The role of scar tissue in knee replacement recovery

Something that I get asked regularly is why does it hurt so much when you do the exercises and should it actually hurt? Should you push into the pain barrier or stop when it hurts?

So, let’s start at the beginning: a knee replacement operation sucks: it is widely known as the most painful elective surgery that you can have. So therefore, rehab is not going to be pleasant either.

Firstly let’s look at what they actually do in a knee replacement operation. This was recorded in june 2018: before I had mine done and is taken from my business YouTube channel. The model of the knee was lent to me by my doctor for the purposes of the video demonstration (greatly appreciated, thank you doc!).

The surgery is pretty major as you can see, with lots of elements disturbed: bone, muscle, ligaments and tendons alike. So, it’s not surprising that you will have a lot of scar tissue.

Scar tissue forms quickly after a surgery / injury. It is the body’s automatic healing mechanism.

Scar tissue is more rigid and less pliable than the original tissue.

That means that, if left to do its own thing, the joint will become less flexible and less functional. THIS IS WHY the physiotherapists go hell for leather at rehab after a knee replacement. You are in a race against this scar tissue formation. Your goal is to keep it broken up and to NOT allow it to form into large rigid unmovable clumps!

That is why the flexion exercises are so excruciatingly painful. That is why they are so hard and that is also why you should push through this regardless of how hard they are, if you want a proper functional nice and flexible knee.

Time is not your friend.

There is a point of no return for scar tissue. It tends to be roughly around the 6 month mark, but there are no hard and fast rules, it might be less, or more, there is no way to actually tell. But, there is a point, after which it will be too late and flexibility / function will, to a degree, be lost if you did not do the hard yards at the beginning of the rehab.

The first 4 months are key.

This is your window to smash the scar tissue and lay the foundations for a fabulously flexible knee. So don’t mess about, get it done regardless of how painful it is. This was one of my pain faces early on, this is how much it should hurt. (sorry, but it’s true).


If you don’t, then you could face MUA: manipulation under anaesthetic. This is to manually break up scar tissue, done under anaesthetic because it hurts. A lot. I avoided this option, you should be very motivated to also avoid this option.

Hope that helps. Do comment below or contact me directly if you have any questions and I will do my best to help.


Published by Melanie Magowan

I am a personal trainer, massage therapist and small business owner.

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