QUESTION: What are the effects of manual therapy on pain, range of motion, and activity in patients with anterior knee pain? DESIGN: Randomised controlled trial. PARTICIPANTS: Thirty-eight ambulatory care patients (one dropout) with anterior knee pain. INTERVENTION: The experimental intervention consisted of six sessions of manual therapy, while the control intervention was to remain on the waiting list for two weeks. OUTCOME MEASURES: Pain was measured using the Patellofemoral Pain Severity Questionnaire. Active knee flexion and extension was measured from photographs. Activity was measured by having the participants step up and down a 15 cm step, leading with the painful leg as many times as they could in a 60 second period. Measurements were taken before and after intervention by a blinded assessor. RESULTS: The experimental group decreased their pain by -8 mm (95% CI -17 to 1, p = 0.08) and pain on stairs by -10 mm (95% CI -22 to 2, p = 0.10) compared with the control group. They increased their active knee flexion by 10 deg (95% CI 4 to 16, p = 0.004) and the number of steps in 60 seconds by 5 (95% CI 2 to 8, p = 0.001) compared with the control group. CONCLUSION: Manual therapy is effective in improving knee flexion and stair climbing in patients with anterior knee pain. There is a trend towards a small improvement in pain.

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