Knee pain is a common complaint, and patients often wonder if manual therapies provided by a doctor of chiropractic can help manage their knee pain. In many cases, the answer is yes. Let’s take a look at what the research has to say about using manual therapy to address two frequent causes of knee pain and disability: knee osteoarthritis (KOA) and patellofemoral (PF) pain.
A recent systematic review and meta-analysis (the highest regarded level of research) studied the effectiveness of manual therapy for relieving pain, stiffness, and dysfunction in patients with KOA. The review uncovered 14 studies that showed that manual therapy offered “statistically significant” benefits in relieving pain, stiffness, and improving function, with the best results obtained when treatment extended for four or more weeks. The authors concluded that manual therapy is effective and safe and offers a complementary and alternative treatment option for KOA.
In a 2021 study, researchers found that KOA patients who received treatments that included manual therapy and supervised exercise experienced more significant improvements in pain and functions than participants in a supervised exercise-only group.
In 2018, an international panel of 41 specialists released a consensus statement following their review of the available literature with respect to the treatment of PF or kneecap pain and made strong recommendations in support of the use of exercise therapy (especially when combined with hip- and knee-focused exercise) and foot orthoses to improve PF pain and/or function. Researchers also found support for manual therapy applied to the soft tissues, dry needling, and gait retraining; however, they required additional evidence prior to issuing a strong recommendation for these treatment options.
A 2020 study reported that mobilization is an effective treatment in both weight bearing and non-weight bearing positions. Another study published in the same year recommended addressing alignment, muscle imbalance, and patellar maltracking in runners with PF pain.
A literature review published in 2021 highlighted the importance of patient education (PE) with and without targeted, knee-specific exercise intervention as important components of care in decreasing pain and improving function in patients with PF knee pain. The review recommended including individualized PE to each patient that focuses on the latest effective treatments, self-management strategies (specific exercise training), and an explanation of risk factors and movement patterns that may lead to and/or exacerbate PF pain.
For both PF and KOA, doctors of chiropractic utilize a multimodal approach that may include patient education, focused exercises, manual therapies, posture correction, gait retraining, nutrition recommendations, and prescription foot orthotic fitting, if necessary.
