Knee pain can affect nearly every aspect of daily life, from walking up stairs and getting out of a chair to exercising, gardening, or simply enjoying a long walk. Whether the discomfort comes from arthritis, patellar tracking issues, tendon irritation, or chronic strain around the knee, acupuncture can be a valuable part of a comprehensive approach to pain management and mobility.
When treating knee pain with acupuncture, it is important to look beyond the location of the pain itself. The patella (kneecap), the muscles that guide its movement, the tendons and soft tissues along the inner knee, and the underlying joint all play a role in how the knee functions.
A thoughtful acupuncture treatment considers these interconnected structures rather than treating the knee as an isolated joint.
Getting Around the Patella: Treating the Kneecap and Surrounding Tissues
The patella plays an important role in knee extension, helping the quadriceps muscles transmit force when we straighten the leg, climb stairs, or rise from a seated position. When the tissues surrounding the kneecap become irritated or overloaded, movements such as squatting, kneeling, and descending stairs can become painful.
Acupuncture treatments may include points around the patella, including the soft-tissue regions above, below, and alongside the kneecap. Commonly used local acupuncture points include:
ST 34 (Liangqiu): Located above the outer side of the patella, this point is traditionally used for anterior knee pain.
ST 35 (Dubi): Located near the lower outer border of the patella, this is a commonly used local point for knee discomfort.
EX-LE5 (Xiyan): The knee-eye points are located on either side of the patellar tendon, near the lower margins of the patella.
SP 10 (Xuehai): Located on the inner thigh above the knee, this point is traditionally used for conditions involving the knee and surrounding tissues.
The selection of points depends on the patient's symptoms, anatomy, and clinical presentation. The goal is to address pain and support comfortable movement while considering the surrounding muscles and soft tissues.
Acupuncture around the patella should be performed by a trained practitioner with appropriate knowledge of knee anatomy. Needling should not be directed into the patellar tendon or joint itself.
SP 9 and the Pes Anserine: Addressing the Inner Knee
Pain along the inner side of the knee can have several causes, including osteoarthritis, medial meniscal problems, and irritation of the pes anserine tendons or bursa.
The pes anserine is the shared insertion of three muscles—the sartorius, gracilis, and semitendinosus—on the upper inner portion of the tibia, just below the knee joint. These muscles help bend the knee and contribute to control of the lower leg during walking and other activities.
When the pes anserine region becomes irritated, people may experience tenderness below the inner knee, particularly when climbing stairs, getting up from a chair, or exercising.
SP 9 (Yinlingquan) is a traditional acupuncture point located on the inner lower leg, near the medial side of the tibia below the knee. It is commonly incorporated into acupuncture treatments for knee discomfort and is also associated with the traditional Chinese medicine function of regulating fluid metabolism.
In a treatment focused on medial knee pain, SP 9 may be considered alongside local points selected for tenderness around the pes anserine insertion and the surrounding soft tissues.
It is important to distinguish between traditional acupuncture point locations and the precise anatomical source of pain. SP 9 is not the same as the pes anserine insertion, and tenderness in this region does not automatically mean that the pes anserine is the source of the problem. A careful assessment helps guide appropriate treatment.
The Vastus Medialis: An Important Part of Knee Control
The quadriceps muscle group plays a central role in knee stability and movement. One of its components, the vastus medialis, lies along the inner portion of the thigh and contributes to knee extension.
Its lower fibers are often referred to as the vastus medialis obliquus (VMO). These fibers have traditionally received attention for their potential role in controlling patellar movement.
When the quadriceps muscles are weak, poorly coordinated, or insufficiently conditioned for a person's activity level, knee function may be affected. This can be particularly relevant for people experiencing patellofemoral pain, which often presents as discomfort around or behind the kneecap.
Acupuncture treatment may incorporate the vastus medialis and other quadriceps muscles when muscle tenderness or increased tone is present. Depending on the individual, treatment may also address the surrounding hip and thigh muscles.
