Free Kneed is a short educational introduction designed to help you understand why pain can persist after a knee replacement and whether a rehabilitation approach like Kneed feels right for you.
This is not a treatment program and there is no obligation to continue.
You can move through the material at your own pace and stop at any time.
Many people find that simply understanding why pain persists helps them feel more confident about next steps in recovery.
Reading time is around 10 – 15 minutes
Understanding persistent pain
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 knee pain has lasted for longer than 3 months after surgery.
Moderate to severe pain can be present in up to 25% of people 6 months after a knee replacement.
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 better protected.
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 works (we have sensors in most our tissues including skin, joints, bones, ligaments and muscles.
How we move influences pain.
How our nervous system (nerves, spinal cord and brain) processes information changes pain.
Sleep, stress (emotional, physical and environmental) mood and worry influence pain.
Even how we think and feel about pain can influence pain.
These factors can all change to increase or decrease how much pain we experience.
Why do some people still have pain after knee replacement?
This is likely to be different for everyone but it involves changes in the way the body and nervous system process sensory information.
This may start with a knee injury and osteoarthritis and be exacerbated by knee replacement surgery.
As everyone’s pain experience is very personal, multiple factors such as sensitisation of the pain system, stress, sleep, medication, movement patterns, thoughts and feelings can all play a part in pain continuing.
What this means after knee replacement is that these changes (before, during and after surgery) lead to an increased awareness of the knee, increased pain in the knee and continued protection of the knee. This in turn impacts on activities.
But doesn’t knee pain after knee replacement mean that there is something wrong with my knee?
No, it is important that you know that your knee is ok by speaking to your doctors.
It is normal to focus on your knee when you are experiencing pain. But, once you know that your knee is ok, you can shift focus to the rest of the pain experience system and rehabilitation.
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.
Before you move on...
Before continuing, we’ve included a short set of questions to help you reflect on the ideas covered so far.
The questions are designed to help you check whether this explanation fits your own experience.
Many people find this reflection useful before deciding what to do next.
What does this mean for recovery?
When pain persists after knee replacement, recovery often requires more than exercises alone.
Research shows that persistent pain is influenced by a combination of factors, including how pain is understood, how movement feels, how the nervous system responds and how people regain confidence in activity.
Rehabilitation programs like Kneed are designed around this broader understanding. They combine education, exercise, movement retraining and self-management strategies to help people move forward safely and confidently after surgery.
Free Kneed is designed to help you decide whether this kind of approach feels right for you.
