Exploring Research on Acupuncture for Knee Osteoarthritis
New 2025 Studies Provide Better Understanding Behind Acupuncture’s Role in Relieving Knee Osteoarthritis Pain and Improving Mobility
Knee osteoarthritis (KOA) is a debilitating condition marked by pain, stiffness, and reduced mobility, significantly impacting quality of life. Traditional treatment options include pharmacological, physical, and surgical interventions, but many patients seek complementary approaches due to the limitations of conventional care. Acupuncture and electroacupuncture have emerged as promising alternatives for managing KOA symptoms. Recent studies delve into their efficacy, shedding light on mechanisms and outcomes that could reshape treatment paradigms.
Key Points
KOA is a chronic condition with high prevalence, particularly among aging populations, often linked to pain and cartilage degeneration.
Acupuncture can reduce inflammation and pain by modulating biological pathways.
Thread-embedding acupuncture (TEA) combined with electroacupuncture (EA) shows promise for postoperative KOA pain relief.
New findings highlight the MLT/cAMP/PKA/CREB signaling pathway as critical in acupuncture's analgesic effects.
Both animal models and clinical trials underscore significant improvements in pain and function.
Knee osteoarthritis
Overview of Knee Osteoarthritis
Knee osteoarthritis (KOA) is a chronic, degenerative joint condition characterized by the breakdown of cartilage in the knee. This progressive deterioration exposes the underlying bones, causing pain, inflammation, stiffness, and reduced mobility. KOA can significantly impair daily activities like walking, climbing stairs, and even standing for prolonged periods.
Symptoms of Knee Osteoarthritis
Pain: Typically worsens with activity and improves with rest, although severe cases may cause pain even at rest or during sleep.
Stiffness: Especially noticeable after periods of inactivity, such as getting out of bed or standing after sitting.
Swelling: Caused by inflammation or excess fluid accumulation in the knee joint.
Reduced Range of Motion: Difficulty bending or straightening the knee fully.
Crepitus: A grinding or clicking sensation when moving the knee.
Weakness or Instability: The knee may feel as though it could "give out."
Risk Factors for Osteoarthritis
Age: The risk increases with age due to natural wear and tear on joints.
Obesity: Excess weight puts additional stress on knee joints, accelerating cartilage breakdown.
Joint Injuries: Previous injuries, such as fractures or ligament tears, can lead to early onset of KOA.
Repetitive Stress: Occupations or activities involving repetitive kneeling, squatting, or heavy lifting may contribute to KOA development.
Treatment Options for Knee Osteoarthritis
While there is no cure for KOA, various treatments aim to manage symptoms, slow progression, and improve quality of life. These include:
Non-Pharmacological Treatments:
Exercise: Low-impact activities like swimming, cycling, or yoga help maintain joint flexibility and strengthen supporting muscles.
Weight Management: Reducing excess weight relieves pressure on the knee joint.
Physical Therapy: Customized exercises to improve mobility and joint function.
Assistive Devices: Knee braces, canes, or shoe inserts can provide additional support.
Pharmacological Treatments:
Pain Relievers: Over-the-counter options like acetaminophen or NSAIDs (e.g., ibuprofen) help manage pain and inflammation.
Topical Treatments: Creams and gels containing NSAIDs or capsaicin may provide localized pain relief.
Injections: Corticosteroid or hyaluronic acid injections can temporarily reduce inflammation and improve joint lubrication.
Surgical Options:
Arthroscopic Surgery: Minimally invasive procedure to remove loose cartilage or repair joint damage.
Osteotomy: Realignment of bones to redistribute weight on the knee.
Knee Replacement: Reserved for advanced cases, this involves replacing the damaged joint with an artificial implant.
Complementary and Alternative Therapies:
Acupuncture: Proven to reduce pain and inflammation while improving joint function.
Electroacupuncture (EA): Combines electrical stimulation with acupuncture for enhanced effects.
Supplements: Glucosamine and chondroitin sulfate are commonly used for joint health, though their efficacy is debated.
Despite the variety of available treatments, many patients find traditional therapies insufficient for managing chronic pain and improving mobility. This has led to growing interest in alternative options, such as acupuncture and electroacupuncture, which are gaining recognition for their ability to address both symptoms and underlying mechanisms of KOA.
