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Knee Replacement

Can Pilates Help Before and After Surgery?

A total knee replacement is a surgical procedure where the damaged parts of the knee joint are removed and replaced with specialized metal and plastic. It is estimated that 700,000 knee replacement surgeries are performed in the US annually. This number is expected to increase 673% to 3.48 million procedures per year by 2030. (1) To date, total knee replacement surgeries are the most commonly performed elective surgery in the US. (2).


Many people receive a total knee replacement as a way to reduce pain and restore function at the end-stage of knee osteoarthritis. However, some people may receive a total knee replacement as a result of trauma or disease affecting the knee joint. 


If you are experiencing chronic knee pain and believe that you might be a candidate for a total knee replacement, then it is recommended that you consult a medical provider. While your doctor may suggest that you to try non-surgical methods for pain relief prior to receiving a total knee replacement, some signs that you may be eligible for this procedure include:


- Moderate to severe knee pain that interferes with your everyday activities 

- Moderate to severe pain when at rest and in the evening

- Long-term inflammation around the knee joint that persists even after rest and medication

- A knee joint that bows in or out 

- Chronic knee stiffness


Many people are unaware that a common contributor to knee osteoarthrosis is compensatory movement patterns. These compensations often stem from weakness in the hip abductors, which are located on the outside of the hip and play a large role in maintaining knee alignment when walking, running, or climbing the stairs. While any joints can be affected by movement compensation, the knee is particularly vulnerable, because it is located in the middle of the leg and is heavily influenced by how well the hip and ankle function. 


While a total knee replacement will replace the damaged parts of the joint, the underlying muscular weakness and compensations that contributed to the original problem will still exist after surgery. (3) This is important, because if it is left unaddressed further breakdown can occur, potentially resulting in future surgeries. 

Physical Therapy Versus Pilates


Physical therapy is an important part of the rehabilitation process after a total knee replacement, so it is beneficial to understand the role that in plays in recovery. 

The primary purpose of physical therapy is to:

  • Reduce pain, swelling, and inflammation around the knee

  • Monitor for medical complications post-surgery

  • Re-establish full range of motion, or mobility in the surgically repaired knee 

  • Strengthen the muscles that bend and extend the knee, so the patient can have independence during activities of daily life (4)


Physical therapy is designed to restore mobility to the knee that has been operated on and help someone successfully resume normal day-to-day activity. However, there aren’t necessarily enough visits for physical therapy to address how the patient is moving as a whole and many patients will be prematurely discharged from physical therapy before they are able to progress to exercises that would help them restore their activity level and strength prior to the surgery. (5)


Pilates can help bridge the gap between physical therapy and the activities or exercise that you aspire to do. An experienced Pilates teacher can assess your overall quality of movement and address muscles imbalances or movement compensations, which may have contributed to the original knee issue, and can continue to affect the replaced joint, and influence how successful the surgery is for enhancing your quality of life long term.

How Pilates Can Help During the Total Knee Replacement Process


While a total knee replacement has been found to reduce pain and improve function, there is evidence suggesting that surgery alone will not resolve the movement compensations that existed before the surgery. Rather, it is thought that exercise may be the best option for helping people resume regular activity and restore function long term. (5)

Pilates can be an ideal way to build strength and restore healthy movement patterns both when preparing for and following a total knee replacement, if your teacher is educated in therapeutic work and has experience working with clients with joint replacements. This is because many of the Pilates exercises are designed to strengthen the hip abductor muscles through whole body movement, while improving body awareness and alignment of the hips, knees, and ankles.

Furthermore, unlike physical therapy exercises, which often target one muscle group at a time and focus primarily on the surgically repaired knee, Pilates takes holistic approach to restoring healthy movement patterns and building flexibility and strength. This can help you move efficiently and minimize the stress that any one joint experiences during activity.



After two knee surgeries and physical therapy, I still felt that my knees would give out causing me to fall. When I started McEntire Pilates, Trent helped me to understand the problems that needed to be addressed: (1) my knees were not functioning the same creating imbalances and pain, (2) the knees were giving out because of the limited muscle responsiveness and strength, and (3) my fear of falling was limiting my movement. Through the Pilates work, we were able to counter the imbalances in my body and create more muscle responsiveness and strength for supporting my knees. I am now able to walk without pain and a great deal of confidence with everyday movement. 

-- Kathy Coe, McEntire Pilates Client

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