Lumbopelvic manipulation for anterior knee pain: protocol for a multicenter, pilot randomized controlled trial

Anterior knee pain is a common overload-related musculoskeletal condition affecting nearly one in five individuals in both the general and athletic populations. Lumbopelvic manipulation is frequently used by manual therapists to reduce pain and improve function. Emerging evidence suggests that, when combined with other therapies, it may reduce pain in individuals with anterior knee pain. However, its specific contribution and role in routine care remain unclear. This study aims to evaluate the feasibility of a future full-scale trial comparing lumbopelvic manipulation with a sham technique, both combined with an exercise program.

This article describes a multicenter pilot randomized controlled trial. Participants with anterior knee pain will be randomized to usual care plus one lumbopelvic manipulation (HVLA thrust) or usual care plus sham manipulation. The intervention will last 4 weeks (weekly sessions), followed by a 6-week follow-up. Usual care will be delivered according to current clinical guidelines. The primary objective is to assess feasibility based on recruitment, retention, adherence, intervention fidelity and safety, blinding, and data completeness. Secondary outcomes include exploratory analyses of pain and function, accounting for participants' expectations.

This pilot study will determine whether a large-scale randomized controlled trial assessing the clinical effectiveness of lumbopelvic manipulation for anterior knee pain is feasible. Additionally, it will generate preliminary evidence regarding the potential added value of integrating this intervention with usual care strategies for managing anterior knee pain.

Prospectively registered in OSF registries (https://doi.org/10.17605/OSF.IO/TD3V6) on 06/02/2026.