Acupuncture for Knee Osteoarthritis Research Overview
Two recent studies explored acupuncture's efficacy for KOA. The first study examined the effects of acupuncture in animal models, focusing on biological pathways like melatonin signaling. The second was a clinical trial assessing TEA and EA for postoperative KOA pain.
Research Findings
Animal Model Study:
This study used rabbits with induced KOA to explore how acupuncture affects cartilage health and pain. The researchers found that acupuncture triggered the melatonin (MLT) pathway, which is known to regulate inflammation and pain perception. By activating this pathway, acupuncture increased levels of melatonin and related signaling molecules (e.g., cAMP, PKA, and CREB) in the knee joint, reducing inflammation and slowing cartilage breakdown. Essentially, acupuncture helped the body’s natural pain-relief and repair mechanisms kick in.Clinical Trial on TEA and EA:
This randomized clinical trial included patients experiencing persistent knee pain after surgeries like arthroscopy. Participants who received TEA and EA, along with usual care, reported significant pain reduction as measured by the Visual Analogue Scale (VAS). Their knee function also improved, as indicated by the Korean Western Ontario and McMaster Universities Osteoarthritis Index (K-WOMAC). The combination of TEA and EA provided prolonged and synergistic effects, which may explain the enhanced outcomes.
Recommended Acupuncture Treatment
Based on current research, acupuncture for knee osteoarthritis (KOA) can be customized to address pain, inflammation, and functional impairments. Studies highlight the importance of targeting specific acupoints and employing techniques tailored to the patient’s condition.
Key Acupoints:
EX-LE4 (Neixiyan): A local acupoint around the knee joint that directly alleviates pain and swelling.
ST36 (Zusanli): Renowned for boosting overall energy (Qi), enhancing blood circulation, and reducing inflammation.
SP10 (Xuehai): Promotes blood flow, reducing stiffness and addressing joint pain.
GB34 (Yanglingquan): Commonly used for musculoskeletal conditions, it improves joint flexibility and reduces swelling.
Techniques:
Electroacupuncture (EA):
Mild electrical currents are applied to inserted acupuncture needles, creating a deeper and more consistent stimulation. This approach enhances endorphin release, regulates pain pathways, and reduces inflammation by promoting anti-inflammatory cytokines.
Studies suggest EA significantly improves knee pain, stiffness, and function over standard care alone.
Thread-Embedding Acupuncture (TEA):
Biodegradable threads are embedded into specific acupoints, offering sustained stimulation over days or weeks. This is particularly effective for chronic pain management, as it continuously engages the body’s repair mechanisms.
TEA has shown promise in reducing postoperative pain and improving mobility when combined with EA.
Treatment Frequency:
For optimal results, a combination of TEA once per week and EA twice per week over a four-week period is recommended. Incorporating dry needling into the treatment plan can address muscular components of knee pain, making the overall therapy more comprehensive and effective.
How Acupuncture Treatment Works for Knee Osteoarthritis
Acupuncture works for KOA by targeting both the local and systemic factors contributing to the condition. At the local level, inserting needles into specific acupoints increases blood circulation around the knee, which nourishes cartilage and surrounding tissues while reducing swelling. This improved microcirculation helps to clear inflammatory markers, such as cytokines, that contribute to joint degeneration. Electroacupuncture enhances these effects by stimulating the release of natural pain-relieving compounds like endorphins and modulating nerve pathways associated with pain perception.
At the systemic level, acupuncture engages the body’s neuroendocrine and immune systems. It reduces overall inflammation by decreasing pro-inflammatory mediators and promoting anti-inflammatory cytokines. Additionally, acupuncture has been shown to regulate the hypothalamic-pituitary-adrenal (HPA) axis, which can help manage chronic pain and stress associated with KOA.
Integrating techniques like EA, TEA, and acupuncture offers both immediate relief and long-term improvements, making it a valuable addition to KOA treatment plans.
Additionally, regular reassessments of pain and joint function can help adjust the treatment to the individual’s progress and needs.
Strengths of Studies
The animal study provided valuable insights into acupuncture’s molecular mechanisms, linking it to pathways that reduce inflammation and cartilage damage.
The clinical trial demonstrated measurable improvements in pain and mobility without adverse effects, showing that acupuncture can complement existing care safely.
Weaknesses of Studies
The clinical trial had a small sample size, limiting generalizability.
