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Acupuncture helps to treat knee pain

I am no stranger to the treatment of knee pain.  I often see patients in the clinic for treatment of knee pain.  From a Chinese medicine perspective, there are a number of causes, so as always an accurate diagnosis is key to getting pain relief.  In addition to acupuncture, I often use tuina massage as part of my treatments because this kind of massage can help reset muscle imbalances to support the work of the acupuncture. In some cases, herbal medicine is beneficial, too.

What are different types of knee pain do you treat with acupuncture?

Knee ligament injuries
The knee contains several pairs of ligaments that are classified by their location, either intra-capsular or extra-capsular. These ligaments help stabilize the knee. The major intra-capsular ligaments are the cruciate ligaments (anterior cruciate ligament (ACL) and the posterior cruciate ligament (PCL)). The major extra-capsular ligaments are the collateral ligaments (medial collateral ligament (MCL) and lateral collateral ligament (LCL)). Tears or sprains of the ACL, PCL, LCL, and/or MCL are common in athletes that play sports that involve sudden changes in direction, such as soccer or basketball.

Knee arthritis
There are two main types of knee arthritis. Osteoarthritis is caused when the cartilage that prevents the ends of bones from rubbing together degrades over time. Rheumatoid arthritis is caused by a chronic immune system disease in which the immune system attacks the body’s own tissues, causing joint swelling and bone deformation. The causes of knee arthritis are age, injury, obesity, inactivity and overuse. The symptoms of knee arthritis are pain, tenderness, stiffness, loss of flexibility, a grating sound in the joint and possibly bone spurs.

Knee bursitis
Fluid-containing sacs, called bursae, cushion the joint. The bursa absorbs the shock of impact from walking, running and the like. Bursitis is caused when these sacs become inflamed. Common causes of bursitis include repetitive motion (athletics or manual labor) and prolonged kneeling. Some of the symptoms of knee bursitis pain include joint stiffness, pain upon movement or pressure, swelling and redness.

Patellofemoral pain syndrome
Patellofemoral pain syndrome is the result of the back of the knee cap (patella) rubbing on the thigh bone (femur). Patellofemoral pain syndrome is statistically more likely to occur in women than men and younger people rather than older ones. It is very common among athletes, too. Eventually, cartilage under the kneecap breaks down (chondramalacia), making the knee pain worse. The cause of patellofemoral syndrome is not exactly known, but we can say that it is the result of uneven strain on the knee cap during moving or resting. Some of the causes of this strain are unbalanced muscle pulling, misalignment of the joint surfaces, genu valgus (i.e., “knock knees”), and quadriceps contractures (tightening of the thigh muscles). The symptoms of patellofemoral syndrome include pain behind the knee cap (retropatellar pain), and is worse during bending the knee, contracting the thigh muscles, rapidly going from rest to movement, and after keeping the knee bent for long periods of time (AKA “movie-goer’s knee”). Pain in the knee typically appears after 30 minutes of activity or up to a few hours after stopping activity.

Chondromalacia patellae
Chondromalacia patellae (CMP) is characterized by pain at the front and inner side of the knee. CMP often affects the adolescents who are otherwise healthy. In fact, CMP is most common in athletes. Chondromalacia patellae is caused by the irritation of the cartilage of the knee cap that allows for smooth knee bending. Chondromalacia patellae is an extension of patellofemoral pain syndrome. The causes are the same as above.

Jumper’s knee (patellar tendinitis)
The patellar tendon connects the knee cap to the shin bone. When this tendon becomes inflamed and irritated, pain can result. The term jumper’s knee implies a functional stress overload due to jumping, and so I often see this condition in basketball and volleyball players. Patients report aching pain in the front of the knee. Onset of pain is typically slow, and rarely related to a specific injury or trauma to the knee. Jumper’s knee can progress to tendon tear if left untreated.

Osgood-Schlatter disease
Osgood-Schlatter disease occurs in growing children, especially those participating in sports. It affects the growth plate at the end of the leg bone. The cause of Osgood-Schlatter disease is stress on the tendon connected to the lower leg bone (tibia), which pulls on the soft growth plate. This pulling causes inflammation and pain. The symptoms of Osgood-Schlatter disease include pain below the kneecap, tightness of the thigh muscles, and pain worse with activity and better with rest.

Iliotibial band syndrome (ITBS)
The iliotibial band (ITB) extends from the hip (pelvic bone) to the larger bone of the lower leg (tibia). ITBS is the most common cause of lateral knee pain in athletes (pain on the outside of the knee). Iliotibial band syndrome is caused by inflammation of the fibers surrounding the ITB or the ITB itself. Iliotibial band syndrome usually affects athletes involved in sports that require continuous running or repetitive knee flexion and extension, like long distance running and cycling. ITBS presents as lateral knee pain worse with activities, like running, and pain going down stairs or walking/running downhill. Pain at rest is a sign of severe tendinitis, bruising of the cartilage or meniscus tear.

How is knee pain diagnosed by my doctor?

Your doctor will diagnose knee pain by:

  • Taking a medical history

  • Performing a physical exam, concentrating on knee and its function

  • X-ray, MRI, ultrasound, or computerized tomography (CT) imaging

How is knee pain treated by my doctor?

Your doctor may prescribe the following treatments for knee pain include:

  • Self-care by icing and resting

  • Pain medication

  • Anti-inflammatory drugs

  • Physical therapy

  • Orthotics, braces, or taping

  • Steroid injections

  • Surgery and/or joint replacement

How does an acupuncturist diagnose knee pain?

As an acupuncturist, I was trained to evaluate pain conditions, perform physical exams and use orthopedic tests according the Western medical model. These evaluations are an important part of my practice, but when someone comes into my clinic with pain somewhere, my first step is to evaluate that pain from the perspective of an acupuncturist.

Acupuncture theory says that the meridians of the body must be unobstructed. When there is obstruction there is pain. Obstruction can be caused by injury, emotional stress and other factors. So, I evaluate each patient based on which meridian and part of the body is effected. I also do what we call a constitutional diagnosis, in which I take into account the whole body, or overall, wellness of the patient.

By putting the acupuncture diagnosis together with the Western medical diagnosis that your doctor might do, I am able to create a treatment plan.

How does acupuncture help to treat knee pain?

I address knee pain with acupuncture and tuina massage for the most part. Acupuncture and massage can help correct the obstructions and imbalances I mentioned above. When using acupuncture to treat knee pain, I use a combination of local and distal points to remove obstruction, relax muscles and improve circulation in the affected area. In other words, I apply acupuncture near or on the knee and also in other places on the leg along the affected meridians. I will often use tuina massage, moxibustion and possibly cupping to treat the pain. In some instances, I will use herbal medicine, but it is entirely dependent on the acupuncture theory diagnosis of the pain and the patient’s interest in herbal medicine.