Latest / The Total Knee Success Podcast: Your Essential Resource for Navigating Total Knee Replacement / Episode 93: Why Is Kneeling So Difficult After Knee Replacement? (What the Research Says and a Step-by-Step Way to Regain It)

Transcript

Episode 93: Why Is Kneeling So Difficult After Knee Replacement? (What the Research Says and a Step-by-Step Way to Regain It) · The Total Knee Success Podcast: Your Essential Resource for Navigating Total Knee Replacement

• 0:00
  A person may feel mild pressure, interpreted
• 0:02
  as danger, immediately unload their knee, and
• 0:05
  conclude that kneeling is impossible. Another
• 0:08
  person may have enough motion to kneel, but avoid
• 0:10
  trying because no one ever told them it was permitted.
• 0:15
  Are you ready to get back to what you love after
• 0:18
  knee replacement? The Total Knee Success podcast
• 0:21
  is your trusted guide with practical tips, evidence
• 0:24
  -based strategies, and no fluff. It's not personal
• 0:27
  medical advice, just solid education to help
• 0:30
  you manage pain, regain mobility, and get back
• 0:33
  to living the life you love. Let's dive in. Welcome
• 0:39
  back to the Total Knee Success podcast. I'm Michelle.
• 0:43
  A few weeks after her knee replacement, Maria
• 0:46
  found herself standing in her garden staring
• 0:48
  at the weeds she used to pull without a second
• 0:50
  thought. She hesitated, unsure if her new knee
• 0:53
  could handle kneeling. and worried she might
• 0:56
  damage something if she tried. That moment of
• 0:59
  uncertainty is something many people experience
• 1:01
  after knee replacement surgery. By the end of
• 1:04
  this episode, you'll understand why kneeling
• 1:06
  can feel so difficult after knee replacement,
• 1:08
  what the research actually says about safety
• 1:11
  and ability, and how a gradual practice plan
• 1:14
  can help you work toward this skill with more
• 1:16
  clarity and control. Kneeling is one of those
• 1:19
  activities that can highlight a gap between a
• 1:22
  technically successful knee replacement and how
• 1:25
  a person uses their knee in everyday life. You
• 1:28
  may be walking farther, sleeping better, and
• 1:30
  getting through the grocery store with less discomfort,
• 1:33
  yet the idea of placing your new knee on the
• 1:35
  floor can still feel unreasonable. For some people,
• 1:39
  kneeling is connected to gardening, cleaning,
• 1:41
  home repairs, prayer, exercise, playing with
• 1:44
  grandchildren, working, or getting up after a
• 1:47
  fall. For others, it's not a daily priority.
• 1:50
  Either choice is valid, and it's important to
• 1:52
  understand that difficulty kneeling is extremely
• 1:55
  common after knee replacement and does not necessarily
• 1:58
  mean that you're physically unable to kneel.
• 2:01
  Research has shown a striking difference between
• 2:03
  what people believe they can do and what they
• 2:06
  can actually do when they are given clear instruction.
• 2:09
  A review by Wilde and colleagues described kneeling
• 2:12
  as a valued activity that remains limited for
• 2:14
  many people after total knee replacement. Some
• 2:18
  studies have found that only a small portion
• 2:20
  of people report kneeling easily. even though
• 2:23
  many have needed to kneel during daily life.
• 2:25
  That doesn't automatically indicate a problem
• 2:27
  with the implant, the surgery, or your effort.
• 2:31
  Kneeling combines pressure, deep knee bending,
• 2:34
  skin sensitivity, strength, balance, and confidence.
• 2:38
  Any one of those can become the limiting factor.
• 2:41
  Let's start with the sensation itself because
• 2:43
  the word pain can describe several very different
• 2:46
  experiences. When you kneel, the front of your
• 2:48
  knee takes direct pressure from the surface beneath
• 2:51
  you. Even without surgery, kneeling on a hard
• 2:54
  floor can be uncomfortable. After knee replacement,
• 2:57
  the skin, scar, small sensory nerves and tissues
• 3:00
  at the front of your knee have been through a
• 3:02
  major procedure. Pressure that once felt ordinary
• 3:05
  may now feel sharp, hot, tender, strange, or
• 3:09
  simply unfamiliar. That is different from the
• 3:12
  deeper ache you might feel when your knee is
• 3:14
  bent, and it's also different from fear. Pressure
• 3:18
  is the contact sensation between your knee and
• 3:20
  the surface. Pain may come from sensitive tissue,
• 3:23
  swelling, the scar, or the amount of knee bend.
• 3:27
  Fear is the protective question that appears
• 3:30
  before you even lower yourself down. Could I
• 3:32
  damage the replacement? Could something move?
