Saturday, July 2, 2016

Acupuncture Is Probably Another Dud for Treating Knee Pain

I have a colleague at work who swears by “needles.” When he’s tired and stressed, he vanishes for an hour or so and returns from his acupuncturist feeling revived.

Is acupuncture useful for knee pain?

Evidence-based science indicates probably not. Here’s a summary for a recent study, published in a very reputable periodical (the Journal of the American Medical Association). Now of course it’s only one study, but everything on the subject that’s landed in my inbox over the last few years generally agrees with these conclusions.

First, 282 patients over age 50 with chronic knee pain were divided into four groups. The researchers were interesting in finding out whether traditional acupuncture or laser acupuncture helped alleviate pain. So two of those four groups were controls that received either no acupuncture or sham laser acupuncture.

Over the course of three months, patients received as many as 12 20-minute treatments.

After a year, there were “no differences between any of the groups on measures of knee pain and function.” The researchers suggest there were no real or direct effects of the acupuncture sessions.

I found this quote, from Rana S. Hinman, the study's lead author, most telling:
"Acupuncture tends to be more effective for people who believe in the benefits of acupuncture."
In other words: this is classic placebo effect.

One footnote that may comfort acupuncture believers: it was suggested the treatment may be effective for some people with neuropathic (nerve-related) pain. They weren’t included in this particular study.

And also, let me chime in: If acupuncture works for you, keep doing it! There’s no harm that I can tell. Even if 80 scientific studies say it’s worthless, if your knees feel better after being stuck with needles, that’s good enough. Who cares if it’s the placebo effect, really?


  1. Hi Richard
    This is completely off the topic of your post on acupuncture but I wondered if you'd seen this. Maybe cartilage repair is fastest than we thought in the right conditions?

    1. Certainly sounds intriguing. I'll have to look more closely at this later, but this would be faster regeneration than I would have thought possible.

    2. I am going to see a surgeon that does neocart or aci cartilage repair surgery. They grow the hyaline for 5 weeks are inject into damaged area. Has anyone had this done or had success? I have had PPFS since Feb. On my second round. PT hurt me bad couple days ago and I am in a rutt again almost limping with a lot of pain. Has anyone had orthodics for overpronate help? If strengthening the quad and gluten and hips worked I would be better. I have done everything I have been told to do and keep relapsing. It is devastating. This is why I think maybe the no big deal small defect in my patella cartilage may be a bigger deal than the Dr. Or physical therapist believe. The MRI just says small defect. I really appreciated your book. It has helped me understand a lot. I want to get back on that bike again. Nat

    3. Thanks for the comment on the book. I've never had the ACI procedure done. Anyone else?

  2. I was very skeptical about using acupuncture to treat knee pain but I was eventually desperate enough to try it. To my total astonishment, acupuncture took my knee pain away completely, but for only for a maximum of 2 hours after each treatment. It did nothing to improve pain or function in the long term. I got the impression that it worked a bit like a nerve block. It was only useful for short term, drug free pain relief. - Amy

  3. dear richard, i just advised by my doc to start physio therapy for knee due to cartilage burn out....32yr for me, is it too early to get cartilage burned out? is reduce walking help the condition?

    1. Physical therapy is a good idea. But I would make sure I got a good physical therapist; a bad one will only make your knee worse. I would want someone who believes what Doug Kelsey believes (

      I don't know what you mean by cartilage "burned out," but even people in their 20s can have bad cartilage. Will walking work for you? I don't know. It's something you could try and monitor symptoms to see if it's helping/hurting.

      If I were you, my No. 1 priority would be getting a good physical therapist. I'm sure you have many questions, but no one here will be able to answer them as well as someone who has looked at your knee in person and who understands your complete history.

    2. i see. thanks richard for your input. hows your knee condition now?

    3. My knees feel fine, and I just did a fairly hard bike ride of 52 miles today, so that's a good sign.

  4. OK, after reading this guys blog (, I finally think I've nailed what happened to me (and probably to Richard & Ed).

    Chronic synovitis.