However, acupuncture alone does not strengthen the quadriceps in the same way that progressive resistance exercise does. For longer-term improvements in knee function, acupuncture may be combined with targeted strengthening, mobility work, and movement retraining.
Why the Q-Angle Matters in Women's Knee Pain
The Q-angle is the angle formed by the line of pull of the quadriceps and the patellar tendon. It has historically been discussed as one factor that may influence patellar tracking.
Women, on average, have a wider pelvis than men, which can influence lower-limb alignment. This has contributed to the theory that some women may experience greater lateral forces on the patella and a higher susceptibility to certain types of patellofemoral pain.
However, the relationship between Q-angle and knee pain is more complex than this traditional explanation suggests. Q-angle alone does not reliably predict patellar tracking problems or knee injury. Hip strength, lower-limb mechanics, activity levels, anatomy, and training load can all contribute.
For women experiencing pain around the kneecap, a comprehensive treatment plan may include:
Assessing quadriceps strength and function, including the vastus medialis.
Evaluating hip strength and control during activities such as squatting and stepping.
Considering foot and lower-limb mechanics where clinically relevant.
Using acupuncture to help manage pain and muscle tenderness.
Incorporating individualized strengthening and movement exercises.
The goal is not simply to correct one muscle or angle, but to improve how the entire lower limb manages load and movement.
Acupuncture for Knee Arthritis
Osteoarthritis is one of the most common causes of persistent knee pain. It involves changes in the joint, including cartilage deterioration, remodeling of the underlying bone, and changes in the surrounding tissues. Symptoms may include aching, stiffness after rest, swelling, and difficulty walking or climbing stairs.
Although osteoarthritis is often described as “wear and tear,” it is a complex joint condition influenced by age, genetics, previous injury, body weight, muscle strength, and other factors.
Acupuncture may help some people with knee osteoarthritis by reducing pain and improving physical function. Research suggests that acupuncture can offer modest symptom relief for some patients, although study findings vary and the size of the benefit is not consistent across trials.
A treatment plan may combine local points around the knee with distal points selected according to the patient's presentation. Points around the patella, SP 9, and other points along the lower leg may be considered alongside treatment of relevant thigh muscles.
The purpose is to help reduce symptoms and support movement—not to regenerate lost cartilage or reverse the structural changes associated with arthritis.
For people with arthritis, even a modest reduction in pain can make everyday movement more manageable. When acupuncture helps someone participate more comfortably in strengthening exercises or walking, it may serve as one useful component of a broader treatment plan.
Why a Whole-Knee Approach Matters
The knee does not function in isolation. Pain around the kneecap may be influenced by quadriceps function, while discomfort on the inner knee may involve the pes anserine region, joint structures, or other tissues. Arthritis may affect several of these areas simultaneously.
An individualized acupuncture approach considers:
The patella: Pain around or behind the kneecap and the surrounding soft tissues.
The medial knee: Tenderness along the inner joint line or below it near the pes anserine insertion.
The quadriceps: Muscle tenderness, conditioning, and the role of the vastus medialis in knee extension.
The broader movement system: Hip strength, lower-limb control, activity demands, and gait.
The joint itself: Signs of osteoarthritis, swelling, stiffness, and limitations in daily function.
This approach helps guide treatment toward the person's specific presentation instead of relying on the same points for every case of knee pain.
Combining Acupuncture With Movement
Acupuncture is often most useful when it is part of a larger plan for knee health. Depending on the cause of the pain, additional strategies may include progressive quadriceps and hip strengthening, appropriate activity modification, physical therapy, and medical evaluation when needed.
For osteoarthritis, regular low-impact activity and strengthening are important components of care. Exercises can be adjusted to the person's current pain level and functional ability rather than avoiding movement altogether.
Persistent or worsening knee pain deserves an appropriate assessment, particularly when accompanied by substantial swelling, locking, instability, inability to bear weight, or a recent injury. A hot, red knee with fever requires urgent medical evaluation.
