Periosteal Electrical Dry Needling for Knee Osteoarthritis

Inclusion Criteria: 1. Adult over the age of 18 years old: 2. Report of knee pain of at least 2/10 per NPRS (0---10 scale) for \>3 months 3. Report of at least 3 of the following per Altman et al. (1986) (sensitivity = 95% / specificity = 69%) 1. Over 50 Years of age 2. Less than 30 minutes of morning stiffness 3. Crepitus on active motion 4. Bony tenderness 5. Bony enlargement 6. No palpable warmth of Synovium Exclusion Criteria: 1. Report of red flags to manual physical therapy to include: hypertension, infection, diabetes, peripheral neuropathy, heart disease, stroke, chronic ischemia, edema, severe varicosities, tumor, metabolic disease, prolonged steroid use, fracture, RA, osteoporosis, severe vascular disease, malignancy, etc. 2. History of physical therapy, massage therapy, chiropractic treatment, or injections for knee pain in last 4 weeks. 3. History of a partial or total knee replacement on the painful lower extremity. 4. History of a surgical procedure on either lower extremity in last 12 months. 5. Two or more positive neurologic signs consistent with nerve root compression, including any two of the following: 1. Weakness involving a major muscle group of the lower extremity. 2. Diminished patella or achilles tendon reflex 3. Diminished or absent sensation to pinprick in lower extremity dermatome. 6. Involvement in litigation or worker's compensation regarding knee pain. 7. Any condition that might contraindicate the use of periosteal electric dry needling 8. The patient is pregnant.