Articularis Genu Needling to Improve Knee Flexion, Gait Pattern & Pain: A Hidden Treasure

What is an Articularis Genu?

Origin-Insertion-Action:
O: Anterior, distal femoral periosteum.
I: Cephalic portion of the synovial membrane of the knee (joint capsule)
A: Pulls the cephalic knee capsule cephalically to facilitate knee extension.

I never learned about this muscle in school, and let me tell you, I didn't go to school just to eat my lunch... Now, I don’t know if needling the articularis genu is the actual cause, or part of the cause, of significant improvements in knee flexion and pain.

However, inserting a needle directly above the patella, to the periosteum, through the rectus femoris, vastus intermedius and articularis genu, is a magical needle to reduce knee pain, improve knee flexion, LBP, gait pattern, autonomic nervous system homeostasis and more.

The knee range of motion and pain improvements totally may be because the needle is going through the rectus and vastus intermedius tendons. The causative factor may be the articularis genu. It may be the periosteum. It’s probably an amalgamation of numerous factors. Whatever it is, this needle placement works wonders for just about any knee impairment out there.

Related: Click here to read "Dry Needling: Benefits of Low-Frequency Stim for the Autonomic Nervous System"

Make sure to incorporate needles targeting the parasympathetic portion of the autonomic nervous system (PANS), along with whatever other areas you are needling, including the articularis genu. Remember, the majority of our patients present with SANS hyperactivity. Needle down to the periosteum over the sacral plexus, S2-S4, the base of C2 spinous or suboccipital periosteum, and the most direct placement to target the PANS, the concha of the ears. The concha of the ears is directly innervated by the auricular branch of the vagus nerve, the primary nerve of the PANS. Add about 2 Hz stim in various ways, connecting the PANS needles directly to each other, along with connecting the various distal points to their corresponding spinal nerve root levels.

Targeting the nerve roots, I place needles to the base of the vertebral spinous processes, through the multifidus, at an inferior medial angle, starting no more the 0.5 inches lateral to the center of the spinous process. This safely accesses periosteum adjacent to the nerve root exit. This is key. There is some type of increased cerebral and peripheral neuroplastic effect when needles are placed from nerve root to distal impairment. Especially when needles are placed bilateraly, to the periosteum (if safe), with low frequency microcurrent. I like to cross the left spinal segments to the right distal treatment zones and vis versa. Again, there is something that happens in the brain and nervous systems when you do this that dramatically improves treatment efficacy and patient outcome.

Remember: Low frequency stim, 1-5 Hz (I like 2 Hz), is the best, as far as we know, at stimulating endogenous opioid release (beta-endorphin), sympathetic depression, pain reduction and patient relaxation.

Don’t forget about needling the adductor attachments on the pubis. This is a counterintuitively comfortable area to be needled. You hardly feel it. And it's super important. Normalizing adductor length is an essential aspect to manipulating the pelvis to neutral, which is necessary to achieve maximal knee health. Pelvic homeostasis is key to all health, if you think about it. The adductors typically form latent trigger points and are often unnoticed by the patient. This may be secondary to worse pain in other areas, such as the low back, or because they attach and blend with some of the pelvic floor musculature, or some other reason. Regardless, the adductor attachments on the pubis, especially the gracilis, blend with the pelvic floor musculature. The pelvic floor musculature is innervated by the PANS dominant S2-S4 spinal nerves. If the adductors are not addressed, the pelvic floor, along with the ANS, will continue to dysfunction.

In summary:
Needle the articularis genu, just above the patella, down to the periosteum, through the rectus femoris and vastus intermedius tendons. This has a magical effect on knee pain, knee ROM, LBP, gait pattern and numerous other impairments. Make sure to needle the adductor attachments at the pubis. This will regulate the ANS, reduce knee pain, LBP, pelvic alignment and improve knee flexion. Needle bilaterally, connect the nerve root levels, target the PANS and add low frequency microcurrent.

Test out the effect of needling the articularis genu by performing knee ROM measurements, then needle, then perform the measurements again. You will see some awesome improvements.

Let me know if anyone has any questions about anything.

