Knee pain has many causes. NICE (the National Institute for Health and Care Excellence) says: "Do not offer acupuncture or dry needling to manage osteoarthritis." [3] The NHS lists osteoarthritis among the causes of knee pain [1]. A 2019 American College of Rheumatology and Arthritis Foundation guideline, as reported by NCCIH, reaches a different conclusion, set out below.
What knee pain is
The NHS says knee pain can often be treated at home, and that you should start to feel better in a few days. It says knee pain can be a symptom of many different conditions and advises not to self-diagnose [1].
For pain after an injury, the NHS lists causes such as sprains and strains, tendonitis, a torn ligament, tendon or meniscus, and a dislocated kneecap. For pain with no obvious injury, it lists osteoarthritis, bursitis, bleeding in the joint, gout or septic arthritis, and Osgood Schlatter's disease [1].
Osteoarthritis. The NHS describes osteoarthritis as a condition that causes joints to become painful and stiff, and the most common type of arthritis in the UK. It most often causes problems in the knees, hips and small joints of the hands. It is a long-term condition that cannot be cured, but the NHS says it does not necessarily get any worse over time and can sometimes gradually improve [2]. In osteoarthritis, the NHS says, the protective cartilage on the ends of the bones breaks down [2].
What the guidance and research say about acupuncture
NICE guidance (NG226, osteoarthritis in over 16s). NICE's recommendation 1.3.8 reads: "Do not offer acupuncture or dry needling to manage osteoarthritis." [3] This guideline covers osteoarthritis in general, not only the knee.
The NHS. For osteoarthritis, the NHS lists regular exercise, losing weight if overweight, suitable footwear, painkillers and a structured exercise plan with a physiotherapist. In a small number of cases it lists surgery. Its knee pain and osteoarthritis pages do not list acupuncture [1][2].
NCCIH. NCCIH, part of the US National Institutes of Health, reports [4]:
- a 2018 review of 10 studies (2,413 participants) found acupuncture more effective than no treatment for osteoarthritis pain
- the same review's analysis of 9 studies (2,376 participants) found acupuncture more effective than sham acupuncture
- most participants had knee osteoarthritis, and the difference from no treatment was greater than the difference from sham acupuncture
- the pain-relieving effect of acupuncture was comparable to that of NSAIDs (anti-inflammatory painkillers) in that review
- a 2019 guideline from the American College of Rheumatology and the Arthritis Foundation conditionally recommends acupuncture for osteoarthritis of the knee, hip or hand, and states that the greatest number of studies showing benefits have been for knee osteoarthritis
NICE and the American guideline were produced by different bodies and reach different conclusions. This page does not decide between them.
Acupuncture in Malaysia
What acupuncture is. NCCIH, part of the US National Institutes of Health, describes acupuncture as a technique in which practitioners insert fine needles into the skin. The needles may be manipulated by hand or stimulated with small electrical currents (electroacupuncture). Acupuncture originated from traditional Chinese medicine [4].
Registration. Malaysia's Traditional and Complementary Medicine Act 2016 (Act 775) defines traditional and complementary medicine to include traditional Chinese medicine [5]. Under section 25 of the Act, in force since 1 March 2021, a person who is not a registered practitioner shall not practise traditional and complementary medicine services [5][6]. A registered practitioner must hold a valid practising certificate, which is valid for not more than twelve months and must be displayed at the place of practice (section 26) [5].
Referral. Section 30 of the Act requires a registered practitioner to refer a patient to a medical or dental practitioner if the patient has an acute medical emergency, or if the condition is beyond the practitioner's skill, competency or expertise [5]. Under section 30(3) the practitioner must explain this duty to the patient, or the patient's guardian or representative, so that they can make an informed decision about whether to refuse being referred. Section 30(4) says that if the patient, guardian or representative gives written notice consenting not to be referred, the practitioner is not obliged to refer [5].
NCCIH's guidance is not to use acupuncture to postpone seeing a health care provider about a health problem [4].
Safety. According to NCCIH, relatively few complications from acupuncture have been reported, but complications have resulted from nonsterile needles and improper delivery. When not delivered properly, acupuncture can cause serious adverse effects, including infections, punctured organs and injury to the central nervous system [4]. The NHS lists two situations in which acupuncture may not be safe: taking blood-thinning medicine or being at increased risk of bleeding, and having a skin condition or skin infection [7].
When the sources say to get medical help
Each source below sets its own level of urgency. Malaysia's emergency line is 999 [8]. The regulator's numbering plan also lists 112 as the code for mobile phones routed to emergency services [9].
Urgent advice from NHS 111 (NHS, UK) [1], for knee pain together with any of:
- the knee is very painful
- you cannot move the knee or put any weight on it
- the knee is badly swollen or has changed shape
- the knee locks, gives way or painfully clicks (the NHS says painless clicking is normal)
- a very high temperature, or feeling hot, cold or shivery, with redness or heat around the knee, which the NHS says can be a sign of infection
The NHS says 111 will tell you what to do and where to get help [1].
See a GP (NHS, UK):
- knee pain that does not improve within a few weeks [1]
- persistent symptoms of osteoarthritis, so a GP can confirm the diagnosis and prescribe any necessary treatment [2]
In Malaysia (Ministry of Health portals). Klinik Kesihatan Kuala Lumpur, a government health clinic, lists outpatient (Pesakit Luar) services. It lists its service hours as 8.00am to 5.00pm Monday to Friday, with extended hours on weekday evenings and on weekends and public holidays, and says it is closed on some festival days [10]. Hospital Kuala Lumpur's emergency department says it provides 24-hour emergency medical services to people in Kuala Lumpur [11].
Find a clinic
The NHS's suggested next step for knee pain that does not improve within a few weeks is to see a GP [1]. The clinic directory lists acupuncture and traditional Chinese medicine clinics across Malaysia by state and town.
Sources
- NHS. Knee pain. Page last reviewed 21 December 2023.
- NHS. Osteoarthritis. Page last reviewed 20 March 2023 (review was due 20 March 2026).
- National Institute for Health and Care Excellence (NICE). Osteoarthritis in over 16s: diagnosis and management (NG226). Recommendation 1.3.8. Published 19 October 2022.
- National Center for Complementary and Integrative Health (NCCIH), US National Institutes of Health. Acupuncture: Effectiveness and Safety. Last updated October 2022.
- Laws of Malaysia. Traditional and Complementary Medicine Act 2016 (Act 775), English text published by the Ministry of Health Malaysia. Sections 3, 25, 26 and 30.
- Federal Government Gazette P.U. (B) 118, 23 February 2021. Appointment of date of coming into operation, Traditional and Complementary Medicine Act 2016.
- NHS. Herbal medicines and complementary therapies. Page last reviewed 1 May 2026.
- Malaysia.gov.my (MyGovernment portal). Malaysia Emergency Response Services (MERS) 999. Page updated 25 September 2025.
- Malaysian Communications and Multimedia Commission. Numbering and Electronic Addressing Plan, issued 26 January 2006. Schedule D.
- Kuala Lumpur and Putrajaya State Health Department, Ministry of Health Malaysia. Klinik Kesihatan Kuala Lumpur.
- Hospital Kuala Lumpur, Ministry of Health Malaysia. Kecemasan & Trauma.