• 3:35
  What if I can't get back up? Those experiences
• 3:38
  can overlap. A person may feel mild pressure,
• 3:41
  interpret it as danger, immediately unload their
• 3:44
  knee, and conclude that kneeling is impossible.
• 3:47
  Another person may have enough motion to kneel
• 3:50
  but avoid trying, because no one ever told them
• 3:52
  it was permitted. Studies examining kneeling
• 3:55
  after knee replacement repeatedly identify discomfort,
• 3:59
  pain, fear of harming the implant, and lack of
• 4:02
  instruction as common barriers. The barrier is
• 4:05
  not always a mechanical block. Numbness around
• 4:08
  the incision is also common. During a typical
• 4:11
  knee replacement, small superficial skin nerves
• 4:14
  at the front of the knee may be stretched or
• 4:16
  divided as part of the surgical approach. This
• 4:19
  can result in an area of reduced or altered sensation,
• 4:23
  often along the outer or lateral side of the
• 4:25
  incision. The size and intensity of this area
• 4:28
  may decrease over time, but some degree of altered
• 4:31
  sensation can persist. When a numb or partially
• 4:35
  numb area is pressed against a surface, it may
• 4:38
  not feel natural and can be perceived as thick,
• 4:41
  electric, prickly, hypersensitive or somewhat
• 4:44
  disconnected from the rest of the knee. That
• 4:47
  altered sensory input can make kneeling feel
• 4:49
  less predictable. You place your knee down, but
• 4:52
  the sensation may not match your memory of kneeling
• 4:54
  before surgery. Your nervous system receives
• 4:57
  a new pattern of pressure and sensation, and
• 5:00
  the first response may be to pull away. With
• 5:02
  appropriate clearance and gradual exposure, repeated
• 5:05
  contact on a forgiving surface may help the sensation
• 5:08
  become more familiar. The goal is not to force
• 5:12
  numb tissue to feel normal. The goal is to learn
• 5:15
  what your current knee can tolerate safely. Now
• 5:18
  we need to separate implant safety from individual
• 5:21
  precautions. For many people with a well -heeled,
• 5:25
  uncomplicated total knee replacement, kneeling
• 5:27
  does not appear to damage the implant. Studies
• 5:30
  of implant mechanics and post -operative kneeling
• 5:33
  have not established that ordinary kneeling causes
• 5:35
  loosening simply because the front of the knee
• 5:38
  touches the floor. but that general statement
• 5:40
  does not override your surgeon's instructions.
• 5:44
  Before beginning direct kneeling practice, clarify
• 5:47
  with your surgeon or physical therapist whether
• 5:49
  you're cleared to kneel and when it's appropriate
• 5:51
  to begin. Early kneeling is generally discouraged.
• 5:55
  The incision must be fully healed and your care
• 5:58
  team may have additional precautions based on
• 6:00
  your specific surgery, tissue healing or medical
• 6:03
  history. Some surgical approaches and implant
• 6:06
  designs may affect comfort or available motion,
• 6:09
  but research has not identified one design that
• 6:12
  guarantees easy kneeling for every person. A
• 6:16
  2021 systematic review of surgery -related predictors
• 6:19
  reported that kneeling ability varied widely
• 6:22
  and was not explained by a single surgical factor.
• 6:27
  One of the most practical studies on this subject
• 6:29
  was published by Wallace and Berger in 2019.
• 6:33
  They surveyed people 18 to 24 months after total
• 6:36
  knee arthroplasty. Among the individuals included
• 6:39
  in the survey, 68 % could kneel with little or
• 6:42
  no difficulty, even though they had received
• 6:45
  no special kneeling training. People who reported
• 6:48
  difficulty were invited to complete a five -week
• 6:51
  graded kneeling program. Of those who completed
• 6:54
  all or most of the program, every participant
• 6:57
  reported being able to kneel afterward, and none
• 7:00
  reported significant difficulty. That result
• 7:03
  deserves both attention and restraint. It does
• 7:06
  not prove that every person can kneel, and not
• 7:09
  everyone who is eligible chose to participate.
• 7:12
  The group that completed the training was relatively
• 7:14
  small. Still, the study suggests that difficulty
• 7:17
  kneeling may improve with structured practice,
• 7:20
  even well after the early postoperative period.
• 7:23
  Individual results can vary, and patients should
• 7:26
  consult their surgeon or physical therapist before
• 7:29
  beginning a kneeling program. The published protocol
• 7:32
  progressed from softer to firmer surfaces. Participants
• 7:36
  practiced kneeling for about 10 minutes each
• 7:38
  day as tolerated. During the first week, they
• 7:41
  knelt on a couch. In the second week, they used
• 7:43
  a couch cushion placed on the floor. In the third
• 7:46
  week, they progressed to a thin pillow or thick
• 7:49
  carpet. In the fourth week, they used a thin
• 7:52
  carpet or rug. In the fifth week, the goal was
• 7:55
  kneeling on a firm floor or the ground, if comfortable
• 7:57
  and safe. That sequence is simple, but the details
• 8:01
  of how you enter and leave the position are important.
