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Acupuncture and Dry Needling 

Acupuncture treatment for knee pain

What is acupuncture and how does it work??


Acupuncture and dry needling are often used interchangeably in sports medicine. It remains a popular choice for pain management and represents one of the few treatments that have stood the test of time, dating back to 200BC. However, the voodoo nature and selection of points, sometimes far away from the pain source often make people question its validity. And quite rightly so…


So how does it work? Put simply acupuncture works physiologically at 3 levels:

  1. At the local level ie where you are getting pain

  2. At a segmental level- where that pain inputs the central nervous system

  3. At a central level- how this pain is processed at our higher order centers- the brain


So lets have a look at each of these in turn

At the local level- If a needle is inserted into your knee, close to where you are getting your pain- this represents a harmful/ or potentially harmful stimulus- this activates receptors in the skin called nociceptors. These nociceptors release vasodilatory neuropeptides that increase blood flow and modulate immune responses.


At the segmental level- where pain enters the central nervous system via the dorsal horn of the spinal cord- the input from the acupuncture needle activates pathways that reach the spinal cord first. Consequently we get a pain relieving affect. The sympathetic nervous system can also be manipulated at this level to promote homeostasis- ie if there is harmful or potentially harmful stimulus- the body can get stuck in a sympathetic/ flight or fight mode which can heighten how pain is experienced.


At the central level- blood flow is increased to cortical regions if the brain (supraspinal affects) to stimulate analgesic pathways and subsequent descending inhibition. This includes endorphin secretion. Recent research also shows acupuncture can inhibit the limbic systems and activate the pre frontal cortex to reduce anxiety and promote relaxation.


These affects can be seen objectively using fMRI scans- which show changes in blood flow in the brain. We can see changes locally using ultrasound ie in treating tendon pathology.


They is sustainable evidence that needling is more effective than placebo or sham acupuncture in the treatment if a whole variety of musculoskeletal conditions including chronic low back, neck and shoulder pain, chronic muscular pain headache and knee osteoarthritis. However it should always be part of a multimodal treatment program that combines exercise and education. 

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