Jason

References

• Rahou-El-Bachiri, Y., Navarro-Santana, M.J., Gómez-Chiguano, G.F., Cleland, J.A., López-de-Uralde-Villanueva, I., Fernández-de-Las-Peñas, C., Ortega-Santiago, R. and Plaza-Manzano, G., 2020. Effects of trigger point dry needling for the management of knee pain syndromes: a systematic review and meta-analysis. Journal of Clinical Medicine, 9(7), p.2044.
• Farazdaghi, M., Abdollahian, N., Rahimi, M. and Motealleh, A., 2021. Dry needling trigger points around knee and hip joints improves function in patients with mild to moderate knee osteoarthritis. Journal of bodywork and movement therapies, 27, pp.597-604.
• Dunning, J., Butts, R., Young, I., Mourad, F., Galante, V., Bliton, P., Tanner, M. and Fernández-de-Las-Peñas, C., 2018. Periosteal electrical dry needling as an adjunct to exercise and manual therapy for knee osteoarthritis: a multicenter randomized clinical trial. The Clinical journal of pain, 34(12), p.1149
• Sánchez-Romero, E.A., Pecos-Martín, D., Calvo-Lobo, C., Ochoa-Sáez, V., Burgos-Caballero, V. and Fernández-Carnero, J., 2018. Effects of dry needling in an exercise program for older adults with knee osteoarthritis: A pilot clinical trial. Medicine, 97(26).
• Ughreja, R.A. and Prem, V., 2021. Effectiveness of dry needling techniques in patients with knee osteoarthritis: a systematic review and Meta-analysis. Journal of bodywork and movement therapies, 27, pp.328-338.
• Ma, Y.T., Li, L.H., Han, Q., Wang, X.L., Jia, P.Y., Huang, Q.M. and Zheng, Y.J., 2020. Effects of trigger point dry needling on neuromuscular performance and pain of individuals affected by patellofemoral pain: a randomized controlled trial. Journal of Pain Research, 13, p.1677.
• Raeissadat, S.A., Rayegani, S.M., Sadeghi, F. and Rahimi-Dehgolan, S., 2018. Comparison of ozone and lidocaine injection efficacy vs dry needling in myofascial pain syndrome patients. Journal of pain research, 11, p.1273.
• Butts, R., Dunning, J. and Serafino, C., 2021. Dry needling strategies for musculoskeletal conditions: Do the number of needles and needle retention time matter? A narrative literature review. Journal of Bodywork and Movement Therapies, 26, pp.353-363.
• Rodríguez‐Sanz, J., Pérez‐Bellmunt, A., López‐de‐Celis, C., Hidalgo‐García, C., Koppenhaver, S.L., Canet‐Vintró, M. and Fernández‐de‐las‐Peñas, C., 2021. Accuracy and safety of dry needling placement in the popliteus muscle: A cadaveric study. International Journal of Clinical Practice, 75(11), p.e14669.
• Fakhari, P., Shadmehr, A., Khanmohammadi, R., Hadian, M.R. and Kazemi, A.H., 2022. Effect of dry needling on hamstring muscles flexibility; A randomized controlled trial. Journal of Modern Rehabilitation.
• Karamiani, F., Mostamand, J., Rahimi, A. and Nasirian, M., 2022. The Effect of Gluteus Medius Dry Needling on Pain and Physical Function of Non-athlete women with Unilateral Patellofemoral Pain Syndrome: A Double-Blind Randomized Clinical Trial. Journal of Bodywork and Movement Therapies, 30, pp.23-29.
• Wang, X., Sun, Q., Wang, M., Chen, Y., Wang, Q., Liu, L. and Yuan, Y., 2022. Electrical Dry Needling Plus Corticosteroid Injection for Osteoarthritis of the Knee: A Randomized Controlled Trial. Archives of Physical Medicine and Rehabilitation.
• Mishra, N.J. and Ganvir, S., 2018. Meta-Analysis on Physiotherapy Modalities Used in Patients of Total Knee Replacement for Pain Relief. Indian journal of physiotherapy & occupational therapy, 12(4).
• Sánchez Romero, E.A., Fernández Carnero, J., Villafañe, J.H., Calvo-Lobo, C., Ochoa Sáez, V., Burgos Caballero, V., Laguarta Val, S., Pedersini, P. and Pecos Martín, D., 2020. Prevalence of myofascial trigger points in patients with mild to moderate painful knee osteoarthritis: a secondary analysis. Journal of clinical medicine, 9(8), p.2561.
• Dommerholt, J., Mayoral del Moral, O. and Gröbli, C., 2006. Trigger point dry needling. Journal of Manual & Manipulative Therapy, 14(4), pp.70E-87E.
• Calvo, S., Navarro, J., Herrero, P., Del Moral, R., De Diego, C. and Marijuán, P.C., 2015. Electroencephalographic changes after application of dry needling [DNHS© technique] in two patients with chronic stroke. Myopain, 23(3-4), pp.112-117.
