Bi Syndrome of the Knee Treated with Acupuncture with Patellofemoral Pain Syndrome as a Case

Musculoskeletal problems are some of the most frequent seen health problems in acupuncture clinics. Pain seems to be the main complaint in addition to reduced function. According to Traditional Chinese Medicine (TCM) obstruction of qi and/or blood lead to pain. Soreness, swelling, and stiffness in muscles and joints develop if the obstruction is not cleared, and the normal function of the whole body can be affected. As a result, daily life, recreational activities and participation in sports suffer. Reduced ability to work may put a strain on private and community economy. Reduced function due to obstruction of qi or blood in the knees may affect all ages, both sexes, athletes and those with sedentary lifestyles. The patients experience pain in the knee on activity and/or at rest. It is claimed to affect as many as one in four of us, and as many as 15% of young men attending military service 1, 2. Adolescents participating in sports seem to be particularly vulnerable to knee problems3, and anterior knee pain is one of the main diagnoses at sports medicine centres4. In western medicine various terminology has been applied to this problem, such as chondromalacia patellae, anterior knee pain, or knee arthralgia. The current terminology is “Patellofemoral Pain Syndrome”5. Symptoms include chronic knee pain of insidious onset aggravated by walking uphill or downhill, squatting, kneeling, or prolonged sitting with flexed knees5. Excluded are those cases of anterior knee pain that occur secondary to trauma and/ or dislocation of the patella. Numerous theories have been proposed regarding the aetiology of Patellofemoral Pain Syndrome. These include extensor mechanism misalignment in the leg, quadriceps muscle insufficiency, patellar subluxation, quadriceps muscle tightness and chondral defects. The mechanism, by which these causes produce pain is not understood. Some observations imply that peripheral local nerve injury and central sensitisation in the nervous system can lead to Patellofemoral Pain Syndrome6. There are few published controlled trials evaluating the effect of any treatment on Patellofemoral Pain Syndrome5. No treatment modalities have proven to be effective. It is generally accepted that appropriate use of rest, strengthening of the quadriceps and stretching of the muscles and soft tissues around the patella is beneficial. The mechanism by which these treatments have a positive effects is not clear. According to TCM, local pain at the knee without any other condition will normally be diagnosed as “obstruction” or “bi” syndrome. The obstruction of qi and or blood will give rise to pain and soreness as the main symptoms. Reduced function of weight bearing activities and knee stiffness are often reported. If the painful obstruction in this condition is not treated it can lead to long-lasting chronic pain, motor impairment, and even mental depression as normal functions of the body may be affected. There are internal or external causes for this condition. Overuse, exposure to cold weather, wind, dampness or local trauma can lead to obstruction of qi or blood. Internal causes which weaken the function of the Spleen and Liver can lead to a weakened wei-qi (defensive-qi) resulting in local obstruction of qi and blood from external causes. Many acupuncturists report good results when treating musculoskeletal problems. Acupuncture has been shown to give promising results in the treatment of gonarthrosis7, 8, 9, 10. In the absence of a documented effect for any other treatment, it became interesting to evaluate the effect of acupuncture on this condition. In a recent study we evaluated the effect of acupuncture on the Patellofemoral Pain Syndrome, diagnosed as “bi syndrome of the knee” in TCM. The results of this study were originally presented in the Journal of Alternative and Complementary Medicine, in December 199911. The study was a controlled clinical trial where individualised acupuncture treatment was compared to no treatment. 70 patients aged between 18 and 45 years of age (mean 31 years), were found to suffer from Patellofemoral Pain Syndrome, and were included in the study. 41 of the 70 patients were females. The level of knee function and pain was measured with the Cincinnati Knee Rating System. This scale is numerical, and evaluates pain, swelling, feeling of giving-way and function (walking, climbing stairs, running and jumping/twisting)12. Patients were further tested by the “Stairs Hopple test”13. In this test the patients