Latest / The Total Knee Success Podcast: Your Essential Resource for Navigating Total Knee Replacement / Episode 65: How to Actually Reduce Pain (What Works & What Doesn’t)

Transcript

Episode 65: How to Actually Reduce Pain (What Works & What Doesn’t) · The Total Knee Success Podcast: Your Essential Resource for Navigating Total Knee Replacement

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  Rest absolutely has a place, especially early
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  on. But when rest turns into prolonged avoidance,
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  the system can become more sensitive and less
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  tolerant of activity. Are you ready to get back
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  to what you love after knee replacement? The
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  Total Knee Success podcast is your trusted guide
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  with practical tips, evidence -based strategies,
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  and no fluff. It's not personal medical advice,
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  just solid education to help you manage pain,
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  regain mobility, and get back to living the life
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  you love. Let's dive in. Welcome back to the
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  Total Knee Success podcast. I'm Michelle. If
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  you've been dealing with ongoing pain after knee
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  replacement, it can feel like you're doing all
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  the right things and still not getting the response
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  you expected. By the end of this episode, you'll
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  understand what actually helps reduce pain. and
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  how to start applying it in a way that works
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  with your body. This is the third episode in
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  a four -part series on pain. If you haven't listened
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  to episode 63 and 64 yet, you can always go back
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  after this because they built the foundation
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  for what we're talking about today. I want to
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  bring you back to Linda, someone we introduced
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  earlier in the series, a made -up patient we
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  use to help walk through what many people experience
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  after knee replacement. At this point, Linda
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  has started to recognize that she may be in a
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  loop we talked about, where fear, tension, and
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  pain are feeding into each other. So the question
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  becomes, what does she actually do about it?
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  This is where a lot of people get stuck, because
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  the instinct is usually to do less, to rest more,
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  or to avoid anything that might increase pain.
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  And while that seems logical, it often doesn't
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  work the way people expect. One of the most consistent
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  findings across research in knee osteoarthritis
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  and after knee replacement is that movement,
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  when done appropriately, is not the problem.
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  In fact, appropriate movement is one of the most
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  important tools we have for improving pain and
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  function over time. There's even evidence challenging
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  the long -standing belief that exercise wears
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  down the joint. Instead, exercise and activity,
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  when done appropriately, do not appear to harm
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  the knee joint, and can support better outcomes.
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  So the goal is not to eliminate movement. The
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  goal is to change how you approach it. Let's
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  walk through what this looks like. There are
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  five key strategies that consistently help reduce
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  pain in a way that works with your body, not
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  against it. I'm going to walk you through each
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  one and as you listen, you can start to notice
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  which ones apply most to your situation. These
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  strategies are consistent with what we understand
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  from modern pain science. about how the nervous
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  system responds and adapts. They're not about
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  forcing your body to change. They're about creating
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  the conditions where your system can start to
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  respond differently over time. These are also
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  the strategies that begin to break the cycle
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  we talked about in the last episode, the loop
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  of fear, tension, and pain. What breaks that
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  loop is not doing nothing, and it's not pushing
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  through everything. It's changing how your system
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  responds. Here's what that looks like in practice.
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  Some of these strategies overlap, and that's
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  expected. You may hear one and think, that's
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  exactly what I've been dealing with, and another
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  might not feel as relevant right now. That's
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  okay. The goal isn't to apply all five at once,
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  but to recognize where you are and start with
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  what fits. The first strategy is shifting away
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  from an all -or -nothing approach. This is one
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  of the biggest patterns that keeps the cycle
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  going, doing too much or doing nothing. What
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  often works better is finding a middle ground.
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  where your system can start to adapt without
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  becoming more reactive. For Linda, this showed
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  up with stairs. She had started avoiding them
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  altogether because they were uncomfortable, but
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  avoiding them completely meant her body never
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  had the opportunity to adapt. Instead, we look
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  for a starting point that feels manageable. That
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  might mean fewer repetitions, a slower speed,
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  or using a handrail for support. This is often
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  referred to as graded exposure. You're not forcing
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  through pain and you're not avoiding it entirely.
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  You're finding a level your system can tolerate
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  and gradually building from there. Over time,
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  this helps the nervous system become less reactive
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  to that movement. The second strategy is calming
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  the nervous system. If the system is more sensitive,
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  then part of reducing pain is helping it feel
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  safer again. And just to be clear, this isn't
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  about you being a sensitive person. It's about
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  how the nervous system becomes more reactive
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  after surgery or ongoing pain. This is not a
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  judgment of personality. And this is where understanding
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  what's called the sympathetic and parasympathetic
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  nervous system becomes helpful. When your system
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  is in a more protective, high alert state, the
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  sympathetic side is more active. When things
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  feel safer and more settled, the parasympathetic
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  side becomes more active. I'll explain how that
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  works in more detail in a short educational download
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  I've put together called Making Sense of Pain
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  After Knee Replacement. But for now, just think
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  of it as your nervous system shifting between
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  more on edge and more settled. What we're trying
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  to do is shift that balance. Simple ways to do
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  this include pacing your activity, reducing constant
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  monitoring of your knee, and using your breathing
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  to settle the system. A practical starting point
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  is slow breathing through your nose, in for about
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  four seconds and out for six seconds, for a few
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  minutes at a time. If you want a more detailed
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  walkthrough, I go through some breathing exercises
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  step -by -step in episode 12 of the Totally Success
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  podcast. You can check it out when you're done
