Chronic Knee Pain

• Cartilage: The knee contains two types of cartilage—the menisci (shock-absorbing fibrocartilage) and articular cartilage, which covers the ends of bones to facilitate smooth movement.
• Ligaments: The anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial collateral ligament (MCL), and lateral collateral ligament (LCL) stabilize the knee.
• Tendons: The quadriceps and patellar tendons connect muscles to the knee, enabling movement.

Chronic knee pain may stem from conditions such as:

• Osteoarthritis: Degeneration of articular cartilage, leading to joint inflammation, stiffness, and pain.
• Patellofemoral Pain Syndrome: Pain due to misalignment or overuse of the patella, often aggravated by activities like squatting or climbing stairs.
• Tendinopathies: Chronic inflammation or degeneration of tendons, especially the patellar tendon, causing pain with jumping or running.
• Meniscus Tears: Damage to the meniscal cartilage can lead to persistent pain, swelling, and joint instability.
• Ligament Injuries: Chronic pain can result from partial or healed ligament tears that affect knee stability.

Chronic knee pain often involves inflammation, cartilage degradation, or changes in the surrounding tissues. Prolonged inflammation can damage tissues and lead to fibrosis or cartilage erosion, causing pain, swelling, and limited mobility. Additionally, weakened or imbalanced muscles around the knee can increase joint strain, exacerbating pain.

Chronic knee pain may include the following symptoms:

• Persistent or intermittent pain, often worsened with specific activities (e.g., climbing stairs or prolonged sitting)
• Swelling, stiffness, and sometimes joint instability
• Decreased range of motion and strength

Conventional diagnosis by a Medical Doctor typically involves a physical examination, imaging (X-ray, MRI), and sometimes lab tests to assess for inflammatory conditions. Treatment may include physical therapy, anti-inflammatory medications, lifestyle modification, and, in some cases, surgical intervention if conservative measures fail.

Acupuncture treatment aims at first and foremost reducing the pain and discomfort felt by the patient in their daily activities. Acupuncture points will be chosen to reduce any muscle tension and increase circulation in any atrophied muscles. Electrical stimulation is often applied as it has been shown to increase the production of pain-reducing chemicals such as endorphin and regulate the nervous system’s response to chronic pain. 

While direct resolution of any serious structural issues such as a torn ligament is not likely with acupuncture, it can provide lasting relief of many chronic symptoms by addressing the pain and dysfunction sustained by surrounding and supporting structures even in such serious cases. 

Treatment Case: 62 year old female

   The patient is a 62-year-old teacher who spends a lot of time standing and walking around as part of her job. Since 6 months ago, she has been suffering chronic knee pain aggravated by prolonged standing and walking. Patient has no history of traumatic knee injury but has reported occasional knee discomfort in the past. When she had a physical a few years back, the X-ray results showed mild degeneration in the patellofemoral joint consistent with early osteoarthritic changes.

   The patient reports a pain of 5 to 6 during prolonged standing, which may sometimes increase to a 6 to 7 out of 10 after a long day of standing. The pain is achy and focused around the patella. Her range of motion is unremarkable, but has mild discomfort in knee flexion. Upon palpation, there is tenderness around the patella and quadriceps tendons. There is slight swelling both on the right and left side. Mild knee valgus can be observed during standing and walking, likely due to muscle fatigue and weakness in stabilizers.

   After the second weekly treatment, the patient noted some reduction in pain, now going down to a 3 to 4 out of 10. She was able to teach for about 2 hours before starting to feel the pain. She noted a temporary reduction in pain following each session, with less tightness around the knee joint, but mentioned that it did come back after a couple days. Patient was convinced to come in biweekly instead of on a weekly basis. After another two weeks in treatment, pain was further reduced, and this time the swelling seemed to have resolved. Her gait was noticeably more stable. And after another week she was discharged.