Osteoarthritis (OA) of the knee is a progressive disease common among the aging population and a leading cause of disability. It is typically categorized as excessive ‘wear and tear,’ with symptoms including joint stiffness, joint swelling, limited range of motion, eventual lower extremity malalignment, and pain ranging from barely perceptible to debilitating.
There are over 100 forms of arthritis, and OA is the most common and most often leads to chronic disability. Costs associated with knee OA are very high considering treatments, adaptations in activity level, and lost productivity at work. This painful disease affects millions of patients; about 13% of women and 10% of men aged 60 years and older have symptomatic OA of the knee.
Due to the prevalence of the condition, there are numerous treatment options for managing OA. These options include over-the-counter anti-inflammatories, prescription nonsteroidal anti-inflammatory drugs (NSAIDs), application of ice or heat, hyaluronic acid injections, corticosteroid injections, bracing, arthroscopic surgery, or total knee replacement surgery.
A lesser-known treatment option for knee OA is dry needling therapy. Increasing evidence has shown this procedure to be effective in reducing pain and disability in the osteoarthritic knee, and studies have shown it can increase arterial pressure around the knee by up to 40%. Studies have also indicated it causes specific physiological responses that increase blood levels of beta-endorphins, which produces a pain relieving effect. This can help patients reduce their reliance on analgesic or anti-inflammatory medications. Needling therapy has also been shown to activate the hypothalamus and deactivate the limbic system in the brain, both of which can alter our perception of pain.
Dry needling involves the insertion of acupuncture needles at 9 different points around the knee, specifically to stimulate an increase in blood flow around the joint. The insertion of needles can feel uncomfortable, but it is not typically painful. Once the needles are inserted, they are often gently twisted to cause an internal stretch in the tissue. The needles are then left in place for up to 30 minutes, and the treatment is sometimes combined with low-frequency electrical stimulation using a device specifically designed for acupuncture. Occasionally some tenderness, bruising, or mild hematomas may develop post-treatment, but these are minor and temporary conditions. The risk of infection is also extremely low at about 1 in 10,000. Typical treatment frequency is 2-3 times per week for a duration of 6-8 weeks. When combined with an appropriate supervised exercise program, pain and functional impairments were significantly improved for the majority of patients.
Although dry needling isn’t a common treatment alternative in the U.S., it is frequently used in other countries. In the United Kingdom, dry needling is used to manage OA knee pain for patients awaiting joint replacement surgery. As a physical therapist certified in dry needling, I have performed the treatment on a number of patients not only for OA knee pain but also for patients with anterior knee pain caused by patellofemoral dysfunction. Anecdotally, all patients I have treated reported significant reductions in knee pain in as little as two weeks, and no other manual therapy or modality interventions were used. These patients also reported a decreased intake of pain medication and a significant increase in activity levels.
Dry needling therapy is safe and accompanied by very few precautions or contraindications. There is both research support and anecdotal evidence showing its effective use in the treatment of knee pain. Treatment time is relatively short, ranging from 10 to 30 minutes for each session. The cons are only slight discomfort during needle insertion, possible bruising, and the 4-12 weeks it takes to get results.
While no single treatment works for every patient dry needling may be right for you, especially if other options have not worked and you wish to postpone knee replacement surgery. For more information on dry needling from certified specialists, contact your local ProActive Physical Therapy clinic today!