This systematic review and meta-analysis looked at the potential benefits of adding manual therapy to exercise therapy for patients with hip or knee OA. The authors included 19 trials and found very low to moderate certainty evidence that manual can improve pain, WOMAC scores, and stiffness but not performance-based or self-reported function in the short term.
Low to very low certainty evidence suggests manual can improve performance-based function and WOMAC global scores but not pain in the medium term. High certainty evidence suggests manual provides no long-term benefits for pain or function. The last statement suggests manual therapy is not necessary for patients with knee or hip OA. However, it may be beneficial in the short term which can be the difference between a patient returning to PT or seeking medical care.
If manual therapy can be used to reduce medication usage, build a therapeutic alliance, enhance exercise participation, and increase the likelihood of completing a plan of care, then it should be used. But many patients can likely achieve those same benefits with exercise and education alone. Manual therapy can be a useful tool, but it is often not a necessary tool.