Objective To review current research advances in Pendulum Leg Swing Therapy for the management of knee osteoarthritis (KOA). MethodsRelevant research literature published in recent years was reviewed, and progress in the field was summarized across five dimensions: theoretical origin, mechanisms of action, clinical evidence, limitations of existing research, and future directions. Results Derived from ancient Chinese Daoyin Therapy, Pendulum Leg Swing Therapy activates and strengthens the periarticular musculature of the knee and hip to enhance knee joint stability. On this basis, it optimizes local biomechanical loading of the joint, improves blood circulation and metabolic homeostasis, and modulates the inflammatory microenvironment, exerting synergistic therapeutic effects via multiple targets. In clinical settings, Pendulum Leg Swing Therapy demonstrates notable advantages in pain relief, joint function improvement, muscle strength enhancement, and patient adherence. When administered as monotherapy or in combination with other interventions, its efficacy is non-inferior to that of conventional physiotherapy, structured exercise therapy, pharmacological interventions, and intra-articular injections. Nevertheless, certain safety risks remain. Comprehensive baseline assessments must be performed for all patients prior to treatment. For individuals with lumbar or lower extremity disorders, high habitual physical activity levels, or severe KOA, training intensity should be reduced, movement patterns modified, or adjunctive therapies added to compensate for the limitations of monotherapy. Throughout the treatment course, clinicians are required to strengthen supervision, standardize training protocols, and prohibit patients from independently adjusting training volume or exercise intensity. ConclusionPreliminary and positive progress has been made in clinical research on Pendulum Leg Swing Therapy, covering both efficacy validation and safety evaluation. Going forward, large-sample, multi-centre randomized controlled trials with long-term follow-up are warranted to further elucidate underlying mechanisms and provide robust evidence for the formulation of clinical guidelines and optimization of treatment regimens. Meanwhile, integrating precision medicine frameworks to construct efficacy prediction models and individualized training protocols, alongside biosensor-enabled monitoring for home-based training, will elevate the standardization of this therapy and improve long-term patient adherence.