If you ask a friend or family member if they have any history of pain, there is a good chance that they will say they experience or have experienced knee pain. Osteoarthritis of the knee is one of the world’s most common joint conditions. For those of us who do not want to undergo surgery or regularly take pharmaceuticals, acupuncture is an effective (and well-researched) treatment option.
Knee osteoarthritis is one of the world’s most common diseases that affect the joints. It is estimated that one-third of the world’s population has signs of osteoarthritis, with knee osteoarthritis being the most common type. According to Western Medicine, knee osteoarthritis can have various etiological causes, including damage done to the hyaline joint cartilage resulting from trauma, congenital conditions/malformation, malposition (varus or valgus deformity), postoperative complications, metabolic conditions (such as Rickets), endocrine disorders, and aseptic osteonecrosis. These can all result in the eventual breakdown of the knee cartilage, leading to pain and additional physical complications of the knee or related areas. Lifestyle factors or conditions such as obesity and old age have been studied and seen to affect the onset of knee osteoarthritis.
Chinese Medicine often addresses knee osteoarthritis as Bi, or Painful Obstruction Syndrome. This understanding suggests the idea that there is some sort of blockage in the local area of pain; this blockage can consist of substances or environmental factors such as wind, cold, and heat. There can also be an argument that qi or blood stagnation may be causing the pain. With this understanding, we can begin to design an acupuncture plan for knee pain and osteoarthritis treatment.
Western Medicine would note the pathophysiology mechanism of the development of knee OA as a breakdown of the cartilaginous matrix of the knee. In health, there is an equilibrium between the continuous formation and breakdown of this matrix, but in the case of OA, there is only the breakdown. Michael et al. (2010) note that this equilibrium is maintained by anabolic influences (such as insulin-like growth factor I and II) and catabolic influences (such as tumor necrosis factor alpha), and that to a limited extent, these mechanisms can compensate for or eliminate the harm being done that is causing OA by moderating and mediating metabolic activity; mechanical and enzymatic factors work to impact cell functions and matrix damage. When these metabolic activities cannot be sufficiently modified to support the body, the breakdown of the matrix begins to occur. This will degeneration begins the development of OA. Michael et al. (2010) note that the initial cause of cartilage degeneration is not yet fully understood.
Chinese Medicine, as aforementioned, addresses knee pain OA as Bi Syndrome. Bi Syndrome is an exterior condition, as it affects the sinews and channels, as opposed to the Zangfu; it often has a slow onset and explains how knee OA can get worse over time. Exterior conditions can manifest from an invasion of the exterior by a pathogenic factor; these pathogenic factors include cold, heat, wind, and dampness, and each has corresponding symptoms. This is also considered a full condition. These pathogens block the smooth flow of qi and blood, among other substances, in the channels, and this obstruction is what results in pain. Understanding these mechanisms will help to inform our acupuncture for knee pain and osteoarthritis treatment plan.
Knee OA manifests with limited range of movement of the joint and pain. Pain is often brought on by the initial movement of the knee, such as when starting to walk; it may also be painful during movement. Knee pain may become permanent as time goes on. As a result, knee OA can impede daily activities and lifestyle. Someone with knee OA may also find themselves more sensitive to climate conditions such as cold or damp, which is similar to that of the Chinese Medicine view of knee OA.
Bi Syndrome will manifest as pain at a local site. Bi Syndrome can be further diagnosed with certain symptoms corresponding to different invading pathogenic factors. Cold is indicated with often one severely painful joint that is relieved by heat. Wind is identified with pain that moves from joint to joint. Dampness manifests with swelling of the joints. Heat is indicated by severe pain with hot, swollen joints. Aversion to cold, wind, dampness, and heat can also present with each of the pathogens.
A Western medical practitioner would diagnose knee OA by obtaining relevant patient history, performing a physical examination, ordering imaging tests, and occasionally laboratory tests. A physical examination would test for findings upon inspection and palpation, testing the range of motion of the knee, and explore other functions such as gait analysis and ligament stability. Imaging studies such as X-rays would be used for a primary diagnosis, as well as to examine disease progression. MRI imaging can be used to display the cartilage, and ultrasonography can be used to explore tissue and fluid-filled spaces. A western practitioner can then make a formal diagnosis of knee OA, and note what stage the OA is at, ranging from Stages 0-4.
A Chinese medicine practitioner would also gather relevant patient information, as well as examine the knee locally. The practitioner would palpate the whole knee, including the channels surrounding it; a practitioner may also consider palpating the channels of the entire leg. Pulses and tongue would be inspected as well. The practitioner would determine what invading pathogen has caused the painful obstruction and pain symptoms; again, the obstruction of the smooth flow of blood and qi is resulting in the pain. The practitioner would then make a diagnosis of Bi Syndrome, with either cold, dampness, wind, or heat being present. After making this diagnosis, we can now make our treatment plan for acupuncture for knee pain and osteoarthritis.
