The benefits of adding manual therapy to exercise therapy for improving pain and function in patients with knee or hip osteoarthritis – a systematic review with meta-analysis

Review written by Dr Joanne Kemp info

Key Points

  1. The addition of manual therapy to exercise programs had a large effect on reducing pain in the short-term in patients with hip and knee osteoarthritis.
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Hip and knee osteoarthritis (OA) create a large economic burden for society due to rapidly growing healthcare costs (1), mostly because of escalating joint replacement surgery rates. The impact of OA on the individual is also large, where affected people have daily pain impairing sleep, and preventing participation in work, sport and exercise, and social activities (2). Over time, they stop enjoying physical activities, put on weight and become less fit – increasing their risk of other chronic diseases (e.g. diabetes and cardiovascular disease) (3).

Non-surgical treatments, including exercise, are recommended before more invasive surgical treatments are considered, however the effects of exercise are modest. Physiotherapists often use manual therapy in conjunction with exercise, but we don’t know whether this enhances the effects of exercise.

This systematic review aimed to see if adding manual therapy to exercise improved outcomes of pain or function for patients with hip or knee OA.

Hip and knee osteoarthritis create a large economic burden for society.
In osteoarthritis we commonly see flares of pain where we could use manual therapy to settle pain in the short-term to allow patients to then re-engage with exercise effectively.


  • The researchers conducted a systematic review and meta-analysis, where they included randomized controlled trials that compared manual therapy and exercise to exercise alone in patients with hip or knee OA. The exercise programs needed to be supervised by a clinician
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