To wrap your head around the reasons your knee replacement recovery hasn’t gone according to plan, put your thinking cap on, because I’m going to give it to you straight, leaving no knee left unturned.
While we’re on the subject of your knee turning (twisting), one of the many reasons your knee replacement rehab has gone slower than expected is the lack of attention to restoring your muscles’ ability to rotate your leg at your knee and your thigh (femur) at your hip joint.
AI, Standard Procedure, and First-Layer Knowledge
Regardless of what large language model (LLM) you use to see what your knee replacement recovery will entail, you’ll get the story the vast majority of practitioners have been acting out for decades.
It’s the standard procedure, making it unremarkable and, by design, easily repeatable.
When you don’t know what you don’t know going into knee replacement recovery, it’s nearly impossible to see the signs of first-layer knowledge.
First-layer knowledge does leave clues, though. One clue among many indicators is the practitioner’s readiness and willingness to simply throw everything (and anything) at the area where you feel pain and stiffness.While you’ve experienced setbacks in your knee replacement recovery, it’s less about you not doing the common-knowledge exercises and stretches, and more about unknowingly following along with first-layer knowlege, a level of understanding that doesn’t align with the principles of human function.
For instance, stretching and actively releasing muscles practitioners with first-layer knowledge can’t confirm are tight.
If I Were In Your Shoes
If practitioners with first-layer knowledge could identify tight muscles from those that are underperforming, I’d cross my fingers. Then, I’d hope they have the mental acuity to recognize that stretching and actively releasing muscles results in your muscles responding to ground reaction forces like a Slinky, which is a level of function that has your foot in contact with the ground longer than you want it to be.
In the sections that follow, my objective is to convince you that the setbacks you’ve encountered stem from practitioners’ flawed thought processes at the outset of your knee replacement recovery and, of course, their failure to course-correct along the way.What you want is for muscles to respond to the ground like a spring.
When I Taught Kinesiology
I taught kinesiology (the study of human movement) for 15 years. Each semester, I told students that to have a complete understanding of human motion, you have to know how the body functions in two ways: how muscles produce motion when you’re lying on a massage table, for instance, is different than when your foot interacts with the ground during the walking gait cycle.
For example, when you walk, your quadriceps don’t straighten your knee; your calf muscles are primarily responsible for playing that role (hint, hint).
With ground reaction forces to contend with, two of your calf muscles work together to straighten your knee, giving your psoas major, a muscle that originates from the front of your spinal column and acts as the primary flexor of your hip, the go-ahead to pull your heel off the ground when you walk.
Has anyone confirmed that your psoas major and those two calf muscles are, in fact, capable of performing their role to the best of their ability?
Knee Pain? Activate THIS Muscle.
Common-Knowledge Exercises and Compensation
Before your knee was replaced, you were compensating for every pain, injury, surgery, foot orthotic, and, if you’re a female, pregnancy and the delivery of a child.
Since the vast majority of practitioners fail to address muscle imbalances before introducing their one-size-fits-all exercises, those common-knowledge exercises add to the compensation that was occurring before your knee was replaced.
Compensation, in other words, is cumulative.
When you perform a common-knowledge exercise for your quadriceps, for instance, the muscles that are receiving the appropriate amount of neurological feedback get stronger. Whereas the underperforming quadriceps don’t get stronger.Because common knowledge exercises lack specificity, they fail to strengthen muscles that are underperforming.
A note for learners: a wall sit is a common-knowledge exercise that isn’t as productive as it’s been made out to be. This can be figured out with a basic understanding of physics, something I learned over two decades ago. Yet today, you’d be hard-pressed to find a college program that teaches its students to recognize the detrimental forces on both knees when a wall sit is the exercise of choice.
Your Screw Home Mechanism
When you’ve lain on a treatment table and worked hard to bend and straighten your knee, it’s unlikely any effort went into restoring your muscles’ ability to rotate your leg, a motion you have to own before terminal knee extension (straightening) can be accomplished.
I mentioned owning the range of motion because the standard procedure mindset has you renting motion for approximately 24 hours, only to be right back where you were before the previous session.
Regardless of how much improvement you’ve felt with stretching and common-knowledge exercises, neither one of those inputs has what it takes for your brain to remodel itself, i.e., neuroplasticity.When you’re stuck in the vicious cycle of renting motion, you aren’t creating an environment for optimal healing to take place between appointments.
A note for learners: the outward rotation of your leg that’s required to straighten your knee is called the screw home mechanism. For this to occur, the muscles that are responsible for producing the motion have to receive the neurological feedback to rotate your leg when it’s bent at a 30-degree angle on a treatment table. It’s a joint motion that requires no conscious effort on your part. While it rarely enters into the thought process when recovery from a knee replacement is the goal, every practitioner deemed qualified to work with your muscular and skeletal systems learns the mechanics that allow for the screw home mechanism. Not only that, but they also learn that terminal knee extension is the most stable position for your knee (e.g., the closed-pack position).