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  here. For Linda, shifting that balance meant
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  setting specific times to check in with her knee
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  instead of thinking about it all day long. Using
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  her breathing, to settle things when she noticed
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  tension building. That shift helps turn down
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  your nervous system's reactivity, so movement
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  becomes easier to tolerate. The third strategy
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  is consistency. One of the most common patterns
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  we see is doing a lot on a good day and then
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  needing to pull back significantly the next.
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  This is often called a boom and bust cycle. That
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  up and down pattern can keep the system more
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  reactive. because it never really gets the chance
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  to settle and adapt. What tends to work better
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  is a more consistent approach, where the amount
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  you're doing is something your body and your
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  knee can tolerate day after day, even if it feels
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  a little slower at first. So what does that look
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  like in practice? For Linda, on days she felt
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  better, she was walking 30 minutes and doing
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  a full set of exercises. And then the next day,
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  her pain would spike and she would skip everything.
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  Instead, She shifted to 15 to 20 minutes of walking
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  and a shorter exercise routine she could repeat
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  daily, even on days her knee felt a little more
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  sensitive. When the plan feels manageable and
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  fits into your routine like that, it becomes
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  much easier to stay consistent, which is where
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  progress starts to build. The fourth strategy
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  is using rest strategically. Rest absolutely
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  has a place, especially early on. But when rest
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  turns into prolonged avoidance, the system can
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  become more sensitive and less tolerant of activity.
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  So instead of relying on rest as the main solution,
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  it becomes something you use to support your
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  activity, not replace it. This is also where
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  things like heat and ice can be useful. These
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  can help settle symptoms temporarily, but they
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  work best when they support your overall plan,
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  not replace movement entirely. So what's that
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  look like in practice? For Linda, she had been
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  spending long stretches of the day sitting down
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  or lying down anytime her knee felt uncomfortable,
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  hoping that more rest would help it calm down.
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  Instead, she shifted to shorter, planned rest
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  breaks between activities, using a few minutes
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  to elevate her leg or apply ice, and then returning
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  to movement before stiffness and sensitivity
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  started to build up. Using rest in this way helps
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  support recovery, without letting your nervous
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  system become more reactive to movement. The
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  fifth strategy is learning how to respond to
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  pain in a way that supports progress. Pain is
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  real but it is not always a direct measure of
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  what's happening in the tissue. So instead of
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  reacting by stopping everything or pushing through
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  completely, you adjust. So what does that look
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  like in practice? For Linda, if her pain increased
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  during a walk, she used to stop completely and
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  avoid it the next day. Other times, she would
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  push through and end up more flared up afterward.
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  Instead, she began adjusting in the moment, slowing
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  her pace, shortening the distance, or taking
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  a brief pause, then continuing at a level she
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  could tolerate. Over time, this helped her build
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  confidence with movement and reduced how reactive
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  her system was because it was no longer swinging
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  between extremes. So when we put all of this
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  together, this is how you begin to break the
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  cycle. You're gradually showing your brain, your
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  nervous system, your body that movement is safe,
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  and that it doesn't need to stay on high alert.
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  This is not always easy, but it's doable. I help
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  people through this process all the time, and
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  you can also get support from a physical therapy
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  professional who's trained in pain science and
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  can guide you through it. The goal is not zero
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  pain. I guess, you know, tell that to your knee.
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  The goal is to retrain how your system responds
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  to movement and daily activity so it becomes
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  more predictable and less limiting. If you're
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  thinking about your own situation you might start
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  by asking yourself a few questions. Where am
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  I avoiding something completely that I could
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  try at a smaller level? Where am I doing too
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  much on a good day and paying for it the next?
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  What is one activity I could make more consistent
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  from day to day. Those small adjustments can
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  make a meaningful difference over time. And if
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  you're not sure where to start, go back to the
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  strategy that felt most familiar as you were
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  listening. This is usually the best place to
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  begin. If you're interested in going a little
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  deeper into this topic, I've put together a short
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  30 -page educational download called Making Sense
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  of Pain After New Replacement. It walks through
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  these concepts in a little more detail and helps
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  you understand how to apply them in your own
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  situation. You can find a link in the show notes
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  if you'd like to check it out. Before we wrap
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  up, a quick safety note. Most of what we talked
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  about today reflects normal patterns in how pain
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  can behave after knee replacement. There are,
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  however, situations where pain may signal something
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  outside the usual pattern. Things like increasing
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  calf pain with swelling or tenderness, shortness
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  of breath, chest pain, a fever, or a knee that
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  is becoming more red hot. and swollen instead
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  of gradually settling. These can be signs that
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  something else is going on. If you notice these
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  kinds of symptoms, it's important to contact
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  your surgeon or medical team so they can evaluate
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  what's happening. Next time, we'll take this
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  one step further and talk about what's actually
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  possible when it comes to changing pain over
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  time. You don't have to apply all of this at
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  once and small changes in how you approach things
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  can add up over time. Thanks for joining me.
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  I'm Michelle. And this has been the Total Knee
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  Success podcast. This podcast is for educational
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  purposes only. Discover more at TotalKneeSuccess
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  .com. And be sure to subscribe and share because
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  every step forward takes you closer to living
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  the life you love.