• 8:04
  Ten minutes does not have to mean dropping onto
• 8:06
  both knees and remaining perfectly still. Early
• 8:09
  practice may begin with your hands supported
• 8:11
  on a sturdy counter, chair, or bench, while you
• 8:14
  place part of your weight through the knee onto
• 8:16
  the soft surface. You can keep more weight through
• 8:19
  your arms and the other leg, then gradually allow
• 8:22
  the replaced knee to accept more pressure. A
• 8:25
  bed or a firm couch can be a useful first surface.
• 8:28
  because it allows your knee to sink in slightly.
• 8:32
  Begin near the edge so you have something stable
• 8:34
  to hold. Step close. Place your hands securely.
• 8:38
  Bring the involved knee onto the surface and
• 8:40
  pause. Notice whether you're feeling surface
• 8:43
  pressure, incision sensitivity, a stretch from
• 8:46
  your knee bending, or a deeper pain. Those distinctions
• 8:49
  guide the next decision. Remember, this is for
• 8:52
  educational purposes only. If the sensation is
• 8:56
  tolerable, and it settles soon after you unload
• 8:59
  the knee, you may remain for a brief interval
• 9:01
  and repeat. If you notice a sharp escalating
• 9:05
  pain, new or worsening swelling that does not
• 9:07
  improve with rest, redness, warmth, a sudden
• 9:09
  loss in motion, or a sense that something is
• 9:12
  mechanically catching or giving way, stop and
• 9:15
  contact your surgical team promptly. A practice
• 9:18
  session should not become a contest between you
• 9:20
  and your knee. Progress can occur in more than
• 9:23
  one direction. You can increase the amount of
• 9:25
  weight through the knee. You can increase time
• 9:28
  or you can move to a firmer surface. You can
• 9:31
  reduce hand support. You can increase the knee
• 9:33
  bend. Change only one variable at a time. That's
• 9:37
  generally best. Moving from a couch directly
• 9:39
  to a tile floor while also removing hand support
• 9:42
  makes it difficult to know which part might have
• 9:45
  exceeded your current capacity. Some people will
• 9:48
  be limited less by pressure and more by range
• 9:50
  of motion. Kneeling doesn't require the same
• 9:53
  knee bend for every technique. but lower kneeling
• 9:56
  positions usually require more flexion. You may
• 9:59
  be able to kneel upright with your hips over
• 10:01
  your knees before you can sit back toward your
• 10:03
  heels. Those are different tasks. Sitting all
• 10:06
  the way back is not the definition of successful
• 10:09
  kneeling. Others have enough motion but lack
• 10:12
  a safe way to get down or to stand back up. In
• 10:15
  that situation, the problem may be hip strength,
• 10:18
  quadricep strength, balance, hand support or
• 10:21
  confidence with floor transfers. Your physical
• 10:23
  therapist can help you choose a route that fits
• 10:25
  both your body and your surgeon's precautions.
• 10:29
  You might lower onto the non -operated knee first,
• 10:31
  use a padded bench, practice a half -kneeling
• 10:34
  position, or use a sturdy support to return to
• 10:37
  standing. The safest method is the one that you
• 10:40
  can control in both directions and that aligns
• 10:42
  with your post -operative guidelines. The five
• 10:46
  -week graded kneeling protocol described earlier
• 10:48
  was published by Wallace & Berger. A second important
• 10:51
  study comes from Jenkins and colleagues who examined
• 10:54
  a kneeling intervention after partial knee replacement.
• 10:57
  The people who received education and kneeling
• 10:59
  practice reported better kneeling ability at
• 11:02
  one year. A partial replacement is not the same
• 11:05
  operation as a total replacement, so we should
• 11:08
  not treat the results as interchangeable. Yet
• 11:11
  the study supports a consistent idea. Education
• 11:14
  and task -specific practice can change what people
• 11:17
  report being able to do. That idea may sound
• 11:21
  obvious, but kneeling is often omitted from formal
• 11:24
  rehabilitation. People practice walking, stairs,
• 11:27
  getting out of a chair, and bending their knee,
• 11:29
  then reach the end of therapy without ever placing
• 11:31
  their knee on a surface. Months later, they try
• 11:34
  once on a hard floor, feel strong pressure, and
• 11:37
  decide the skill is gone. A single test on a
• 11:40
  most demanding surface is not a fair assessment.
• 11:44
  Think of kneeling as a skill with levels. The
• 11:46
  first level may be touching your knee to a pillow
• 11:48
  while your hands carry most of your weight. Even
• 11:51
  individuals more than a year after a very successful
• 11:54
  knee replacement with strong leg muscles may
• 11:56
  still prefer or require padding and avoid harsh
• 11:59
  surfaces while continuing to work on kneeling
• 12:02
  tolerance. A folded yoga mat, towel or dedicated
• 12:05
  kneeling pad can make practice more manageable.
