In Episode 66, Michelle explores whether pain can actually change after knee replacement and what that means for recovery. She explains neuroplasticity in simple terms and how the nervous system can adapt over time. Listeners will learn how expectations, consistency, and experience shape pain, and what signs to look for as progress begins. This episode closes the pain series with a grounded, hopeful perspective.

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Medical Disclaimer: This podcast is for educational purposes only and does not constitute medical advice. The content is not intended to replace individualized medical guidance, diagnosis, or treatment. Always consult your surgeon, physical therapist, or other qualified healthcare provider regarding your specific condition, surgical decisions, and rehabilitation plan.

Amazon Affiliate Disclaimer: Some resources mentioned in this podcast may include Amazon affiliate links. If you choose to purchase through these links, the podcast may earn a small commission at no additional cost to you.

Evidence-Based Content Statement: All information presented in this episode is grounded in peer-reviewed research, published clinical guidelines, and current best practices in orthopedic surgery and rehabilitation.

Music Licensing Statement: Intro and outro music for the Total Knee Success Podcast is licensed for commercial use. Editing and production for this episode were completed using Descript.

References:

Moseley GL, Butler DS. Fifteen years of explaining pain: the past, present, and future. J Pain. 2015;16(9):807-813.

Apkarian AV, Hashmi JA, Baliki MN. Pain and the brain: specificity and plasticity of the brain in clinical chronic pain. Pain. 2011;152(3 Suppl):S49-S64.

Tracey I, Mantyh PW. The cerebral signature for pain perception and its modulation. Neuron. 2007;55(3):377-391.

Kosek E, Cohen M, Baron R, et al. Do we need a third mechanistic descriptor for chronic pain states? Pain. 2016;157(7):1382-1386.

Colloca L, Barsky AJ. Placebo and nocebo effects. N Engl J Med. 2020;382(6):554-561.

Watson JA, Ryan CG, Cooper L, et al. Pain neuroscience education for adults with chronic musculoskeletal pain: a mixed-methods systematic review and meta-analysis. J Pain. 2019;20(10):1140-1159.

Louw A, Zimney K, Puentedura EJ, Diener I. The efficacy of pain neuroscience education on musculoskeletal pain: a systematic review and meta-analysis. Phys Ther. 2016;96(5):730-740.

In Episode 65, Michelle explains what actually helps reduce pain after knee replacement and what common approaches tend to fall short. She walks through practical strategies including graded exposure, consistency, and calming the nervous system. Listeners will learn how to approach movement in a way that supports progress without increasing reactivity. This episode builds on earlier concepts and provides clear next steps.

Support the podcast

Free newsletter: Total Knee Success Insider

Get the Making Sense of Pain After Knee Replacement Guide

totalkneesuccess.com

Medical Disclaimer: This podcast is for educational purposes only and does not constitute medical advice. The content is not intended to replace individualized medical guidance, diagnosis, or treatment. Always consult your surgeon, physical therapist, or other qualified healthcare provider regarding your specific condition, surgical decisions, and rehabilitation plan.

Amazon Affiliate Disclaimer: Some resources mentioned in this podcast may include Amazon affiliate links. If you choose to purchase through these links, the podcast may earn a small commission at no additional cost to you.

Evidence-Based Content Statement: All information presented in this episode is grounded in peer-reviewed research, published clinical guidelines, and current best practices in orthopedic surgery and rehabilitation.

Music Licensing Statement: Intro and outro music for the Total Knee Success Podcast is licensed for commercial use. Editing and production for this episode were completed using Descript.

References:

Woolf CJ. Central sensitization: implications for the diagnosis and treatment of pain. Pain. 2011;152(3 Suppl):S2-S15.

Moseley GL, Butler DS. Fifteen years of explaining pain: the past, present, and future. J Pain. 2015;16(9):807-813.

Apkarian AV, Bushnell MC, Treede RD, Zubieta JK. Human brain mechanisms of pain perception and regulation in health and disease. Eur J Pain. 2005;9(4):463-484.

Tracey I, Mantyh PW. The cerebral signature for pain perception and its modulation. Neuron. 2007;55(3):377-391.

Bricca A, et al. Exercise therapy “wears down” my knee joint: myth or reality? J Orthop Sports Phys Ther. 2025;55(7):463-470.

Duong V, et al. Predictors of adherence to a step-count intervention following total knee replacement. J Orthop Sports Phys Ther. 2022.

White DK, et al. A telehealth physical therapy intervention to increase physical activity in adults with knee osteoarthritis. 2025.

