When discussing acupuncture for chronic knee pain we are referring, for the most part, to OA of the knee. Clinically there may be other forms of chronic knee pain such as that due to meniscal injury, patellofemoral maltracking/ chondromalacia patella which may also respond well to acupuncture when used as an adjunct.
What's the evidence?
A systematic review by White et al, 2007 concluded the following:
- Acupuncture at traditional points in the vicinity of the knee (verum acupuncture) is superior to minimal, off point needling which avoided needling points which share the same segmental innervation as the knee (sham acupuncture)
- Acupunctures benefits for pain and function last for more than 6 months
- In view of acupuncture’s advantages, such as safety, and no need for a daily dose, it should be considered as a genuine alternative to NSAID’s
A more recent systematic review by Manheimer et al, 2010, also confirms efficacy of verum acupuntcure over sham and that providing Acupuncture is more effective with clincially relevant effects over leaving the patient on a waiting list i.e doing nothing.
Start with a segmental approach (needling muscle tissue which shares the same segmental innervation as the knee joint i.e L3-L5) using two to four local points eg: SP9, SP10, ST36 and ST33.
Also include an extrasegmental point (outside the segmental innervations of the knee) eg LR3. This will enhance the descending pain inhibitory effect.
Increase the dose by using more local segmental points and extrasegmental points – ideally choose traditional points eg GB34, ST37 that are tender and situated in the area of referred pain.
If you find MTrP’s which in muscles which act on/ or refer to the knee joint, treat them - for example upper rectus femoris
The evidence suggests:
- At least six treatments
- At least once per week
- At least four points needled
- For at least 10 minutes
- Either manual stimulation to elicit de qi or EA of intensity to produce more than a minimal sensation
- Do not insert needles into the joint space due to infection risk
- Combine with manual/ exercise therapy as appropriate for best clinical results
- Do not expect complete relief in patients with serious joint destruction, TKR may be required in advanced cases
As a standalone treatment I find Electroacupuncture (EA) very effective for mild to moderate OA knees, more so when combined with graded manual therapy, exercise, self management and lifestyle advice.
Please let me know via @SimonAcuPT how you get on should you decide to include Acupuncture in your approach to managing this common condition.