Managing Osteoarthritis and Chronic Knee Pain Without Surgery

by TCM Physician Aaron Lai (黎彦廷医师)

Knee pain can gradually make everyday activities difficult. Simple routines like walking to the MRT, taking the stairs, exercising, or standing up from a chair may begin to feel stiff or unstable.

For many adults and seniors in Singapore, the underlying cause is knee osteoarthritis, commonly referred to as joint wear and tear. Although osteoarthritis cannot always be reversed, its symptoms can often be effectively managed through a structured combination of clinical treatment, rehabilitation, and lifestyle adjustments.

At Health Traditional Medicine Singapore (HTM), our integrative approach combines Traditional Chinese Medicine (TCM) acupuncture, manual osteopathy, biomechanical assessment, and rehabilitation. Our goal is to relieve local knee pain while addressing the broader physical factors placing excessive stress on your joint.

Why Does Knee Wear and Tear Cause Pain?

The knee does not function in isolation. Its movement and loading are influenced by the hips, pelvis, ankles, feet, surrounding muscles, and overall walking pattern.

During activities such as walking or climbing stairs, the knee must tolerate considerable force. If the surrounding muscles are weak or the lower limb is moving inefficiently, the pressure passing through the knee may become uneven.

Several factors may contribute to this process:

1. Muscle Weakness

   
   

   1. Weakness in the quadriceps may reduce the knee’s ability to control movement during walking, squatting, and stair climbing.

   2. Weakness in the gluteal muscles may also allow the thigh and knee to move inward excessively. This may increase stress around the kneecap and the inner aspect of the knee.

      
      

2. Altered Patellar Tracking

   
   

   1. The patella, or kneecap, should glide smoothly within a groove at the front of the thigh bone.

   2. Muscle imbalance, tight surrounding tissues, previous injuries, or changes in lower-limb mechanics may affect how the kneecap moves. This can contribute to pain around or behind the kneecap, particularly during stair climbing, squatting, or prolonged sitting.

      
      

3. Hip, Ankle, and Foot Restrictions

   
   

   1. Reduced hip movement, limited ankle mobility, or excessive foot pronation may alter the way a person stands and walks.

   2. As the body compensates, additional stress may be transferred to certain areas of the knee. This is why a thorough knee assessment should also examine the hip, ankle, and foot.

      
      

4. Osteoarthritis-Related Joint Changes

   
   

   1. Knee osteoarthritis affects more than cartilage. It may also involve the underlying bone, joint lining, surrounding muscles, and soft tissues.

   2. Common symptoms include:

      • Pain during walking or stair climbing

      • Morning stiffness

      • Swelling

      • Reduced knee movement

      • Grinding or clicking sensations

      • Weakness or instability

      • Difficulty standing from a chair

        
        

The severity of pain does not always correspond directly with the degree of change seen on an X-ray. A proper clinical assessment is therefore important before deciding on an appropriate management plan.

An Integrative Approach to Knee Pain

Effective knee pain management usually requires more than temporary symptom relief.

A structured treatment plan should aim to reduce discomfort, improve movement, strengthen the lower limb, and identify the mechanical factors that may be contributing to the condition.

At HTM, treatment may involve acupuncture, electroacupuncture, manual osteopathy, soft-tissue therapy, movement assessment, and rehabilitation exercises tailored to your individual diagnosis, physical condition, and goals.

Acupuncture and Electroacupuncture

In Traditional Chinese Medicine, chronic knee pain is commonly classified under Bi Syndrome referring to pain and restricted movement associated with an obstruction in the circulation of Qi and Blood.

From a modern clinical perspective, acupuncture helps influence pain-processing pathways, muscle tension, local circulation, and nervous-system activity. Electroacupuncture - applying gentle electrical stimulation through selected needles - may also be used.

Commonly selected acupuncture points around the knee may include:

• Dubi, ST35

• Neixiyan, EX-LE4

• Yanglingquan, GB34

• Yinlingquan, SP9

• Zusanli, ST36

Point selection should be individualized according to pain location, clinical examination, medical history, and TCM diagnosis to support:

• Pain and stiffness management

• Reduction of muscular tension

• Improved knee movement

• Better tolerance for exercise

• Symptom management in knee osteoarthritis

Note: Acupuncture does not regrow damaged cartilage or reverse advanced osteoarthritis. Its primary role is to support symptom management and improve physical function.

Manual Osteopathy and Biomechanical Assessment

Manual osteopathy examines how the joints, muscles, fascia, and movement patterns throughout the body may influence the painful area.

During a knee assessment, the practitioner may examine:

• Pelvic and hip movement

• Knee range of motion

• Patellar mobility

• Ankle mobility

• Foot posture

• Muscle strength

• Standing and walking patterns

Treatment may include gentle joint mobilization, soft-tissue therapy, myofascial techniques, muscle-energy techniques, and movement retraining.

