Welcome to my blog, discover acupuncture with Dr Maggie Ju

Qualified as a medical doctor in Western medicine in China with a Medical degree from Beijing, China and a PhD degree from the UK. Many year research and clinical experiences. This blog is for information only.

Thursday, 28 July 2022

Knee is painful, what to do?

Acupuncture is a valuable treatment for chronic knee pain

Thanks to the knee joint, we can move around freely and go wherever we want without any difficulties. Knee is the largest joint in the body which can bend and straighten bringing us about. It bears most of the body weight and pressure loads. It supports 1.5 times the body weight when one walks and 3-4 times the body weight when one climbs stairs. Knee is vulnerable which can be injured and can suffer from some diseases causing pain, swelling, stiffness, redness, locking, weakness or instability etc. The symptoms may vary depending on the type of injury. Pain may occur when you bend or straighten the knee.

There could be swelling; difficulty bearing weight on the knee and trouble with knee motion. Some of the most common reasons for knee pain are sprained ligaments, meniscus (cartilage) tears, tendonitis. Other conditions that cause knee pain include as follows:

Knee injury: a knee injury can affect any of the ligaments, tendons, bone or fluid-filled sacs (bursae) that surround the knee joint as well as the bones, cartilage and ligaments that form the joint itself.

Bursitis: A bursa is connective tissue below the skin over the knee. Overuse, a fall, or repeated bending and kneeling can irritate the bursa overlying the knee cap (patella), causing pain and swelling.

Illiotibial band syndrome: The iliotibial band is a piece of tough tissue that runs from your hip down to the outer part of your knee. If it's irritated by overuse or other problems, it can become inflamed and cause pain on the outer side of the knee.

Overuse during repetitive motions as are found during certain exercises (jogging, skiing) or work conditions (long periods of kneeling) can cause breakdown of cartilage and lead to pain.

Others Include osteoarthritis, dislocated kneecap, patellofemoral pain syndrome and patellar tendonitis, a condition caused by inflammation of the tendons around the knee.

Hip or foot pain: If you have hip or foot pain, you may change the way you walk and this can place extra stress on the knee joint. In some cases, problems in the hip or foot can refer pain to the knee.

Acupuncture can help release the pain by reducing the inflammation and improving circulation to speed up the healing process.

Iliotibial band syndrome, acupuncture can help

The iliotibial band (IT band) is a thick band of fibers on the outside part of the thigh. It starts from the border of the most prominent bone of the pelvis and ends into the tibia bone, to which the gluteal muscles and tensor fscia latae muscle attached. IT band coordinates muscle function and stabilize the knee during running. This band is one of the most common overused among the runners causing Iliotibial Band Syndrome (ITBS). ITBS is caused by inflamed of IT band. When it happens, knee pain is the most common symptom and can be mild to severe. Pain is most severe with the heel strike of walking or running and may radiate from the knee up the leg to the hip. Pain may also be felt with knee flexing, especially going up or down steps. Swelling on the outside of the knee can be seen in some cases. Tightness of IT band is very common. MRI can show a partial thickening of the IT band, which results from inflammation. When the IT comes near the knee, it becomes narrow, and rubbing can occur between the band and the bone. This causes inflammation. ITBS is more common in women, possibly because some women's hips tilt in a way that causes their knees to turn in. Tenderness over the site of the iliotibial band insertion at the knee joint, and specific tender points may be found over the lateral femoral condyle.

Initial treatment for most overuse injuries remains the same: rest, ice, elevation and antiinflammatory medications. If the pain prolonged, it can become chronic. Physical therapy is often used to treat ITBS. Acupuncture is effective to treat acute and chronic ITBS. It releases the pain and inflammation; reduces tightness of IT band; improves circulation and improves scarring.

knee pain from osteoarthritis, acupuncture can help.

If you are over 40 year old female and you are overweight with knee disease history, you are at great risk of having knee osteoarthritis. You could have pain and swelling in your knee and the pain is accompanied with stiffness and restricted movement. You could have grinding feeling when you move the knee. Osteoarthritis (OA) of the knee is the most common disabling condition and major cause of chronic pain. Knee pain or osteoarthritis affects 25% of people older than 55 year old and one third of populations over 65’s. There is a clear link between knee osteoarthritis and obesity. This may be due to mechanical, hormonal and genetic factors involved.

