Manual Therapy
We are unable to recommend for or against manual therapy in patients with symptomatic osteoarthritis of the knee.

Rationale
We were unable to recommend for or against manual therapy due to the lack of studies examining most manual therapy techniques. No studies evaluating joint mobilization, joint manipulation, chiropractic therapy, patellar mobilization, or myofascial release were found that met our inclusion criteria. Perlman et al.77 examined Swedish massage therapy using a low-strength study design. The findings showed statistically significant results at 8 weeks, but not at 16 weeks. A conclusive recommendation regarding Swedish massage therapy could not be made based on this single low strength of evidence study.

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