Manual Therapy and Exercise for Knee Osteoarthritis: Real-World Care Patterns and Randomized Trial Evidence on Pain

Physical therapists and physical therapist assistants who manage adults with knee osteoarthritis in outpatient, hospital-based, military or community settings, and clinicians who want a plain-language account of what routine-care data and randomized trials each report about exercise and manual therapy for this population.

Physical therapists and physical therapist assistants. Physical therapist assistants may take this course; the content describes their contribution as delivery of selected interventions under the direction and supervision of the physical therapist, with evaluation, diagnosis and plan-of-care decisions remaining with the physical therapist.

Intended audience

Physical Therapy

Level

Intermediate

Delivery format

Online, asynchronous, self-paced course: interactive reading with audio or video, and a scored post-test.

Based on

This course is built on two published papers and reports only what those papers themselves state.

Young JL, Snyder RA, Rhon DI. Real-World Use of Manual Therapy and Exercise for Managing Knee Osteoarthritis—A Military Health System Analysis. JOSPT Open. 2026:1-32. doi:10.2519/josptopen.2026.0221

Zhu B, Ba H, Kong L, Fu Y, Ren J, Zhu Q, Fang M. The effects of manual therapy in pain and safety of patients with knee osteoarthritis: a systematic review and meta-analysis. Syst Rev. 2024;13(1):91. doi:10.1186/s13643-024-02467-7

After completing this course, you will be able to:

1. Describe how often adults diagnosed with knee osteoarthritis in the Military Health System cohort received exercise, manual therapy or both in the year after diagnosis, and how those care patterns related to later knee-related health care use, costs, knee arthroplasty and opioid prescriptions.
2. State what the systematic review and meta-analysis of randomized trials reported about manual therapy for knee osteoarthritis pain compared with usual care, exercise and other comparators, and what it reported about adverse events.
3. Distinguish what an observational cohort of routine care can and cannot establish from what randomized trials of manual therapy can and cannot establish, and explain where the two papers agree and where their conclusions diverge.

1. Start Here: How to Use This Course
2. Part One: Real-World Use of Exercise and Manual Therapy for Knee Osteoarthritis
3. Who Was in the Military Health System Cohort
4. How Exercise and Manual Therapy Use Was Counted
5. What the Cohort Found: Uptake, Costs, Surgery and Opioid Prescriptions
6. What a Records-and-Claims Cohort Can and Cannot Tell Us
7. Part Two: Manual Therapy for Knee Osteoarthritis Pain in Randomized Trials
8. The Trials Behind the Manual Therapy Review
9. How the Review Searched, Pooled and Graded the Evidence
10. Pain and Safety Findings Across the Trials
11. Why the Review Authors Urged Caution About Their Own Results
12. Bringing It Together
13. Where Routine Care and Trial Evidence Agree
14. Where the Two Papers Point in Different Directions
15. What the Combined Evidence Supports in a Physical Therapy Plan of Care
16. Open Questions and What Would Settle Them
17. Key Takeaways
18. Post-Test and Course Evaluation

Quinn Millington, PT, DPT, ECS is the instructor of record: the licensed clinician who reviewed this course and signed off on it. The name and credentials print on the certificate.

Disclosures. This course was developed by The ConEd Solution, which has a financial interest in its sale. No outside funding or sponsorship was received. The instructor of record has no affiliation with the authors of the source publication or their institutions.

This course awards 1.0 contact hour (60 min). How you earn them:

1. Complete the course. Every lesson, in order.
2. Pass the post-test. Score 80% or higher. Retakes are allowed.
3. Complete the evaluation. A short form rating each learning objective and the course.
4. Download your certificate. It is issued on completion and stays available in My Account.

The episode time is its measured length. Reading, post-test and evaluation times are estimates.

This course is designed to satisfy the quality requirements state boards set for continuing education. Requirements vary by state, and confirming that a course fits your renewal is up to you. Each state’s own acceptance statement is in the credit panel on this page.

1. Young JL, Snyder RA, Rhon DI. Real-World Use of Manual Therapy and Exercise for Managing Knee Osteoarthritis—A Military Health System Analysis. JOSPT Open. 2026:1-32. doi:10.2519/josptopen.2026.0221
2. Zhu B, Ba H, Kong L, Fu Y, Ren J, Zhu Q, Fang M. The effects of manual therapy in pain and safety of patients with knee osteoarthritis: a systematic review and meta-analysis. Syst Rev. 2024;13(1):91. doi:10.1186/s13643-024-02467-7