Osteopathic Manipulative Treatment Versus Exercise Program in Runners With Patellofemoral Pain Syndrome: A Randomized Controlled Trial.

Runners with patellofemoral pain, the aching around or behind the kneecap that often flares with running, are usually advised to do targeted exercise programs. This trial asked whether osteopathic manipulative treatment, which combines joint manipulation and myofascial release across the lumbar spine, hip, sacroiliac joint, knee, and ankle, might work as well as a structured exercise program, comparing both against a no-treatment control group over six sessions and a 30-day follow-up. Both active treatments reduced pain more than no treatment at all. The osteopathic group also showed gains in knee functionality, changes in midfoot pressure, and improved posterior thigh flexibility, while only the exercise group improved hip extension range of motion.

This suggests both approaches may help, though they seem to affect somewhat different outcomes. The trial was relatively small, and the abstract does not report a direct statistical comparison between the two active treatments, so it is not clear whether one worked better than the other overall.

If you're a runner dealing with pain around the front of your knee, known as patellofemoral pain, you may wonder whether hands-on manual therapy could help alongside or instead of exercise. This study looked at that question by comparing a manual therapy technique called osteopathic manipulative treatment, exercise routines designed for the legs, and a group that received no treatment at all. Both the manual therapy and the exercise program led to less knee pain compared with no treatment.

The manual therapy group also showed improvements in knee function, some changes in foot pressure patterns, and better hamstring flexibility, while only the exercise group gained hip flexibility. This is encouraging in the sense that both approaches showed benefits, but the study involved a relatively small number of runners, and it does not tell us whether one treatment worked better than the other, since they were not directly statistically compared.

Larger studies would help clarify how these findings apply more broadly.

This is a summary of research, not medical advice. Talk to your own healthcare provider about anything affecting your care.

This randomized controlled trial enrolled 82 runners with patellofemoral pain syndrome, allocated to osteopathic manipulative treatment, an exercise program, or a no-intervention control, with outcomes assessed before intervention, after six sessions, and at 30-day follow-up. Both active groups showed a statistically significant reduction in pain (visual analog scale) relative to control, supporting the established evidence for exercise while extending this to osteopathic manipulation. Secondary outcomes diverged: the osteopathic group showed improved Lysholm functionality scores, decreased plantar pressure in the midfoot, and increased posterior thigh flexibility (sit and reach test), whereas hip extension range of motion improved only in the exercise group.

The abstract does not report a direct statistical comparison between the two active arms, so relative superiority cannot be inferred from these results, only that each outperformed no treatment on certain measures. Clinicians should note the modest sample size split across three groups, which limits precision, and that dynamic knee valgus (step-down test) was assessed but its results were not detailed in the abstract.

No safety data were reported. These findings support further investigation into manual therapy as an adjunct for this population rather than establishing definitive comparative efficacy.