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Acupuncture for Knee osteoarthritis and how to make sure you maintain your mobility into old age

Updated: Nov 24


Osteoarthritis is a chronic and progressive condition marked by the gradual loss of joint cartilage, which commonly results in pain and loss of movement. The risk of suffering from symptomatic osteoarthritis increases with age but there are further risk factors: If you have had a knee injury or are overweight, the risk of knee osteoarthritis increases to 56.8% or 66% respectively (1).


What is osteoarthritis and what are your treatment options?


Osteoarthritis affects mostly the hands, spine and joints including the hips, knees and ankles, often leading to knee and hip replacement surgery. It has painful inflammatory components resulting from the wearing away of articular cartilage in the synovial joints (2). It can limit joint range of motion due to avoidance of pain or from the growth of osteophytes (bone spurs) which form around the degenerated joints.


While there are many different approaches to effectively manage and provide relief for osteoarthritis symptoms, there is currently no cure except for arthroplasty (e.g. total knee replacement), which can be very costly but effective for treatment of advanced stage osteoarthritis (3).


Can acupuncture help with knee osteoarthritis?


Current evidence confirms acupuncture as an alternative for pain medication in patients with osteoarthritis (4). A systematic review of 12 RCTs has shown acupuncture to decrease pain intensity, improve functional mobility and quality of life. A greater reduction in pain intensity was achieved with treatments over four weeks.


Another systematic review of the effectiveness and safety of acupuncture for knee osteoarthritis found that acupuncture achieved a higher total effective rate, short-term effective rate and less adverse reactions than standard western medicine interventions (5).


If you want a drug-free treatment to help manage your osteoarthritis, appointments for our Brisbane clinic can be made online or contact Ken to discuss how acupuncture can help your mobility and pain.


What else can you do if you have a diagnosis of osteoarthritis or want to actively prevent it?


- The strongest evidence-based recommendations are for dietary interventions to reduce weight - if appropriate - together with an increase in physical activity (6).


- Weight loss is especially beneficial for arthritis of the weight-bearing joints such as hips and knees as excess body weight increases pressure on articular cartilage during daily activities. Also, a reduction in fat mass can help reduce systemic inflammation (7; 8).


- According to clinical trial data, exercises that may be especially useful are tai chi, strength and resistance training and general exercise programs which can also help with weight loss (9).


- Strength and resistance training may be useful to address the muscle atrophy and weakness which is commonly associated with OA. Weakness of the periarticular muscles may contribute to joint instability and laxity of the joint, it may impair protective reflexes and increase maximum joint forces, all leading to increased risk of microtrauma to the articular cartilage (10).


Which muscles should be targeted with strength and resistance training?


Most research focuses on the strengthening of the knee extensors (quads) and hip abductors (glutes and TFL). Quadriceps muscle weakness is strongly associated with knee osteoarthritis and has been shown to be a risk factor for developing symptomatic arthritis (11) and thus strengthening the quads may be beneficial. A recent systematic review and meta-analysis showed that hip abductor strength may be 7-24% weaker in sufferers of knee osteoarthritis compared to age-matched controls (12). Another recent systematic review and meta-analysis found that the addition of hip exercises will lead to greater benefits than quadriceps strengthening alone especially when the osteoarthritis is in the medial side of the knee (13).



References:


(1) Murphy, L., Schwartz, T.A., Helmick, C.G., Renner, J.B., Tudor, G., Koch, G., Dragomir, A., Kalsbeek, W.D., Luta G., Jordan, J.M. (2008). Lifetime risk of symptomatic knee osteoarthritis. Arthritis Rheum. 15, 59(9), 1207-13. https://www.doi.org/10.1002/art.24021


(2) Lozada, C. J. (2020). Osteoarthritis. Retrieved October 25, 2021, from https://emedicine.medscape.com/article/330487-overview


(3) Bannuru, R.R., Osani, M.C., Vaysbrot, E.E., Arden, N.K., Bennell, K., Bierma-Zeinstra S.M.A., ... McAlindon, T.E. (2019). OARSI Guidelines for the Non-Surgical Management of Knee, Hip, and Polyarticular Osteoarthritis. Osteoarthritis Cartilage, 27(11), 1578-1589. https://www.doi.org/10.1016/j.joca.2019.06.011


(4) Manyanga, T., Froese, M., Zarychanski, R., Abou-Setta, A., Friesen, C., Tennenhouse, M. et al. (2014). Pain management with acupuncture in osteoarthritis: A systematic review and meta-analysis. BMC Complementary and Alternative Medicine,14, 312. https://www.doi.org/10.1186/1472-6882-14-312


(5) Li, J., Li, YX., Luo, L.J., Ye, J., Zhong, D.L., Xiao, Q.W. et al. (2019). The effectiveness and safety of acupuncture for knee osteoarthritis: An overview of systematic reviews. Medicine, 98, 28(e16301). https://www.doi.org/10.1097/md.0000000000016301


(6) Thomas, S., Browne, H., Mobasheri, A., & Rayman, M. P. (2018). What is the evidence for a role for diet and nutrition in osteoarthritis? Rheumatology (Oxford, England), 57(suppl_4), 61–74. https://www.doi.org/10.1093/rheumatology/key011


(7) Sarin, H.V., Lee, J.H., Jauhiainen, M. et al. (2019). Substantial fat mass loss reduces low-grade inflammation and induces positive alteration in cardiometabolic factors in normal-weight individuals. Sci Rep, 9, 3450. https://www.nature.com/articles/s41598-019-40107-6


(8) Bianchi V.E. (2018). Weight loss is a critical factor to reduce inflammation. Clin Nutr ESPEN Dec; 28, 21-35. https://pubmed.ncbi.nlm.nih.gov/30390883/


(9) Agency for Healthcare Research and Quality (2017). Effective health care program: Treatment of osteoarthritis of the knee. Comparative Effectiveness Review, 190.

Retrieved from https://effectivehealthcare.ahrq.gov/sites/default/files/osteoarthritis-knee-update-executive-170505.pdf


(10) Zacharias, A., Green, R. A., Semciw, A. I., Kingsley, M. I. C., & Pizzari, T. (2014). Efficacy of rehabilitation programs for improving muscle strength in people with hip or knee osteoarthritis: a systematic review with meta-analysis. Osteoarthritis and Cartilage, 22(11), 1752–1773. https://www.oarsijournal.com/article/S1063-4584(14)01178-9/fulltext


(11) Øiestad, B. E., Juhl, C. B., Eitzen, I., & Thorlund, J. B. (2015). Knee extensor muscle weakness is a risk factor for development of knee osteoarthritis. A systematic review and meta-analysis. Osteoarthritis and Cartilage, 23(2), 171–177. https://www.oarsijournal.com/article/S1063-4584(14)01305-3/fulltext


(12) Deasy, M., Leahy, E., & Semciw, A. I. (2016). Hip strength deficits in people with symptomatic knee osteoarthritis: A systematic review with meta-analysis. Journal of Orthopaedic & Sports Physical Therapy, 46(8), 629–639. https://www.jospt.org/doi/10.2519/jospt.2016.6618


(13) Hislop, A.C., Collins, N.J., Tucker, K. et al. (2020). Does adding hip exercises to quadriceps exercises result in superior outcomes in pain, function and quality of life for people with knee osteoarthritis? A systematic review and meta-analysis. British Journal of Sports Medicine, 54, 263-271. https://bjsm.bmj.com/content/54/5/263.long


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