The objective is not to force the body into a fixed or ideal alignment. Instead, treatment aims to improve comfortable movement, reduce unnecessary muscular tension, and help the lower limb distribute force more efficiently.

Structures commonly assessed and treated may include the quadriceps, hamstrings, calves, iliotibial band, hip flexors, gluteal muscles, ankles, and feet.

For some patients, improving movement outside the knee can help make walking and stair climbing more comfortable.

Strengthening for Long-Term Stability

Passive treatment alone is rarely sufficient for the long-term management of knee pain.

Progressive strengthening is important because stronger muscles help absorb load and support the knee during movement.

Rehabilitation exercises may focus on:

• Quadriceps strength

• Gluteal strength

• Hip stability

• Calf strength

• Balance

• Proprioception

• Sit-to-stand ability

• Stair control

The exercise programme should be matched to the patient’s current ability and physical condition.

An older patient with significant weakness may begin with supported sit-to-stand exercises or basic balance training. A younger or more active patient may require more advanced strengthening and movement retraining.

The goal is not only to reduce pain during treatment. It is to improve the patient’s ability to move safely and confidently in daily life.

What Happens During a Knee Assessment?

At our clinic near Commonwealth, we assess more than the painful area. Depending on the patient’s condition, the evaluation may include the following.

1. Medical and Symptom History

   
   

   1. We review when the pain started, activities that aggravate the symptoms, previous injuries, relevant medical conditions, imaging findings, and previous treatments.

   
   

2. Posture and Movement Assessment

   
   

   1. We observe movements such as walking, squatting, standing from a chair, and stair simulation where appropriate.

      
      

3. Range-of-Motion Assessment

   
   

   1. The movement of the knee, hip, and ankle may be assessed to identify stiffness, asymmetry, or painful restriction.

      
      

4. Orthopaedic Testing

   
   

   1. Relevant clinical tests may be performed to assess the ligaments, menisci, tendons, and other structures around the knee.

      
      

5. TCM Assessment

   
   

   1. Where TCM treatment is appropriate, the patient’s pulse, tongue, symptoms, and general constitution may also be considered.

   2. Following your assessment, we will explain the likely contributing factors and recommend an appropriate treatment and rehabilitation plan.

When Should You Seek Medical Attention?

Some knee symptoms require prompt medical evaluation.  Consult a doctor immediately if you experience:

• Inability to bear weight after an injury

• Significant deformity

• A knee that is physically locked

• Rapid and severe swelling

• Fever, redness, and marked warmth around the joint

• Severe pain after a fall or accident

• Persistent and unexplained night pain

• Calf swelling or shortness of breath

• Progressive weakness or numbness

• Symptoms that continue to worsen

Depending on the findings, further investigation such as an X-ray, MRI, blood test, or orthopaedic consultation may be required.

Can Knee Osteoarthritis Be Reversed?

Established cartilage loss and advanced osteoarthritis cannot currently be reversed through acupuncture or manual therapy.

However, pain and disability are influenced by more than joint structure alone. Muscle strength, stiffness, inflammation, sleep, body weight, physical activity, balance, and confidence can all affect how a patient feels and functions.

This means that even when an X-ray shows osteoarthritis, meaningful improvement may still be possible.

The goals of conservative care are to:

• Reduce pain and stiffness

• Improve mobility

• Maintain muscle strength

• Support balance and walking ability

• Improve daily function

• Help patients remain physically active

• Delay more invasive treatment where clinically appropriate

How Many Treatment Sessions Are Needed?

There is no fixed number of sessions that applies to every patient. The treatment timeline depends on several factors, including:

• Severity of the condition

• Duration of symptoms

• Age and general health

• Muscle strength

• Activity level

• Previous injuries

• Response to treatment

• Adherence to rehabilitation

Some patients with a recent muscular or mechanical problem may improve within several sessions. Long-standing osteoarthritis often requires a longer-term programme involving treatment, strengthening, activity modification, and regular reassessment.

Progress should be measured using practical outcomes such as walking distance, stair-climbing ability, knee range of motion, strength, balance, and pain levels.

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Book a Knee Assessment in Singapore

Knee pain should not automatically be accepted as an unavoidable part of aging.

With the right combination of clinical care and rehabilitation, you can stay active and mobile.

WhatsApp

 +65 8891 6118

Clinic Address

One Commonwealth Lane, #08-02, Singapore 149544

Our team will evaluate your condition and advise whether acupuncture, manual osteopathy, rehabilitation, medical imaging, or external referral is right for you.

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Medical Disclaimer

This article is intended for general educational purposes only. It does not replace an individual medical consultation, physical examination, diagnosis, or treatment plan. Anyone experiencing persistent, severe, worsening, or unexplained knee symptoms should consult an appropriately qualified healthcare professional.