Congratulations, you have started Kneed and taken the first step towards reducing pain after a knee replacement.
Kneed starts by helping you develop a clear understanding of why pain persists and what it means.
Once you know this, you will ready to learn how to reduce pain, get moving again and get on with your life.
This module will help you to understand pain and why it persists – it doesn’t diagnose your pain.
Before proceeding, you need to know that your knee prosthesis (the implant, your new knee) is good. Your family doctor (general practitioner) and/or surgeon can help you with that. You might have already heard that “everything is ok” with your knee replacement. This can be frustrating because everything does not feel ok.
Everyone learns at a different pace, so after each section, there are a few questions to test your understanding and guide your knowledge further. A good understanding = a good result.
Complete the second quiz to unlock a 10% off Kneed coupon
Understanding pain (Part 1)
What is persistent (chronic) pain?
Persistent pain refers to pain that has lasted for longer than 3 months. Many people who have knee osteoarthritis experienced persistent pain prior to surgery. Our research showed that over 70% of people with osteoarthritis had severe persistent pain prior to their knee replacement. Persistent knee pain after a knee replacement means that (daily) knee pain has lasted for longer than 3 months after their surgery.
Why 3 months?
Most of the body’s tissues will completely heal within 6 to 12 weeks of any injury or surgery (even broken bones heal within 6 weeks). Inflammation, which helps our body to heal, reduces after a maximum of 18 days following surgery and is usually fully resolved by 4 to 6 weeks.
Why do we experience pain and what does it mean?
Our pain system serves an important role in detecting danger in our body to enable us to protect ourselves. It is designed to help us prevent injury – that is, our pain system activates so that we experience pain before we get injured. As a test, if you bend your finger back – it will become painful before you injure it, a grand design to protect your finger from injury.
So firstly, pain means danger. And if we sense danger, we can protect ourselves.
Does the pain system always stay the same?
No! Our pain system is constantly changing, adapting to our circumstances. For example, surgery causes our pain detection system to be turned up (sensitised) so that danger is detected long before an injury would occur, meaning that we are protected more. Imagine that the finger you bent back had just been operated on, you’d now not be able to bend it as much as pain would be detected sooner and you would protect it more.
What factors are involved in how we experience pain?
Some of the factors known to be involved in how we experience pain include how our body’s sensory system in our skin, nerves and muscles, how we move, how our central nervous system functions (our spinal cord and brain), our past experiences (memories), how we are feeling, stress (emotional, physical and environmental), how much sleep we’ve had and how we think and feel about pain. These factors can all change to increase how much pain we experience and are changeable to reduce how much pain we experience.
Other less changeble factors that can influence pain include genetics (a twin has a 50% chance of experiencing the same persistent pain as their twin), how our body is structured and past trauma (at the time of surgery as well as trauma in the past).
Why do people still have pain after knee replacement?
The simple answer is because their pain detection system has changed. Knee injuries can start this process of changing the pain system, knee osteoarthritis can start this process of changing the pain system and knee replacement surgery can start this process of changing the pain system.
The complex answer is that their pain experience is very personal and it is likely that multiple factors such as sensitisation of the pain system, memory, stress, sleep, medication, movement patterns, thoughts and feelings can all play a part in pain continuing. But as indicated above, because most of these factors are changeable, pain is changeable.
What this means after knee replacement is that these changes (before, during and after surgery) lead to an increased awareness of their knee and increased pain in their knee and continued protection of their knee. Unfortunately, more awareness and more protection of the knee can lead to more pain, more protection and less function.
But doesn’t knee pain after knee replacement mean that there is something wrong with my knee?
No – the something wrong is with the all the changes that have occurred to skin and muscle and the nervous system and the brain and movement patterns and thoughts. It is normal to focus on your knee where you are experiencing pain. And, once you know that your knee is ok, you can shift focus to the rest of the pain experience system and learn to fix it.
Does this mean that pain is all in my head?
No! Pain is not made up or make believe.
Pain is real and involves the brain and the body.
Pain does not mean that you are soft or mad or weak.
Pain does not mean that you are damaged.
You do not have to accept that pain will never get better
So, in summary:
- Osteoarthritis and knee surgery lead to changes in the pain detection system
- And despite the body healing over 6 to 12 weeks after knee replacement
- The changes to the body and brain lead to pain persisting
- Making it easier to detect danger and experience more pain
- Leading to overprotection of the knee
- Which can lead to changes in the way you move
- And changes to the things you do and how you do them
- And changes to the way you think
- And changes to the way you function and live your life
But – these are only changes…
Fortunately, the Kneed pain rehabilitation program is designed to help you change them back, so that you can take control of your pain story and live happily ever after.
