Objective <p>To observe the clinical efficacy of sitting-position knee adjustment Tuina (Chinese therapeutic massage) and therapeutic ultrasound in treating knee osteoarthritis (KOA) and the impact on gait analysis parameters.</p> Methods <p>In a randomized controlled design, 80 KOA patients were randomly allocated to a manipulation group and an ultrasound group, each with 40 cases. Patients in the manipulation group received the sitting-position knee adjustment Tuina treatment; patients in the ultrasound group received low-frequency ultrasounds for treatment. The intervention was conducted twice weekly, and therapeutic efficacy was evaluated after 4 weeks of treatment. Before treatment, immediately after treatment, and after 2-week and 4-week treatment, the visual analog scale (VAS) and the Western Ontario and McMaster Universities osteoarthritis index (WOMAC) scores were observed; the gait analysis outcomes were compared before treatment and after 4-week treatment, including cadence, speed, step length, stride length, single stance phase, double stance phase, and the maximal flexion angle of the knee joint.</p> Results <p>Intra-group comparisons revealed that both groups showed decreased VAS scores and increased WOMAC scores immediately after treatment and after 2-week and 4-week treatment, with statistical significance (<i>P</i>&lt;0.05). Immediately after treatment, the VAS score was lower in the manipulation group than in the ultrasound group (<i>P</i>&lt;0.05), and the WOMAC pain score was higher in the manipulation group (<i>P</i>&lt;0.05), while the ultrasound group had a higher WOMAC stiffness score than the manipulation group (<i>P</i>&lt;0.05). After 2 weeks of treatment, there were no significant differences in VAS and WOMAC scores between the two groups (<i>P</i>&gt;0.05). After 4-week treatment, the ultrasound group had a higher WOMAC pain score than the manipulation group (<i>P</i>&lt;0.05), and the manipulation group had higher WOMAC stiffness and function scores than the ultrasound group (<i>P</i>&lt;0.05). The between-group difference in the WOMAC total score remained statistically insignificant throughout the treatment (<i>P</i>&gt;0.05). Regarding the gait parameters, both groups showed improvements in the cadence, speed, step length, stride length, single stance phase, double stance phase, swing phase, and maximal knee flexion angle immediately after treatment and after 2 and 4 weeks of treatment; the intra-group differences were all statistically significant (<i>P</i>&lt;0.05). After 4-week treatment, the manipulation group surpassed the ultrasound group in improvements in stride length, step length, swing phase, single stance phase, and maximal knee flexion angle (<i>P</i>&lt;0.05).</p> Conclusion <p>Both the sitting-position knee adjustment Tuina and low-frequency ultrasound therapies are effective in treating KOA and can improve the patient’s walking ability; the sitting-position knee adjustment manipulation demonstrates superior immediate pain relief and long-term improvement of stiffness, joint function, and walking ability compared to the low-frequency ultrasound.</p>