Advice for  Knee Replacement Therapy

Most readers know by now that I authored a book, available on Amazon, entitled; Fast Track Your Recovery From A Knee Replacement: How To Eliminate Pain and Pain Medicine The Fastest Way Possible.

A recent reader suggested in a review that including a chapter on ways to “move on” if the surgeon/hospital/PT is at odds with the knee replacement protocol defined in the book would be beneficial.

Here I offer up a few thoughts that might be of value on this subject without laying out an entire chapter.

First of all, I don’t know of any surgeon or hospital that would object to the principles laid out in this book and in fact the book has been read and reviewed by an excellent retired total knee surgeon of 25 years from the east coast.

knee replacement protocolSecondly, the approach while having many similarities to conventional therapy prescriptions is different in emphasis, empowerment, volume of exercises and monitoring effectiveness. It is not different in kind like an owl being different than say a freshwater trout, but different in degree like a common trail horse being different than a race horse.

In the book I recommend a sequential emphasis, range of motion then strength and on to functional mobility with defined benchmarks qualifying your move to the next phase.

I also recommend a limited repertoire of exercises, the meat and taters so that you will wisely be able to ramp up your frequency without feeling overwhelmed and causing your faithfulness to flag.

“The greater the number of exercises in a routine the more likely you are to avoid the most difficult ones” is a truism that I have seen proven over and over again. So I keep the core number of exercises nice and compact.

In addition, I spend a lot of time trying to explain the rationale behind the method, hopefully setting you up to make quality decisions should some part of this be at odds with people on your particular path.

Because the method comes with benchmarks, tons of feedback and an emphasis on incremental stretching, I can’t conceive of a safer more protective way to recover.


Think of this approach as a way of piecing together valuable tactics to accelerate the overall progress. Each tactic taken individually would not be as powerful. The more pieces you can add the more puzzle-210785_640synergy you create. This allows creativity when working with others.

If a therapist gives you a bunch of exercises and only one includes a focus on stretching into flexion, I would definitely try to change that ratio especially if you find yourself stagnant trying to improve your range.

If your therapist is encouraging a lot of early walking (first two weeks) and you are having trouble controlling your pain levels think about curtailing that a bit.

If your therapist is doing active assistive range, meaning they are helping you “push” your knee into greater flexion and you have a lot of soreness immediately following or the next day such that you don’t want to do anything, have a talk with your therapist about scaling that portion back and asking for other flexion exercises that can be done on your own.

Many therapists won’t see the real help that a low friction surface provides but on the other hand probably won’t object if you want to use one.

Most therapists will not have seen the FLEX bar but should intuitively recognize that it is just another method of leverage.

So if someone skims briefly through the book he might conclude there is “nothing new” and in a sense they are right “a horse” is “a horse”. But to someone who knows horses, there is a world of difference between a trail horse and a racing horse.

The book has been laid out so that the patient can hopefully understand the principles behind each prescription and make good decisions that will shorten recovery time from knee replacement surgery. Remember, I learned these techniques over the course of 20 years through trial and error helping hundreds of patients. Your therapist may have seen a limited number of “knees” and is relying on the basics taught in school.

trust-440224_640My final word is about trusting yourself and your ability to think. Do your exercises 2 times a day and then do them 4 times a day. How do you feel? What was the result of your stretching? Did it improve?

Perform your heel slides according to the book method and then do them without. Did it make a difference in effectiveness?

It’s hard for many older people to doubt the absolute expertise of the medical profession. Yet sadly there are abundant reasons in the 21century to be cautious and attempt to think for yourself, gathering information on your own and comparing that with the medical profession. This is not to scare you but to encourage you. Use your brain and go with your gut.




Michelle, PT
Michelle, PT

Michelle Stiles called "the no nonsense" therapist, by her patients, created a company called Cowboy Up Recovery after recognizing the bankruptcy of the present medical model. Too many people regard conventional medical wisdom as gospel, ignoring the subversive influences of Big Pharma and Big Medicine. She believes, Americans in general are being trained from an early age to defer to experts in numerous areas of life and losing the impulses for self-responsibility and self-reliance in the process. Over-diagnosis and over-medicating has become endemic. While thankful for the best miracles of modern medicine, she encourages people of all persuasions to listen to their bodies and seek out answers to maintain not just an absence of disease but optimal health. Her advice is: Cowboy Up, no one cares more about your health than you do.

    2 replies to "Use Your Brain And Go With Your Gut In Knee Replacement Protocol"

    • Pat Exkert

      Just had a total knee replacement 3 weeks ago. Had two weeks in house PT and now out patient PT in a rehab center. I feel like they aren’t doing much, and my 100 degrees has went back to 90 degrees. On my off days, I do the excerises the in home PT gave me. But often one session, My leg swells up and tightens up, making it impossible to do much. It’s so tight!
      I’m at a loss as to what to do.

      • Michelle, PT

        In cases like this please refer to my book on Amazon. The most likley reasons for knee swelling after the initial surgical period is doing too much too soon a very common problem especially for younger people. Follow the three phases of recovery and build gradually in each phase and you will do well. Combining strength training, aggressive stretching or just not stretching frequently enough (the most important goal after surgery) will cause you to regress. I call the hour to hour and a half outpatient sessions “monster sessions”. If you can do more exercise/stretching later in the day or the next day you have done too much.

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