Long-term outcomes, such as sustained pain relief and cartilage repair, were not evaluated.
The animal study's findings need further validation in human populations.
Future Considerations for Research
Larger, multi-center clinical trials to confirm the benefits of acupuncture for KOA.
Long-term studies to assess whether acupuncture helps slow disease progression or delay the need for surgery.
Research into the cost-effectiveness of acupuncture compared to conventional treatments.
Conclusion
Acupuncture offers a promising avenue for managing knee osteoarthritis, addressing both pain and underlying biological mechanisms. By incorporating techniques like EA and TEA, practitioners can enhance treatment outcomes. As research continues to validate these findings, acupuncture could become a mainstay of KOA management. Morningside Acupuncture, the premier acupuncture clinic in New York City, integrates evidence-based approaches like these to provide effective relief for KOA and other chronic conditions.
Over to you
If you liked this article, please share with friends and family who may be suffering with knee osteoarthritis.
Frequently Asked Questions (FAQ)
What is knee osteoarthritis (KOA)?
Knee osteoarthritis is a degenerative joint condition characterized by the breakdown of cartilage in the knee, leading to pain, swelling, stiffness, and limited mobility. It commonly occurs with aging but is also influenced by factors like obesity, prior joint injuries, and repetitive stress.
How does acupuncture help with KOA?
Acupuncture helps manage KOA by increasing blood flow to the knee joint, reducing inflammation, and alleviating pain. It also regulates the body's immune and neuroendocrine systems, which can promote healing and reduce stress-induced symptoms.
What are the key acupuncture techniques for KOA?
Two commonly used techniques are:
Electroacupuncture (EA): This method applies electrical currents to acupuncture needles, enhancing stimulation for faster pain relief and inflammation reduction.
Thread-Embedding Acupuncture (TEA): Biodegradable threads are embedded into acupoints to provide prolonged stimulation, ideal for managing chronic pain.
Dry needling, while not discussed in the referenced studies, can also be combined with acupuncture to release trigger points and relieve muscle tightness contributing to knee pain.
What acupoints are used for treating KOA?
Key acupoints include:
EX-LE4 (Neixiyan): Targets localized knee pain.
ST36 (Zusanli): Improves circulation and reduces inflammation.
SP10 (Xuehai): Promotes healthy blood flow.
GB34 (Yanglingquan): Enhances joint flexibility and mobility.
How often should I receive acupuncture for KOA?
Research suggests an effective protocol involves two weekly sessions of electroacupuncture (EA) and one weekly session of thread-embedding acupuncture (TEA) over at least four weeks. The exact frequency may vary based on individual needs and response to treatment.
Can acupuncture repair damaged cartilage?
While acupuncture does not directly regenerate cartilage, it may slow cartilage breakdown by reducing inflammation and improving blood flow to the affected area. It is most effective when combined with other treatments, such as physical therapy and weight management.
Is acupuncture safe for knee osteoarthritis?
Yes, acupuncture is generally considered safe when performed by a licensed practitioner. The studies referenced reported no significant adverse effects, making it a viable option for managing KOA symptoms.
Can acupuncture be combined with other treatments?
Absolutely. Acupuncture can complement conventional treatments like physical therapy, exercise, and pain management. Techniques like dry needling can also address muscle-related components of knee pain for a more comprehensive approach.
How long does it take to see results with acupuncture for KOA?
Many patients notice improvements in pain and mobility after a few sessions, typically within the first two to four weeks. Long-term benefits often require sustained treatment over several months. Regular reassessments help refine the treatment plan for the best outcomes.
Sources:
Lee, Y. J., Han, C.-H., Jeon, J. H., Kim, E., Park, K. H., Kim, A. R., & Kim, Y. I. (2025). Combination treatment with thread-embedding acupuncture and electroacupuncture for knee osteoarthritis patients with postoperative pain: A randomized controlled feasibility study. Journal of Pain Research, 18, 89–103. https://doi.org/10.2147/JPR.S453133
Zhang, C., Yu, M., Zhang, L., Zhou, X., Han, J., Fu, B., & Xue, H. (2025). Exploring the analgesic effect of acupuncture on knee osteoarthritis based on MLT/cAMP/PKA/CREB signaling pathway. Journal of Inflammation Research, 18, 237–249. https://doi.org/10.2147/JIR.S498202
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