Acupuncture for Knee Pain

How Chinese medicine understands knee pain

In Chinese medicine, most knee pain is a type of Bi syndrome: pain from Qi and Blood that are blocked in the channels around the joint. Six channels pass the knee, so where it hurts (front, inside, outside or behind) helps decide which points are used.

What is causing the blockage decides the rest of the treatment. The common patterns are:

• Wind, Cold and Damp. A stiff, heavy ache that is worse in cold, wet weather and first thing in the morning, and better with warmth and gentle movement. Any swelling feels cool rather than hot. Treatment warms the joint and clears the channels.
• Damp-Heat. A knee that is hot, red and swollen. In Chinese medicine this needs clearing rather than warming. It also needs a medical check first (see below).
• Qi and Blood stagnation. Sharp pain fixed in one spot, often after a fall, twist or sports injury. Treatment moves circulation through the area.
• Kidney and Liver deficiency. In Chinese medicine the Kidneys support the bones and the Liver the tendons. Knees that ache and feel weak over years, worse when you are tired and often with low back weakness, fit here. This is how many cases of osteoarthritis present, and treatment also builds you up.

An old injury with wear on top, or a cold, stiff knee in someone who is run down, is common. That mix is why treatment is planned for you rather than for “knee pain”.

What treatment involves

Your first visit at the clinic in Keswick starts with questions: any past injuries, which movements hurt (stairs, kneeling, getting out of a chair), whether the knee swells, and your general health. I look at your tongue and take your pulse. An assessment of knee pain usually also looks at how the knee bends and straightens, and at the hips and feet, because they change how load goes through the knee.

Acupuncture is usually the main treatment. Needles go into points around the knee and into points further along the leg on the channels involved. I treat the whole body at every treatment, not only the area that hurts. Acupuncture needles are very fine, typically 0.14 to 0.30 mm. The aim is to ease pain and stiffness so the knee moves more freely.

Depending on the diagnosis, treatment may also include cupping or tuina massage to release the thigh and calf muscles that pull on the knee, moxibustion to add warmth for a Cold pattern, or Chinese herbal medicine: a formula written for your pattern.

A recent strain usually needs fewer treatments than a knee that has ached for years. Plan on 5–10 treatments to judge progress.

Between visits

• Keep the muscles strong. Do the thigh and hip strengthening exercises your physiotherapist or doctor gave you. Strong muscles take load off the joint.
• Choose low-impact activity. Cycling, swimming and walking on flat ground are usually easier on sore knees than running or jumping.
• Use heat or cold. Heat for 15 minutes can ease morning stiffness. A cold pack wrapped in a cloth for 10 to 15 minutes can calm swelling after activity.
• Wear supportive shoes. Worn-out or very flat shoes change how your knee takes load.
• Pace your day. Break up long periods of kneeling, squatting or standing.

When to see your doctor first

See your doctor before starting treatment, or promptly if you are already coming in, if:

• The knee is hot, red and swollen, especially with a fever. Infection or gout needs to be ruled out.
• You cannot put weight on the leg, or the knee swelled quickly after an injury or a “pop”.
• The knee locks, catches or keeps giving way.
• You have pain, swelling or redness in the calf. A blood clot needs to be ruled out.
• The knee looks misshapen, or the pain is severe at night and does not ease with rest.