What is Osteoarthritis?
Osteoarthritis (OA) is a degenerative joint disease, affecting 80% of those aged 65 and over. It is the eighth leading cause of disability globally,1 and when affecting the knee joint it is most frequently associated with disability.
Symptoms include achy pains in and around the knee joint, stiffness, weakness, difficulty bending and straightening the knee, inability to take weight during walking or climbing stairs, intermittent swelling, as well as crepitus or ‘grinding’ in the joint.
How can we help?
Since there is no cure for OA, treatment focuses on managing the symptoms conservatively as far as possible. Here at Mount Merrion Chartered Physiotherapy, our focus with our clients who are suffering with OA is to help reduce their pain and stiffness and improve their functional ability. We follow the best available research evidence, our clinical expertise and patient preferences when choosing treatment techniques.
The National Institute for Health and Care Excellence (NICE)2 suggest:
- Local heat or cold therapy
- Paracetamol and/or topical anti-inflammatories
- Graduated exercise programme including strengthening, flexibility and aerobic fitness
- Manual therapy including soft tissue massage, joint mobilisation and passive stretching
- Advice and education on weight loss, keeping active and healthy diet
- The use of electrotherapy e.g TENS
- Biomechanical assessment including advice regarding corrective footwear, braces, joint supports, walking aids if required
What about Medical Acupuncture?
Although the NICE guidelines do not currently recommend acupuncture in the treatment of knee OA, it has been found in many high quality studies to be beneficial in terms of improving pain and function.3 The largest ‘sham’ acupuncture controlled trial to date is the GERAC OA Knee trial with 1007 participants which showed significantly better results in the groups with acupuncture in comparison to the group without it.4 There are also many studies which have shown acupuncture provided in the region of the affected knee to be effective, which would suggest that needing specific ‘points’ is less important and what gives the best clinical effect is simply stimulating the muscles which act on the knee.5
Clinically, we have also seen the benefits of acupuncture to be true and valid, alongside exercise, manual therapy and education.
Medical acupuncture for OA knee involves applying fine needles to gently stimulate the muscles surrounding the knee joint including quadriceps, hamstrings, calf, shin and sometimes gluteal muscles. An comfortable electrical impulse can be applied to the needles to deliver a higher dose of acupuncture stimulation in the tissues, this is known as electroacupuncture. Both forms of acupuncture have been found to have beneficial analgesic effects by deactivating trigger points in the muscle, modulating pain signals sent to the brain and by stimulating the release of neurochemicals.
For best results. Medical acupuncture should be used in conjunction with an exercise programme, manual therapy and advice and education in the management of OA knee to relieve pain, improve movement and optimise function.
By Hannah Moran BSc Physio, MISCP
1.World Health Organization. Diet, nutrition, and the prevention of chronic diseases: report of a joint WHO/FAO expert consultation. World Health Organization; 2003 Apr 22.
2. NICE. Osteoarthritis: care and management: Clinical Guidelines. NICE; 2014.
3. Ernst E, Lee MS. Acupuncture for rheumatic conditions: an overview of systematic reviews. Rheumatology. 2010 Jun 29;49(10):1957-61.
4. Scharf HP, Mansmann U, Streitberger K, Witte S, Krämer J, Maier C, Trampisch HJ, Victor N. Acupuncture and knee osteoarthritis: a three-armed randomized trial. Annals of internal medicine. 2006 Jul 4;145(1):12-20.
5. Selfe TK, Taylor AG. Acupuncture and osteoarthritis of the knee: a review of randomized, controlled trials. Family & community health. 2008 Jul;31(3):247.