    I'm still continuing to improve (did 3x 30 min easy runs last week, as 3min run @ 6 min/km pace/3min easy walk repeat - 2 on treadmill, one on a dirt trial). Knees still twitchy & still have a long way to go, but as this guy said in his blog, the big differece is I now know how to recover them, and it happens faster, and they are still heading in a positive direction.

    Have also discovered cycling is still more of a problem than running (go figure). It might be cos I tend to cycle harder than I run?

    Still doing prety solid leg strength work too - because it is low rep (though high load), it works for me. Also now doing a little more kicking when I swim.

    1. hahaha, he was cured in Croatia. I live in Croatia by the sea all my life, and in my case thatdoes not help .I'm joking of course.

    2. It's great getting your updates, TriAgain. You're like the model for slow healing. You've made some gains, but it's taken a long time, I know.

    3. Well, not as a good a model as you were because I lack your patience and keep pushing the envelope a bit too far (exercise/endorphin addiction I'm afraid). But I now understand the process, even if I fail to enact it sometimes (e.g. I ran a little too hard on the weekend, up too many hills while out in the forest with my wife who is training for a half mara in NZ in Nov. Got a bit carried away!).

  5. Dear Richard,

    I just went through Paul Ingraham's book on PFPS.
    There are two points he makes that got me thinking.
    It will be interesting what are your thoughts on them. Perhaps that will be beneficial information to others as well.

    It seems Paul Ingraham advocates a strategy where you completely give your knees a rest for a month and see if the symptoms fade away somewhat. Then slowly re-introduce your daily activities for another month. And it is at this point that you ought to start training the joints. If you suffer a major setback go back to the rest phase and so on. So the question in my mind is the following. Do you feel it is a good idea one should take a long rest with very gentle movement before embarking on a program that keeps you in the upper reaches of the envelope of function and then gradually edging the training? Let say you can walk 4000 steps without ill effects. According to Ingraham's strategy in the rest phase you scale this movement down before proceeding forward in a month.

    The other strange thing he writes that I find a bit scary is that for some people he thinks PFPS pain cycles occur no matter what they do and in no relation to their activities. A "natural pain cycle" of sorts. Thus they seemed to be doomed no matter what.
    Do you think that this could be true in some cases?


    1. Interesting. I like Paul Ingraham, and I think he's got a lot of good ideas and observations. I never gave my knees a complete rest for a month, but I did scale my "exercise" way, way back, until I was only walking around a pool once every 10 minutes, then resting my knees. And I think that was the first real baby step toward healing that I made. So you do have to reduce your level of activity way, way back to get into what is your new very small envelope of function.

      Do some people get locked into natural pain cycles? I wouldn't be surprised if this were the case. There's weird neurological and systemic stuff that I think occurs with knee pain that I don't understand too well. But even if there's the possibility that this will be your fate -- so what? Are you going to obsess over that, be negative and wait for the surgeon's knife? My suspicion is that those pain cycles, for most people, will lessen over time and they'll work themselves out of that rut.

    2. The pain and symptom cycles interest me much because in the last two months I've been testing the outer limits of my greatly reduced joint function. Really feel gratitude about your pain model where you outline how symptoms kick in with a delay, sometimes two days afterwards. That seems really to be the case and this is a crucial insight.

      However, I am now pondering my own experience and make certain tweaks for this hypothesis for my own use. Before a major flare up, there could a build up of tension and irritation in the joints that could be asymptomatic. So if four days in a row I go for two rounds of 2500 steps each day, there may not be a major change in condition but then you make another day of that with something tiny bit extra and then the following day boom you suffer greatly. And reviewing my routine does not provide me with a lot of clues where exactly I got it wrong. But that could be anything - the straw that broke the camel's back as the Beduin saying goes.

      Afterwards, if I scale down the joint loading greatly and rest, I do not return in two days to my level of performance and pain before the flare up but it takes a week and even more. During that time I rest for days and symptoms just manifest and I could not figure out where I got it wrong during those last days.
      So one way to explain this is by "accumulated overloading" which is asymptomatic building up of tension that afterwards unwinds for a longer time. The other is the "natural cycles of pain" where symptoms just pop up out of the blue and you cannot trace their causes in the activities of your last days.