• 12:09
  Clothing also changes the experience. A thick
• 12:11
  pant leg, folded towel, gardening pad or foam
• 12:14
  cushion spreads the pressure over a larger area.
• 12:17
  A hard, narrow edge concentrates pressure. Before
• 12:20
  you decide that your knee cannot kneel, change
• 12:23
  the surface and the setup. The timing of practice
• 12:26
  should follow tissue healing and surgeon clearance,
• 12:29
  not an arbitrary calendar. Early kneeling is
• 12:33
  typically avoided until the incision is fully
• 12:35
  healed and your care team confirms it's appropriate.
• 12:38
  The Wallace Protocol involved people well beyond
• 12:41
  a year after surgery. So it shows that later
• 12:43
  improvement is possible. It doesn't tell us that
• 12:46
  everyone should wait that long. Some surgeons
• 12:49
  permit kneeling once healing is complete and
• 12:51
  the person can safely get down and up. Others
• 12:54
  use different timelines based on the operation
• 12:56
  and the person's health. Your response after
• 12:59
  practice is useful information. A mild tenderness
• 13:03
  that returns to baseline may be acceptable. A
• 13:05
  flare that lasts into the next day suggests the
• 13:08
  dose was maybe too high. reduce the pressure,
• 13:11
  time, surface firmness, or total number of repetitions.
• 13:15
  There are also situations where kneeling may
• 13:17
  remain limited. Persistent stiffness, substantial
• 13:20
  loss of knee bend, patellar or extensor mechanism
• 13:23
  problems, complex revision surgery, skin vulnerability,
• 13:28
  neuropathy, severe balance limitations, or pain
• 13:31
  from another joint can all change the plan. A
• 13:34
  person with diabetes or reduced protective sensation
• 13:37
  needs particular care with pressure and skin
• 13:40
  inspection. Someone taking anticoagulant medication
• 13:43
  may bruise more easily. These are reasons for
• 13:46
  individualized guidance. If kneeling is personally
• 13:50
  important, tell your surgeon and physical therapist.
• 13:53
  Goals guide care. I want to garden, I need to
• 13:56
  kneel for prayer, or I want to get on my floor
• 13:59
  with my grandchildren gives your team more useful
• 14:01
  information than a general goal of getting stronger.
• 14:05
  They can assess the specific position, the amount
• 14:07
  of knee bend, the route to the floor, and the
• 14:10
  support you need. And if feeling is not important
• 14:13
  to your life, you do not need to pursue it simply
• 14:16
  because someone says you should. Function is
• 14:18
  personal. The purpose of this discussion is to
• 14:21
  replace a blanket assumption with informed knowledge.
• 14:25
  For more practical education like this, the Totally
• 14:28
  Success Insider newsletter provides research
• 14:31
  summaries, clear explanations, and practical
• 14:33
  strategies for educational purposes only. It's
• 14:36
  intended to help you ask informed questions and
• 14:39
  better understand the factors involved in a knee
• 14:41
  replacement journey. And it does not replace
• 14:44
  medical advice from your surgeon or healthcare
• 14:46
  team. Check out the link in the show notes if
• 14:49
  you'd like to receive the newsletter. Kneeling
• 14:52
  after knee replacement can be difficult because
• 14:54
  it's not one problem. It involves pressure, sensation,
• 14:58
  motion, strength, balance, technique, and sometimes
• 15:01
  fear layered together. Many people can kneel
• 15:04
  and some who initially struggle can improve through
• 15:07
  graded practice. Begin only after your surgeon
• 15:10
  or physical therapist has confirmed you're cleared
• 15:13
  to kneel. Ensure the incision's fully healed.
• 15:16
  Use a stable setup, start on a forgiving surface,
• 15:19
  change one variable at a time, and stop if you
• 15:22
  experience significant pain, instability, or
• 15:24
  concerning symptoms. Individual results are going
• 15:27
  to vary. and you should follow the specific guidance
• 15:30
  provided by your healthcare team. In the next
• 15:33
  episode, episode 94, we'll discuss stairs after
• 15:35
  knee replacement and why going down is usually
• 15:38
  harder than going up the stairs, including the
• 15:41
  role of the quadriceps, balance, handrails, and
• 15:44
  exercises that may help you prepare. Thanks for
• 15:47
  joining me. I'm Michelle, and this has been the
• 15:49
  Total Knee Success Podcast. This podcast is for
• 15:56
  educational purposes only discover more at total
• 15:59
  me success calm and be sure to subscribe and
• 16:03
  share Because every step forward takes you closer
• 16:06
  to living the life you love