The Not So Obvious Gap in Knowledge
When practitioners use your leg as a lever, forcing it to bend beyond what you can actively do on your own, and call it a stretch—they increase compensation. It’s counterproductive, and it’s bad for your knee replacement recovery.
On The Wrong Side of RightCommon-knowledge exercises that require movement don’t change the threat of instability your brain perceives.
In Warren Berger’s The Book of Beautiful Questions, he quotes the late Daniel Kahneman saying, “Overconfidence arises because people are often blind to their own blindness.”
Somewhere between ego and bias, practitioners take to their online echo chambers, posting that muscles can always perform their role, while also promoting exercises that require joint motion—thereby increasing compensation and fragility.
There’s Harm in Going By Feel
While it’s comforting to be on the wrong side of right, going by feel isn’t the compass that you think it is.
A note for learners: it’s an oversimplification to say your muscles are tight and that stretching or actively releasing them is the “fix”. For nearly three decades, I haven’t recommended stretching because, regardless of how it feels to you, there’s no therapeutic benefit whatsoever. That’s also the case for foam rolling.
Regardless of how therapeutic it feels when you perform a common-knowledge exercise, beyond your conscious awareness, your brain perceives instability. Then the control center between your ears, which is hardwired to protect you from the threat of instability, calls upon certain muscles to restrict your range of motion.
Because ~99% of practitioners deemed qualified to work with your muscular and skeletal systems aren’t equipped with the skill set to identify underperforming muscles before your first time stretching or doing a common-knowledge exercise, you most certainly have muscles that are unable to contract to the best of their ability.
For well over two decades, I’ve been able to identify the muscles that are underperforming from session to session. Once the underperforming muscles are confirmed, I use a deep tissue massage technique to restore the neurological feedback to muscles that haven’t been able to provide stability for some time.
Hip Pain? Activate THESE Quad Muscles.
Note: In addition to teaching kinesiology, I have 31 years of hands-on experience as a licensed massage therapist, and for 18 of those years, I worked at the highest level as a personal trainer.
Between Joint Motion, There’s A Moment of Stillness
In the space between the time when your muscles go from shortening to lengthening or lengthening to shortening, there’s an isometric contraction, which is a position and moment in time where your muscles are shortened, but there’s no motion at the joint.
Exercise Without Moving
Counterintuitive and not at all sexy, increasing strength without motion at your knee is far more productive than attempting to gain range of motion with common-knowledge exercises and the age-old stretches that, in more ways than one, do more harm than good.
When you work with me online, I’ll address joint instability and compensatory patterns with an underutilized form of exercise that doesn’t involve joint motion, so, of course, compensation is avoided.
Pull, Punch, Punch
When you walk, the constant pull of gravity pulls you into the ground. Your foot, in other words, lands the first punch. And then, the ground reciprocates, landing a punch of its own (that can’t be avoided).
For your knee to tolerate the force that the ground is bringing on every step, muscles have to be capable of contracting at the right time in the walking gait cycle.
A note for learners: when you walk, two calf muscles are primarily responsible for straightening your knee, and your psoas major, which is primarily a hip flexor, is responsible for lifting your heel off the ground. Calf raises, therefore, don’t translate to the walking gait cycle.
Following in the footsteps of practitioners who promote foot orthotics that cost hundreds of dollars and yield the same outcome as store-bought inserts, most athletic shoe companies promote pseudoscience.
Your foot consists of 28 bones and 33 joints, and, like your hip, allows for motion in three directions. When your foot’s in an environment that doesn’t allow it to move as it’s designed to, your front foot can’t follow the lead of your rear foot, and vice versa.
As you’ve gone through rehab for a knee replacement, have you been walking with athletic shoes or custom-molded orthotics that don’t allow your foot, and as a result, your knee to flex properly?
Your foot consists of 28 bones and 33 joints, and, like your hip, allows for motion in three directions.
When your foot interacts with the ground, your knee moves in three directions (or planes of motion). But the motions that allow your knee to move in three directions can only happen when your athletic shoes allow the arch of your foot to flex (pronate).
As you’ve gone through rehab, have you done common-knowledge exercises with your foot on the floor while wearing an athletic shoe that didn’t allow your base of support to move as it’s designed to move?
A final note for learners: to summarize, when your athletic shoe complements how your foot interacts with the ground, your knee allows for a third motion (e.g., abduction of your leg). The aforementioned third motion at your knee is due to the mechanical interrelationship between your rear foot and knee. Because your knee is located between your rear foot and hip, and those joints allow for three directions of movement, your knee follows suit with three planes of motion of its own.
I have held a license to practice massage therapy for 31 years. For 18 of those years, I worked at the highest level as a personal trainer. During that time, I completed thousands of one-on-one personalized fitness training sessions. I went on to teach the biomechanics of exercise to personal trainers, group exercise instructors, and physical therapists throughout New England. Teaching exercise biomechanics led to consulting work for The Greenbrier, Canyon Ranch, and ESPN, which evolved into four years of providing deep tissue sports massage at ESPN.