Time to test your knowledge
Everything can seem easy to understand when reading along, but testing your understanding will help deepen your knowledge and help it to stick. To do this, answer the short quiz below about Jenny.
Jenny is 70 years of age and had a knee replacement 4 months ago for osteoarthritis.
She continues to have 5 out of 10 pain in her knee which limits her walking ability to less than 10 minutes.
Reducing pain and improving function (Part 2)
What are the changes that can occur due to persistent pain?
There are multiple changes that can occur due to persistent pain associated with having osteoarthritis and/ or a knee replacement.
These include changes to the nervous system, often referred to as sensitisation, leading to more awareness of the body, for example, smaller amounts of pressure or movement can lead to higher levels of pain.
There are changes to the brain that include changes to how the brain receives information from the body, how the brain stores that information, how the brain processes that information and how the brain uses that information.
This often leads to changes in movement patterns (like limping when walking), how muscles are used and activated and how much strength and endurance muscles have.
With less movement and less activity occurring, this often reduces balance. Less activity also affects how well the brain is able to function and coordinate movements – doing things becomes harder.
With less exercise, there are a number of secondary problems that can occur like reduced memory, declining heart and lung function, reduced bone strength and increased weight.
Continuing pain can also commonly lead to sleep dysfunction, stress, anxiety, mood disorders, lack of socialisation and relationship difficulties.
Kneed, a pain rehabilitation program, has been designed to address these problems by firstly developing an understanding of why pain persists and then guiding exercises for the brain and body and teaching strategies to reduce pain, improve function and improve quality of life.
How to start to recover when pain persists after a knee replacement
The first place to start is understanding why pain persists.
When pain does persist, there can be multiple potential problems interfering with recovery.
Hopefully Part 1 has helped you to understand why your pain persists. The Kneed program continues pain teaching for those who need or want to understand pain more – more specifically about sensitisation and pain after surgery.
If you understand why pain persists, you will be able to choose which treatments or strategies are likely to help you recover.
Planning your recovery can be assisted by thinking about and setting the goals that you want to achieve. Kneed has a goal planner to help you set goals and achieve them and this is a powerful way to focus and get started on a pain rehabilitation program.
How do you exercise when you still have pain?
By using strategies. Most people have already been exercising after their knee replacement with guidance from clinicians such as physiotherapists (physical therapists) and other clinicians to try to help them.
So it can be frustrating to hear that exercise is one of the keys to recovery and future health! If you keep doing the same exercises, you are likely to receive the same benefits.
Changing strategies for how you exercise as well as changing the type of exercise might be just what you need.
The largest module in Kneed is devoted to exercise – starting with how to exercise safely and when you have pain. There are videos of simple exercises to improve knee movements, balance, strength and walking patterns.
Kneed has education and strategies to guide your exercise, so that you know how much to exercise and when to exercise to achieve your goals and reduce your pain.
How do you retrain your brain when you have pain?
Our brains are very plastic meaning that they are changeable.
If you can appreciate that pain means danger and not harm, you have already started to retrain your brain.
Other ways to retrain the brain include using techniques such as motor imagery and tactile stimulation which are included in Kneed.
Progressive muscular relaxation, an audio program included in Kneed, is a technique to both reduce stress through breath control and to improve the brain-body connection to improve muscle control.
Sleep dysfunction can increase pain and so improving sleep when this is a problem is essential. Kneed provides education and strategies to improve sleep.
Kneed uses other strategies and techniques to help you retrain your brain.
How can Kneed improve mood and anxiety?
Kneed is not a diagnostic or psychological program and does not have modules that specifically address these problems.
A lack of exercise, sleep dysfunction, pain and stress can all contribute to a poorer mood and anxiety.
So with education, guidance and strategies for exercise, better sleep and reduced stress resulting in reduced pain and improved activity and functional levels, this should help to improve mood and anxiety symptoms.
Test your knowledge again and unlock 10% off Kneed
Dave feels that it’s time to regain control of his knee as it has been 6 months since his knee replacement and he still hasn’t returned to doing his enjoyable activities, like dancing due to pain.
Help Dave get started on his recovery with this 10 question quiz.
Completing the quiz unlocks a coupon to give you 10% off the Kneed programs
