Acupuncture for knees

Is Acupuncture beneficial for knee pain?

An overwhelming amount of research has been done to support the efficacy of acupuncture in general and for knee pain in specific. In my own clinical practice I have had many positive responses in patients with knee pain of many different causes.

The conditions generally responsive to medical acupuncture include: knee osteoarthritis, bursitis, tendonitis, strains, local contusions, as well as improvement in motion with conditions such as hamstring and quadriceps strains.

In a study conducted by the University of Maryland School of Medicine that included 570 patients receiving either acupuncture or sham acupuncture treatments for knee osteoarthritis the acupuncture patients received improvement in function and pain relief in comparison to the sham treatments (Annals of Intern Med, December 21, 2004; 141 (12): 901-10 BM Berman, L Lao, P Langenberg, WL Lee, AM Gilpin and MC Hochberg).

There is strong evidence that acupuncture is very effective for pain in the knee and has been proven to be more effective than sham acupuncture treatment. (Arthritis Rhem, April 1, 2001: 44 (4); 819-25).

How does acupuncture work?

Many textbooks have been written regarding the basis of acupuncture and read like an organic chemistry textbook! To simplify, it appears that the local effect of putting a needle through the skin serves to improve local blood flow to an area that may have relative ischemia (a lack of blood flow), that then benefits greatly from a local improvement in circulation. This is particularly true for conditions that involve strain and swelling.

With the addition of electrical stimulation, which is frequently used in conjunction with acupuncture, there is proof of local production of beta endorphins, the body's natural pain killing and pain modulating substance. It appears that acupuncture provides pain relief by activating the pain modulation system of the body, and changes both the processing as well as the awareness of the painful information at various levels in the central nervous system. By modulating pain, decreasing the awareness of the incoming pain signals, improving blood flow, improving the production of pain relieving substances, and in general promoting healing in the area of trauma, acupuncture helps to generate improved blood flow resulting in improved healing to the area.

In my own clinical practice I have found that acupuncture serves as an excellent companion to conventional medical care for many knee conditions.

Medication management including anti-inflammatory agents, quality physical therapy with muscle lengthening, instructions for stretching and appropriate strengthening of the muscles that surround the knee, as well as appropriate orthopedic intervention when medically necessary for such conditions as instability and meniscal pathology, can all be augmented with appropriate and timely use of acupuncture.

Where do the needles go?

Typical acupuncture points for knee pain include many points directly surrounding the knee and foot, local tender points within the muscle, and even at remote points in other parts of the body depending on the style of acupuncture and the practitioner performing the acupuncture treatment. Energy axis style treatment of acupuncture addresses many components of an individual patient's pain, personality structure, and overall biopsychosocial makeup. The beauty of acupuncture is the versatility of treatment that can vary greatly from patient to patient and can be effective for a wide range of conditions.

Does it hurt?

Most practitioners use very thin small disposable acupuncture needles that are nearly painless. While the insertion technique of the practitioner is certainly important, most acupuncturists have excellent skills and the actual insertion of the needle is not painful. Local points within muscles called Ah Shi points literally grab the needle and pull it down within the muscle. This can create a sensation of deep ache and difficult to describe unless personally experienced. Following an acupuncture session and manual stretching, most individuals experience a profound degree of relief if they get such a response.

How many treatments usually necessary?

The average number of treatment sessions varies greatly based on the condition, and the chronicity of the problem, in the individual patient. In my practice, the patient usually gains benefit with an average number of 8 to 10 treatments. I initially schedule two visits per week for two weeks and then quickly taper the number of treatments to one session per week, then every other week, and by the time the patient is seen one time per month I usually instruct them to contact me on an as needed basis for control of pain. Most patients gain additive benefit from each subsequent acupuncture and have longstanding relief without the continuing need for acupuncture services.

I was trained at UCLA where they instruct to perform an average of six treatment sessions to determine if the patient is a responder to acupuncture. In the general population there is an approximate 15 percent of individuals who are what we call 'non responders' to acupuncture. These individuals for unknown reasons are not responsive to the typical mediators that cause acupuncture to be effective. Therefore 85% of the general population is responsive in a positive way to medical acupuncture as a treatment. I have found these numbers to be true in my personal practice as well.

In summary, acupuncture can be very helpful for the control of knee pain for many different underlying knee diagnoses. It is most helpful when used as a companion to conventional medical care, rather than independent of it.

For more information regarding the style of acupuncture that I practice you may find useful information as well as links at the American Academy for Medical Acupuncture (http://www.aama.org). The site includes a link on how to find a provider in your geographic area.