Treatment and prevention of knee pain with acupuncture

Treatment and Prevention of Knee Pain with Acupuncture
Knee osteoarthritis (KOA) is a common degenerative joint disease characterized by knee pain, swelling, and limited mobility. It significantly affects patients’ quality of life.

Conventional treatment options include medications, physical therapy, and surgery. However, long-term medication use can lead to side effects, and surgery carries certain risks. As a result, many patients seek alternative treatments. Acupuncture, a therapy rooted in Traditional Chinese Medicine (TCM), has gained increasing attention as an effective, safe, and low-risk option.

Mechanisms of Acupuncture in Treating Knee Osteoarthritis
From the TCM perspective, knee pain is categorized under "Bi Zheng" (痹证), a syndrome caused by the obstruction of Qi and blood flow, blockage of meridians, or invasion by external pathogenic factors such as wind, cold, or dampness.

Modern research has studied the mechanisms of acupuncture in treating KOA and found the following effects:

1. Improves Blood Circulation and Microcirculation
Stimulating specific acupuncture points helps enhance local blood flow, increase oxygen and nutrient exchange in tissues, reduce accumulation of inflammatory substances, and alleviate pain and swelling caused by osteoarthritis and inflammation.

2. Regulates the Nervous System and Relieves Pain
Acupuncture can modulate central nervous system pain mechanisms. Needle stimulation triggers the release of natural pain-relieving chemicals such as endorphins and enkephalins, which also improve mood and provide comfort.

3. Reduces Inflammation
Acupuncture helps regulate the immune system and reduce the expression of pro-inflammatory cytokines such as interleukin-1 (IL-1) and tumor necrosis factor-alpha (TNF-α), thereby decreasing synovial inflammation and slowing the degradation of joint structures.

4. Enhances Knee Function and Protects Cartilage
Acupuncture can stimulate the secretion of synovial fluid, improving joint lubrication. It may also influence cartilage cell metabolism and help slow down cartilage degeneration.

Common Acupuncture Points and Treatment Methods
Frequently Used Acupuncture Points
- Zusanli (ST36, 足三里): Enhances Qi and blood flow, supports knee joint function.

- Yanglingquan (GB34, 阳陵泉): Relaxes tendons, unblocks meridians, and relieves pain.

- Xiyan (EX-LE4/EX-LE5, 膝眼): Local pain relief and swelling reduction.

- Xuehai (SP10, 血海): Stimulates blood circulation and resolves blood stasis.

- Yinlingquan (SP9, 阴陵泉): Drains dampness, reduces swelling, and eases knee stiffness.

Treatment Techniques
Traditional Needling: Needles are inserted at the above points and retained for 20–30 minutes. Sessions are typically performed 2–3 times per week for 4–6 consecutive weeks.

Electroacupuncture: After inserting the needles, low-frequency electrical stimulation is applied to enhance pain relief.

Moxibustion with Moxa (Ai Ye): Uses warmth from burning moxa to stimulate blood flow; suitable for cold and damp-related KOA.

Chinese Herbal Plaster Therapy: Topical application of herbal mixtures with properties that activate blood circulation and relieve pain; suitable for inflammatory KOA conditions.

Clinical Evaluation of Acupuncture
Clinical studies over recent years have confirmed that acupuncture provides significant benefits for KOA patients. For instance, randomized controlled trials have shown that acupuncture reduces pain scores (assessed by VAS) and improves knee function scores (assessed by WOMAC). Compared to standard medication, acupuncture not only offers similar pain relief but with fewer side effects.

Meta-analyses also demonstrate that acupuncture improves the quality of life in KOA patients and helps slow disease progression when applied long-term.

Indications and Contraindications for Acupuncture
Indications
- Suitable for early to moderate-stage KOA patients, especially those who do not respond well to conventional treatments or wish to reduce medication use.
- Patients experiencing mobility limitations who are not yet candidates for surgery.
- Patients diagnosed by TCM with KOA caused by cold, dampness, or Qi and blood stagnation in the meridians.

Contraindications
- Individuals with skin infections, open wounds, or acute trauma near the acupuncture site.
- Patients with bleeding disorders or those taking anticoagulants.
- Patients with severely damaged joint structures (advanced-stage KOA) should consult a physician before undergoing acupuncture to assess suitability.

Daily Care and Lifestyle Recommendations
1. Diet
- Eat foods rich in collagen and protein: black chicken, white fungus, eel, sea cucumber, pork or chicken tendons, milk, fish, bone broth, green vegetables, tofu, and small fish.
- Avoid inflammatory triggers: coffee, tea, fast food, cold drinks, fried or grilled foods, spicy foods, smoking, and alcohol.

2. Exercise
- Engage in activities like cycling, swimming, or exercises that strengthen knee-supporting muscles to reduce joint load.
- Avoid movements that stress the knee: squatting, sitting on low chairs, hiking, climbing stairs, lifting heavy objects, or running.

3. Precautions
- Maintain a healthy weight to reduce knee stress and delay degeneration.
- Get gentle sunlight exposure to stimulate Vitamin D3 production and prevent calcium loss.
- Protect the knees from cold; keep warm and avoid overuse. Use knee supports if pain occurs.
- Strengthen thigh muscles to reduce patellofemoral joint pressure.
- For chronic knee pain without redness or swelling, apply warm compresses for relief—avoid excessive heat.

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Written by:
林育昇 中医师
TCM Dr. Peter Lin