Effectiveness of manual therapy on pain and self-reported function in individuals with patellofemoral pain: Systematic review and meta-analysis

Patellofemoral pain (PFP) is one of the most severe conditions involving the lower extremity characterized by peripatellar knee pain. The number of systemic reviews recommended the manual physical therapy (MT) to address the multiple impairments of the lower extremity, but the evidence is needed to determine the role MT can play in the rehabilitation of individuals with PFP. Therefore, the present review showed that MT might be helpful short-term for decreasing pain in patients with PFP.

To assess the effectiveness of manual therapy (MT) alone or as an adjunct therapy as compared to the sham or standard treatment to improve self-report function and reduce pain among the persons with patellofemoral pain (PFP).

CENTRAL,  PubMed,  CINAHL, and  OVID databases were searched electronically to collect the studies which involved the comparison of MT  provision either in combination or alone with sham or control therapies through August 2017. Data associated with patient self-reported outcomes and pain were gathered and synthesized. Cochrane risk-of-bias tool was applied to evaluate the trials, and then a meta-analysis of the evidence conducted.

A total of nine studies were selected out of which five found with the low risk of bias. As compared to control or sham, the MT implemented to the local knee structure was related to desirable short-term changes in self-reported pain and function among PFP individuals. However, the changes related to pain were found to be clinically significant. On the basis of three studies, the evidence was inconclusive for lumbopelvic manipulation regarding reduction in pain among the PFP patients.

The MT is helpful in reducing short-term pain among the PFP patients. Various studies incorporated MT into a comprehensive treatment program. Significant changes in self-reported function with the inclusion of manual therapy were noticed. However, it is not clinically significant. More studies are demanded to estimate the suitable approaches and doses of MT and direct longer follow-up to observe long-term effects.