There is currently no cure for knee OA, and western practitioners manage it by reducing symptoms and trying to slow the progression of the disease. Western treatments can include physical therapy, orthopedic aids, pain management medication, and surgical intervention. A Chinese medicine practitioner would address Bi Syndrome by clearing the pathogenic factor. To use acupuncture for osteoarthritis of the knees, the following points may be considered: LR3, BL12, GV16, GB34, ST34, ST35, the extra point MN-LE-16 (Xiyan), SI8, LI11, and TE10. These points can be dispersed, and moxa may be applicable, depending on the pathogen (i.e., not adding heat if there is obstruction caused by heat). Herbs can also be used to treat knee OA.
Researchers Berman, Lao, Langenberg, Lee, Gilpin, and Hochberg (2004) developed a study in which they explored the effects of acupuncture for knee OA pain; 570 patients were randomized into three groups: 1) true acupuncture, 2) sham acupuncture, and 3) patient education control. The true acupuncture group received 26 weeks of acupuncture treatment: 8 weeks of 2 treatments per week, followed by 2 weeks of 1 treatment per week, 4 weeks of 1 treatment every other week, and 12 weeks of 1 treatment per month. The acupuncture practitioners used the following points for the treatment of Bi Syndrome: GB34, SP9, ST36, ST35, Xiyan, KI60, GB39, SP6, and KI3; points were inserted into the affected limb(s). Patient outcome was measured using the Western Ontario and McMaster Universities Osteoarthritis Index. Upon completion of the study, the researchers found that pain among true acupuncture participants had decreased more than in the sham group at all points of assessment following 8 weeks. Knee function in the true acupuncture group also improved greater than that of the sham control group at 8, 14, and 26.
Prevention and symptom management can be supported with patient education, various lifestyle adjustments, and in some situations, weight loss. It is important to keep stress on the knee minimal to avoid further stress or damage. Muscle stimulation (such as using a TENS unit), stretching, walking, and the application of heat or cold can be useful for symptom management. Orthopedic shoe inserts may also be considered to reduce stress at the knee.
Along with using acupuncture for knee pain, a Chinese medicine practitioner would also suggest the addition of heat or cold treatments, depending on what the Bi was caused by, and should be added after the initial pathogen has been cleared. A CM practitioner would also encourage the patient to engage in exercise or regular movement of the knee to help prevent stagnation from returning and building back up. Nutritional recommendations from a CM practitioner may include eating acrid foods to help move blood and qi stagnation; foods such as pepper, chili, garlic, chives, green onions, and vinegar may be suggested.
Acupuncture is clinically proven to help alleviate and treat pain throughout the body. Acupuncture for knee pain (OA) is just one of the many ways that acupuncture works to support the body and health, all without surgery and pharmaceuticals. Contact me to learn more about acupuncture, what it can do for you, and how you can begin to life a pain-free life.
References
Berman, B. M., Lao, L., Langenberg, P., Lee, W. L., Gilpin, A. M., & Hochberg, M. C. (2004). Effectiveness of acupuncture as adjunctive therapy in osteoarthritis of the knee: a randomized control trial. Annals of Internal Medicine, 141(12), 901-910. doi:10.7326/0003-4819-141-12-200412210-00006
Flaws, B., & Sionneau, P. (2005). Osteoarthritis. In The treatment of modern western medical diseases with chinese medicine: a textbook & clinical manual (2nd ed., pp. 391-399). Boulder, CO: Blue Poppy Press.
Kastner, J. (2009). Chinese nutrition therapy: dietetics in traditional chinese medicine (tom)(2nd ed.). New York, NY: Thieme.
Michael, J. W., Schlüter-Brust, K. U., & Eysel, P. (2010). The epidemiology, etiology, diagnosis, and treatment of osteoarthritis of the knee. Deutsches Ärzteblatt International, 107(9), 152-162. doi:10.3238/arztebl.2010.0152
DISCLAIMER: this blog post is intended for informational purposes only. Do not perform any treatments included in the post yourself. This includes, but is not limited to, acupuncture, herbal medicine, and Chinese nutritional therapy. They should only be performed by educated and licensed acupuncture practitioners.
National Institutes of Health (NIH) studies have shown that acupuncture is an effective treatment alone or in combination with conventional therapies to treat the following:
Nausea caused by surgical anesthesia and cancer chemotherapy
Dental pain after surgery
Addiction
Headaches
Menstrual cramps
Tennis elbow
Fibromyalgia
Myofascial pain
Osteoarthritis
Low back pain
Carpal tunnel syndrome
Asthma
It may also help with stroke rehabilitation.
If you are curious about the benefits of acupuncture, scheudule an appointment for a personal consultation, and evaluation.
