Why I Use Medical Acupuncture (including Dry Needling) In The Treatment of Patellofemoral Pain Syndrome
Medical Acupuncture (MA) is a form of therapy in which fine needles are inserted into specific points on the body to bring about various processes within the body. Benefits include pain relief, tissue healing and tension release from tight muscles.
What is Patellofemoral Pain Syndrome (PFPS)?
PFPS is a term used to describe pain in and around the knee cap (patella) (Brukner & Khan, 2007). It is also known as ‘Anterior knee pain’, ‘Patellofemoral maltracking Syndrome’ and ‘Chondromalacia Patellae’ (Brukner & Khan, 2007). It is often cause by muscle imbalance and biomechanical dysfunction of the lower limb coupled with and increased activity load on the knee.
Aims of treatment
The overall aim is to allow the knee and and knee cap to move and function as normally as possible to as to remove mechanical stresses which may lead to the development of or perpetuate the symptoms of PFPS.
How exactly is Medical Acupuncture helpful when treating PFPS?
Local points may be used to ease areas of tenderness or sentivity around the knee or knee cap, in this case the needles are gently inserted into or near the tender structure in order to bring about local physiological effects which may promote pain relief, healing and repair.
Segmental points may be used to reduce the aches and pains arising from the front of the knee associated with PFPS. When using segmental points the muscles surrounding the front of the knee are usually targeted as they share the same nerve supply as the knee itself. Myofascial trigger points are often found in the muscles of the thigh and gluteals which may affect normal muscle function and in turn affect the alignment and normal tracking of the knee cap on the front of the knee. The hamstrings and calf muscles may also contain trigger points. When aiming to de-activate trigger points we refer to the MA technque we are using as Dry Needling.
Other physiotherapy techniques may include various types of manual joint and soft tissue therapy as well as therapeutic exercise to help re-train normal muscle function.
Is there research to support the use of Medical Acupuncture for PFPS? In a word – yes!
A systematic review evaluating the effectiveness of MA in treating chronic knee pain concluded that it was significantly more effective than sham (i.e. ‘missing the point’ acupuncture) and more effective than no treatment at all (White et al, 2007). Another study deemed MA a successful method of treating PFPS providing MA was used on the basis of an individualized treatment approach (Jensen et al, 1999).
Do I find Medical Acupuncture useful when treating PFPS?
I find MA one of the most effective treatment technques to use when treating PFPS. Here is a nice example:
“A few weeks back I had a patient who presented with PFPS. As is our approach in the clinic, I combined MA using local and segmental points with appropriate manual therapy and therapeutic exercises. When he returned a week later, his pain was much improved. However, his quadriceps muscle on the outer quadricep muscle remained very tight. As a result, given the attachments of this muscle to the outer knee cap, the knee cap was sitting over to one side (misaligned), a common finding with PFPS . This time I used the ‘Dry Needling Approach’ along the outer thigh, aiming to reduce muscle tension and de-activate trigger points. After treatment, the muscle was more flexible which allowed the knee cap to move better. The pain subsequently resolved, and he was discharged with advice and exercises with the view to prevention of further episodes”.
So if you are experiencing pain around the knee cap, consider MA as a treatment, it can be very effective!
Brukner P and K Khan. Clinical Sports Medicine. 2007; McGraw-Hill: Australia.
Jensen R, Gothsen O, Liseth K, Baerheim A. Acupuncture treatment of patellofemoral pain syndrome. J Altern Complement Med 1999;5(6):521-7.
White A, Foster NE, Cummings M, Barlas P. Acupuncture treatment for chronic knee pain: a systematic review. Rheumatol (Oxford) 2007; 46(3): 384-390.