Total Knee Replacement Rehabilitation – Is It Safe To Kneel?

Photo of Linda examining the knee

Knee Replacements and Rehabilitation - What I've Found Out

Recently, I’ve been helping a lot of patients who have had total knee replacement (TKR) surgery. It’s not something I knew much about, but I did some research and it’s like any other injury. You encourage movement and restoration of movement, strengthen it and regain normal global movement patterning. How quickly this happens depends on the level of osteoarthritis (OA) before surgery, and general level of fitness, strength and health.

Sadly, patients report that the rehabilitation they were offered (both NHS and privately) was minimal. If they could walk pretty well and climb stairs then that was OK, off you go. I’m sure this isn’t the case for everyone, but it is for those that have found me.

black and white image close up of someone holding their knee, which is glowing red in pain

Is it safe to kneel after a total knee replacement?

Something that has struck me over the years of helping folks, and seeing people with TKR in Pilates classes, is their inability, or perhaps resistance to kneeling. It got me thinking. Surely when you’ve had a TKR, you should be able to kneel? Was there anything in the prosthesis that limited you in this way? Was it dangerous? Wrong to do? 

Here's what the research says:

Kneeling ability is consistently the poorest patient-rated outcome after total knee replacement (TKR), with 60–80% of patients reporting difficulty kneeling or an inability to kneel” (3).

Difficulty kneeling impacts on many activities and areas of life, including activities of daily living, self-care, leisure and social activities, religious activities, employment and getting up after a fall. Given the wide range of activities that involve kneeling, and the expectation that this will be improved with surgery, problems kneeling after TKR are a source of dissatisfaction and disappointment for many patients.” (3)

Thankfully, it turns out, it is safe to kneel after a TKR. To quote Toby Smith (2) (Clinical Specialist Physiotherapist), knee replacements are “pretty bomb proof”. I’ve stolen that line and given it to my TKR patients. It’s wonderful to watch that land with them; their anxiety reduces immediately.

The thing is, what we practitioners say, our language, plays a huge role in the rehabilitation process. Doctors, consultants, surgeons and the like have huge power with their words. One of my patients has been told specifically to never kneel and never squat again. This is impossible. These words are damaging. And, it’s simply not true. We need to be able to squat, lunge, kneel to perform normal daily tasks.

"Discrepancies between patients’ self-reported ability to kneel and observed ability suggests that patients can kneel but elect not to. Reasons for this are multifactorial, including knee pain/discomfort, numbness, fear of harming the prosthesis, co-morbidities and recommendations from health professionals. There is currently no evidence that there is any clinical reason why patients should not kneel on their replaced knee, and reasons for not kneeling could be addressed through education and rehabilitation." (3)

man kneeling infront of snow covered mountains with arms raised in delight

So, what can we do about it?

I asked my rich source of JEMS® people who are movement practitioners, physios and osteopaths. All of them said the same things that I already knew, which is always a relief to hear!

To slowly progress to de-sensitise to kneeling:

  • Give your knee a good rub, perhaps spend some time massaging it and the scar (if it’s healed up) and focus on any tender and numb areas.

  • Start by slowly lowering yourself onto your knees on your sofa. Ask your knees to soften and remember to breathe. Tell your brain that it’s safe. Build up time spent here and then once that feels easier..

  • Progress your way onto the floor, supported by cushions. You don’t need to kneel all the way back, but getting comfortable in four point kneeling is a great function to get back to.

  • Be inventive as to how you get up from the floor – how many different ways can you get back up? Initially, ensure you have sturdy furniture around you to use, and then bit by bit work to not need any help at all.

I also contacted Claire Minshull (1), an expert in S&C and knee OA (I did her S&C course for therapists last year,) and she said that restoration of range of motion and gaining strength is important early on after a TKR. However, the health of the knee before surgery is paramount, so get as strong as you can before you have the surgery.

Obviously pain can get in the way a bit, it can inhibit movement. However, you’ll be surprised what you can achieve with the help of people like myself guiding you through your movements and what gains you can make, even when you have knee OA.

If you need help rehabilitating your knees whether you have/need a replacement or not, contact me to chat further or book online for an appointment.

References:

(1) Claire Minshull: getbacktosport.com

(2) The Physio Matters Podcast: Session 35 – OA Hips, THRs, Dos and Don’ts & Maybes with Toby Smith

(3) Wylde V, Artz N, Howells N, Blom AW. Kneeling ability after total knee replacement. EFORT Open Rev. 2019 Jul 7;4(7):460-467. doi: 10.1302/2058-5241.4.180085. PMID: 31423329; PMCID: PMC6667980.