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Osteoarthritis of the knee is the most common form of arthritis in Canada, affecting roughly 4.4 million Canadians and accounting for hundreds of thousands of knee replacement surgeries each year. For the majority of people at the mild-to-moderate end of the spectrum, the gap between "diagnosis" and "adequate treatment" is enormous: physiotherapy wait times run 3 to 12 months in most provinces, and many extended health benefits cap coverage at a handful of sessions per year. That gap is exactly where evidence-based self-care strategies matter most — and acupressure is one of the few that has recent high-quality clinical trial support.
This is not a page claiming acupressure cures arthritis. It doesn't. But used twice daily as an adjunct to standard care, there's now good evidence it meaningfully reduces pain intensity. Here's what the research shows and how to do it correctly.
What the 2024 JAMA Network Open Trial Found
A randomized controlled trial published in JAMA Network Open in 2024 (PMC11031685) enrolled 314 adults with knee osteoarthritis and assigned them to either a structured self-administered acupressure protocol or a control condition. Over 12 weeks, participants in the acupressure group applied pressure to a standardized set of acupoints twice daily for approximately three minutes per session.
The results showed statistically and clinically significant reductions in pain intensity compared to control — meaning the differences were large enough to matter in daily life, not just on paper. Improvements in physical function and quality of life scores also favoured the acupressure group. The protocol was designed to be self-administered by middle-aged and older adults at home, which is exactly the population most affected by knee OA in Canada and most likely to benefit from a low-barrier daily routine.
Important framing: this is adjunct therapy, not a replacement for physiotherapy, appropriate exercise, weight management, or anti-inflammatory treatment. The trial participants were getting standard care; the acupressure was added on top of it. That's the right model.
Key Acupressure Points for Knee Pain
Location
On the inner side of the knee, in the natural depression just below and behind the large bony knob at the top of the inner shin — the medial condyle of the tibia (tibial head). Sit with your knee bent at a right angle. Run your thumb along the inner edge of the shin bone upward until you reach the top — you'll find a hollow just before the bone curves to form the knee. That's SP9. It's typically quite tender if you have active knee issues.
Why it's used
SP9 is the primary point for knee pain in classical and clinical acupressure protocols. It has a reputation in TCM for resolving "dampness" — which maps loosely to excess fluid, swelling, and the sensation of heaviness that characterizes many OA knees. In clinical studies, it appears consistently in multi-point knee protocols alongside ST36.
Technique
Firm thumb pressure, held for 60–90 seconds per knee. If thumb pressure is uncomfortable due to hand arthritis, a knuckle or massage ball works well here. The sensation should be a dull ache radiating down the inner shin — that's the correct response.
Location
On the inner thigh, approximately 2 inches (about 3 finger-widths) above the upper inner edge of the kneecap. Flex your knee slightly and look for the small muscle prominence on the inner thigh just above the knee — SP10 is in that area. An easy way to find it: cup your right palm over the left kneecap with the thumb pointing toward the inner thigh. Where your thumb naturally rests is approximately SP10.
Why it's used
SP10 is traditionally associated with reducing inflammation and improving circulation to the knee region. It's a secondary point in most knee protocols, often paired with SP9 to work the medial knee area comprehensively. Particularly relevant for knee OA with swelling.
Technique
Firm thumb or finger pressure, 60 seconds per knee. Can be combined with SP9 in a single inner-knee session — work SP9 first, then move up to SP10.
Location
Below the kneecap, in the outer hollow when the knee is bent. When you sit with your knee bent at roughly 90 degrees, you'll see two small hollows (depressions) on either side of the patellar ligament below the kneecap — one medial, one lateral. ST35 is specifically the lateral (outer) hollow. It's commonly called the "knee eye" point; the medial hollow is its pair (EX-LE5, the inner knee eye).
Why it's used
ST35 directly targets the knee joint itself. It's the most locally-positioned point in knee protocols and is particularly indicated for stiffness, restriction of movement, and post-surgical recovery (after medical clearance from your surgeon). Its partner medial knee-eye point can be pressed simultaneously with the thumb and forefinger, one finger on each hollow.
Technique
Knee slightly bent. Apply moderate pressure with the middle finger to ST35 (outer hollow). You can simultaneously press the inner knee eye with your index finger for comprehensive joint stimulation. Hold 60 seconds per knee.
Location
On the outer side of the lower leg, just below and in front of the fibular head — the small bony knob you can feel on the outer side of the upper shin, below the knee. Find that bony prominence, then press just below and slightly in front of it. The point is in a depression and is often tender.
Why it's used
GB34 is the "influential point" for all muscles and tendons in TCM. Its role in knee protocols addresses the chronic muscle guarding and soft-tissue tightness that develops around an arthritic knee — the secondary pain layer that often persists even after the joint inflammation is managed. People with runner's knee and IT band syndrome also find this point helpful.