Acupuncture is one of the most commonly used applications and is very effective treatment for knee osteoarthritis. Its use for relieving knee pain is supported by many research data. Here are some examples, Lansdown H from the University of York UK performed a pilot study for a randomized control trial to compare effectiveness of acupuncture and usual care for knee osteoarthritis. 10 sessions of acupuncture was given to patients in acupuncture group on weekly basis. They found acupuncture has significantly better effect than usual care in patients with knee osteoarthritis.

Cao L et al analysed 14 randomised control trials from July to October 2011, involving 3835 patients with knee osteoarthritis. They found that acupuncture has significantly better effects on reducing pain and restore joint function both in the short term and long term compared to sham acupuncture or standard care.

A new research was just published about acupuncture on knee osteoarthritis. This was a double-blinded randomised trial to identify specific and non specific effects of acupuncture on osteoarthritis of the knee by Karner et al from Heidelberg University Hospital Germany. Karner et al recruited 160 patients aged from 35-82 with knee osteoarthritis in three study centers. These patients were double-blindedly allocated into three groups: classic Chinese acupuncture group, modern acupuncture group and non specific needling. Knee flexibility and pain sensation were tested to measure the effectiveness of the treatment. Their result showed that improvement of knee flexibility was the highest for Chinese acupuncture among three groups, following by modern acupuncture. Pain relief for Chinese acupuncture was also the highest among these groups which was 73% for classic Chinese acupuncture, 64% for modern acupuncture and 48% for non-specific needling. They suggested that there was a specific effect of acupuncture in knee mobility and both non-specific and specific effects of needling in pain relief.

Case report, knee pain with acupuncture treatment

Though long term effect of acupuncture in treating osteoarthritis is to be confirmed, there are many cases in which long term benefit can be seen clinically. For example Mary was 51, she had knee pain for a few years and she was diagnosed osteoarthritis. Her knee pain was getting worse in winter and getting better in summer. She had difficulty to climb stairs. In last winter, her knees were extremely painful and she hardly walked without pain. She decided to seek help from acupuncture. After first session of acupuncture, she felt less pain. With continuing a few sessions of acupuncture her knee pain was completely gone. A year on another winter arrived, she still did not have any pain on her knees.

Acupuncture reduces pain in patients with osteoarthritis by altering brain cortical thickness and brain activity

Recent research data have suggested that knee OA patients can benefit from acupuncture treatment. Some studies have shown that acupuncture may produce an analgesic effect through the endogenous descending pain modulatory system. Brain imaging studies have also shown that acupuncture needle stimulation can evoke widespread brain activity changes and modulate the functional connectivity of the pain processing network. A recent research has studied the effect of acupuncture on patients with knee osteoarthritis. Each patient received a total of 6 acupuncture treatment sessions in one month (twice per week for the first two weeks, once per week for the last two weeks). Result has shown that pain reduction in acupuncture group was significantly higher than that for control group. Daily living and quality of life showed significant improvement in acupuncture group compared to control group. Cortical thickness remained static in acupuncture group and decreased in control group. There was significantly stronger brain connectivity in acupuncture group compared to control group. This study has shown that acupuncture treatment can significantly modulate cortical thickness, functional connectivity, and clinical pain rating in OA patients. These results suggest that acupuncture may achieve its therapeutic effect on knee OA pain by preventing cortical thinning and decreases in functional connectivity in major pain related areas, therefore modulating pain in the descending pain modulatory pathway.

References

Sridhar MS, et al J Bone Joint Surg Br. (2012) 94:433-40.

Iwamoto, Jun et al World J Orthop (2011) 2: 37-42

Lansdown H et al BMC Musculoskelet Disord. (2009) 24;10:130.

Cao L, et al Saudi Med J. ( 2012) 33:526-32.

Karner M et al Evid Based Complemennt Alternat Med (2013): 2013:427265

White A et al Rheumatology (2007) 46:384-390

Plaster R et al Acupunct Med (2014) Feb 24. doi: 10.1136/acupmed-2013-010489

Chen X et al Sci Rep (2014) 4:6482

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