• Hsieh, Y.L., Yang, C.C., Liu, S.Y., Chou, L.W. and Hong, C.Z., 2014. Remote dose-dependent effects of dry needling at distant myofascial trigger spots of rabbit skeletal muscles on reduction of substance P levels of proximal muscle and spinal cords. BioMed Research International, 2014.
• Sollie, M., Pind, R., Madsen, C.B. and Sørensen, J.A., 2021. Acupuncture (superficial dry-needling) as a treatment for chronic postherpetic neuralgia–a randomized clinical trial. British Journal of Pain, p.20494637211023075.
• Ren, L., Zhang, W.A., Fang, N.Y. and Wang, J.X., 2008. The influence of electro-acupuncture on neural plasticity in acute cerebral infarction. Neurological research, 30(9), pp.985-989.
• Xiao, L.Y., Wang, X.R., Yang, Y., Yang, J.W., Cao, Y., Ma, S.M., Li, T.R. and Liu, C.Z., 2018. Applications of acupuncture therapy in modulating plasticity of central nervous system. Neuromodulation: Technology at the Neural Interface, 21(8), pp.762-776
• Lo, Y.L., Cui, S.L. and Fook-Chong, S., 2005. The effect of acupuncture on motor cortex excitability and plasticity. Neuroscience letters, 384(1-2), pp.145-149.
• Liu, C.Z., Kong, J. and Wang, K., 2017. Acupuncture therapies and neuroplasticity. Neural plasticity, 2017, p.6178505.
• Li, X. and Wang, Q., 2013. Acupuncture therapy for stroke patients. International review of neurobiology, 111, pp.159-179.
• Kong, J., Gollub, R., Huang, T., Polich, G., Napadow, V., Hui, K., Vangel, M., Rosen, B. and Kaptchuk, T.J., 2007. Acupuncture de qi, from qualitative history to quantitative measurement. The Journal of Alternative and Complementary Medicine, 13(10), pp.1059-1070.
• Lee, J.D., Chon, J.S., Jeong, H.K., Kim, H.J., Yun, M., Kim, D.Y., Kim, D.I., Park, C.I. and Yoo, H.S., 2003. The cerebrovascular response to traditional acupuncture after stroke. Neuroradiology, 45(11), pp.780-784.
• Yang, Y., Eisner, I., Chen, S., Wang, S., Zhang, F. and Wang, L., 2017. Neuroplasticity changes on human motor cortex induced by acupuncture therapy: a preliminary study. Neural plasticity, 2017.
• Jiang, H., Zhang, X., Wang, Y., Zhang, H., Li, J., Yang, X., Zhao, B., Zhang, C., Yu, M., Xu, M. and Yu, Q., 2017. Mechanisms underlying the antidepressant response of acupuncture via PKA/CREB signaling pathway. Neural Plasticity, 2017.
• Tang, H., Guo, Y., Zhao, Y., Wang, S., Wang, J., Li, W., Qin, S., Gong, Y., Fan, W., Chen, Z. and Guo, Y., 2020. Effects and Mechanisms of Acupuncture Combined with Mesenchymal Stem Cell Transplantation on Neural Recovery after Spinal Cord Injury: Progress and Prospects. Neural Plasticity, 2020.
• Lai, H.C., Chang, Q.Y. and Hsieh, C.L., 2019. Signal transduction pathways of acupuncture for treating some nervous system diseases. Evidence-Based Complementary and Alternative Medicine, 2019.
• Pirnia, B., Bazargan, N.M., Hamdieh, M., Pirnia, K., Malekanmehr, P., Maleki, F. and Zahiroddin, A., 2019. The Effectiveness of Auricular Acupuncture on the Levels of Cortisol in a Depressed Patient. Iranian journal of public health, 48(9), pp.1748-1750.
• Yang, J.W., Ye, Y., Wang, X.R., Li, F., Xiao, L.Y., Shi, G.X. and Liu, C.Z., 2017. Acupuncture attenuates renal sympathetic activity and blood pressure via beta-adrenergic receptors in spontaneously hypertensive rats. Neural plasticity, 2017.
• Ye, Y., Zhu, W., Wang, X.R., Yang, J.W., Xiao, L.Y., Liu, Y., Zhang, X. and Liu, C.Z., 2017. Mechanisms of acupuncture on vascular dementia—a review of animal studies. Neurochemistry international, 107, pp.204-210.
• Li, Y., Wang, Y., Liao, C., Huang, W. and Wu, P., 2017. Longitudinal brain functional connectivity changes of the cortical motor-related network in subcortical stroke patients with acupuncture treatment. Neural plasticity, 2017.
• Wang, T., Wu, L., Liao, D., Zhou, X., Chen, Y. and Takeda, A., 2002. Effect of acupuncture on the expression of NT3 in the process of spinal plasticity. Hua xi yi ke da xue xue bao= Journal of West China University of Medical Sciences= Huaxi yike daxue xuebao, 33(1), pp.46-49.