treatment outcomes through local point palpation. Medical acupuncture. Retrieved October 21, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7583340/
Lin, L.-L., Tu, J.-F., Shao, J.-K., Zou, X., Wang, T.-Q., Wang, L.-Q., Yang, J.-W., Sun, N., & Liu, C.-Z. (2019, July 11). Acupuncture of different treatment frequency in knee osteoarthritis: A protocol for a pilot randomized clinical trial - trials. BioMed Central. Retrieved October 21, 2022, from https://trialsjournal.biomedcentral.com/articles/10.1186/s13063-019-3528-8
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Tongjumchew. (2021, April 14). Treating knee pain with TCM - Tong Jum Chew. TONG JUM CHEW Pte. Ltd. Retrieved October 29, 2022, from https://tongjumchew.com/treat-knee-pain-with-tcm/
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