Technique
Firm thumb pressure, angled slightly upward into the depression below the fibular head. 60–90 seconds per leg. Often produces a strong aching sensation radiating down the outer shin.
Location
Four finger-widths (roughly 3 inches) below the lower edge of the kneecap, one finger-width to the outside (lateral) of the shin bone. Run your fingers straight down from the kneecap until they've traveled the width of four fingers, then shift laterally just to the outside of the tibial crest. There's typically a slight hollow here and noticeable tenderness.
Why it's used
ST36 is the most researched single acupoint in clinical studies and appears in virtually every knee OA protocol. It's associated with systemic pain modulation, immune function, and general energy in TCM — but mechanistically, stimulation of ST36 activates descending pain inhibition pathways in the spinal cord. For knee pain specifically, it's a foundational point that works independently of where the primary pain is located. Studies suggest it raises pain thresholds systemically as well as locally.
Technique
Firm thumb pressure held for 90 seconds per leg. ST36 responds well to slightly longer pressure duration than most points. The sensation should be a strong ache that may radiate downward toward the foot — this is the expected response ("de qi") and indicates correct location.
The Daily Protocol
Based on the JAMA 2024 trial protocol: twice daily, approximately 3 minutes per session. This sounds minimal, but consistency matters more than duration for chronic pain management.
Session structure (seated on a chair, both legs accessible):
- ST36 — 90 seconds each leg
- SP9 — 60 seconds each leg
- SP10 — 60 seconds each leg
- GB34 — 60 seconds each leg
- ST35 (knee eye) — 60 seconds each knee
Morning and evening, seated in a chair. No floor required — this was deliberately designed to be accessible for seniors with limited mobility. If bilateral knee OA is a factor, work both legs fully before moving to the next point.
Give the protocol a minimum of 4 weeks of consistent twice-daily use before evaluating whether it's helping. The JAMA trial showed cumulative benefit over 12 weeks; don't judge after three days.
Types of Knee Pain That Respond Best
Osteoarthritis (most evidence): This is the condition with the strongest clinical trial support. If you have a confirmed OA diagnosis, this protocol is directly applicable.
Post-surgical recovery: After knee replacement or arthroscopy, acupressure can be incorporated once your surgeon has cleared you for gentle self-massage (typically 6–8 weeks post-op). Use moderate rather than firm pressure initially. Focus on ST36 and GB34, and avoid direct pressure over surgical sites.
Runner's knee / IT band syndrome (ITBS): GB34 and ST36 are both relevant here. GB34's effect on tendon and muscle tissue is particularly applicable to ITBS.
When to See a Doctor First
Do not substitute acupressure for medical evaluation if you experience:
- Sudden significant swelling in a knee that wasn't swollen before — could indicate acute injury, Baker's cyst rupture, or gout
- Fever plus joint swelling — septic arthritis is a medical emergency
- Redness and warmth around the knee alongside pain — infection or gout flare requires diagnosis
- Knee pain following a fall, impact, or twisting injury — rule out fracture or ligament tear before any pressure application
- Progressive worsening over weeks that's out of proportion to activity — warrants imaging
A Note on Acupressure Mats
If you use an acupressure mat, standing on it stimulates plantar reflexology points and the soles of the feet, which can provide some systemic relief — but this is not a substitute for the point-specific protocol above. The mat's pressure distribution covers large surface areas, not individual acupoints. The five-point seated protocol targeting SP9, SP10, ST35, GB34, and ST36 is more targeted and better-supported by evidence than general mat use for knee pain specifically.
That said, daily mat use for back and general tension is compatible with this knee protocol and may enhance the overall pain management effect through systemic relaxation and endorphin release.
Tools That Help
For point-specific knee work, a massage ball or acupressure thumb tool gives more precise pressure than fingers — especially useful if hand arthritis limits grip strength. A supportive chair that allows easy knee-bend access is more important than any tool. See our acupressure mat guide for Canadian options if you're interested in adding a mat to your routine.
The Bottom Line
Acupressure for knee osteoarthritis has better clinical trial support than most Canadians — or most family physicians — realize. The 2024 JAMA Network Open RCT adds to a growing body of evidence showing that a structured twice-daily self-administered protocol meaningfully reduces pain intensity over 8–12 weeks. In a healthcare system where wait times for physiotherapy stretch into months and knee replacement wait lists run years, this is a zero-cost, low-risk, and evidence-supported option worth taking seriously.
It works best as part of a complete management plan that includes appropriate exercise (walking, swimming, cycling), weight management if relevant, and anti-inflammatory treatment when needed. See our arthritis acupressure guide for broader coverage of OA and RA, and our complete acupressure points reference for point finder tools.
For back and hip pain that often accompanies knee OA — particularly as gait changes from the knee issue — see our back pain acupressure guide.