In Episode 64, Michelle explains why pain can persist after knee replacement even when healing is progressing. She introduces the fear, tension, and pain cycle and explains how the nervous system can become more sensitive over time. Listeners will learn how pain patterns develop and how attention, stress, and avoidance can reinforce the cycle. This episode sets the foundation for understanding how to begin breaking the loop.

Free newsletter: Total Knee Success Insider

Get the Making Sense of Pain After Knee Replacement Guide

totalkneesuccess.com

Medical Disclaimer: This podcast is for educational purposes only and does not constitute medical advice. The content is not intended to replace individualized medical guidance, diagnosis, or treatment. Always consult your surgeon, physical therapist, or other qualified healthcare provider regarding your specific condition, surgical decisions, and rehabilitation plan.

Amazon Affiliate Disclaimer: Some resources mentioned in this podcast may include Amazon affiliate links. If you choose to purchase through these links, the podcast may earn a small commission at no additional cost to you.

Evidence-Based Content Statement: All information presented in this episode is grounded in peer-reviewed research, published clinical guidelines, and current best practices in orthopedic surgery and rehabilitation.

Music Licensing Statement: Intro and outro music for the Total Knee Success Podcast is licensed for commercial use. Editing and production for this episode were completed using Descript.

References:

Woolf CJ. Central sensitization: implications for the diagnosis and treatment of pain. Pain. 2011;152(3 Suppl):S2-S15.

Kosek E, Cohen M, Baron R, et al. Do we need a third mechanistic descriptor for chronic pain states? Pain. 2016;157(7):1382-1386.

International Association for the Study of Pain (IASP). IASP terminology: nociplastic pain definition. Pain. 2021;162(7):1976-1977.

Apkarian AV, Bushnell MC, Treede RD, Zubieta JK. Human brain mechanisms of pain perception and regulation in health and disease. Eur J Pain. 2005;9(4):463-484.

Tracey I, Mantyh PW. The cerebral signature for pain perception and its modulation. Neuron. 2007;55(3):377-391.

Moseley GL, Butler DS. Fifteen years of explaining pain: the past, present, and future. J Pain. 2015;16(9):807-813.

Orange GM, Hince DA, Jones M, et al. Physical function following total knee arthroplasty for osteoarthritis: a longitudinal systematic review. J Orthop Sports Phys Ther. 2025;55(1):1-13.

Minick KI, Hunter SJ, Capin JJ, et al. Improved outcomes following a care guideline implementation after total knee arthroplasty. J Orthop Sports Phys Ther. 2023;53(3):143-151.

Episode 63 begins a 4-part pain series by explaining what pain actually is after knee replacement and why it can feel confusing. This Episode helps listeners move from fear to confidence by reframing pain as a protective response rather than a direct signal of damage. It also introduces how multiple factors influence pain, setting up the rest of the series.

Get the Making Sense of Pain After Knee Replacement Guide

Medical Disclaimer: This podcast is for educational purposes only and does not constitute medical advice. The content is not intended to replace individualized medical guidance, diagnosis, or treatment. Always consult your surgeon, physical therapist, or other qualified healthcare provider regarding your specific condition, surgical decisions, and rehabilitation plan.

Amazon Affiliate Disclaimer: Some resources mentioned in this podcast may include Amazon affiliate links. If you choose to purchase through these links, the podcast may earn a small commission at no additional cost to you.

Evidence-Based Content Statement: All information presented in this episode is grounded in peer-reviewed research, published clinical guidelines, and current best practices in orthopedic surgery and rehabilitation.

Music Licensing Statement: Intro and outro music for the Total Knee Success Podcast is licensed for commercial use. Editing and production for this episode were completed using Descript.

References:

Orange GM, Hince DA, Jones M, Sharma S, Kim S, Wand BM, Murphy MC. Physical function following total knee arthroplasty for osteoarthritis: a longitudinal systematic review with meta-analysis. J Orthop Sports Phys Ther. 2025;55(1):1-14.

Goff AJ, Donaldson D, de Oliveira Silva D, Crossley KM, Barton CJ. Physical therapists prioritize providing education about exercise therapy and to dispel misconceptions about radiology for people with knee osteoarthritis: a concept mapping study. J Orthop Sports Phys Ther. 2022;52(9):607-619.

Minick KI, Hunter SJ, Capin JJ, Stevens-Lapsley JE, Snow GL, Woodfield D, Dibblee P, Brennan GP. Improved outcomes following a care guideline implementation: part 1 of an analysis of 12 355 patients after total knee arthroplasty. J Orthop Sports Phys Ther. 2023;53(3):143-151.

Capin JJ, Minick KI, Stevens-Lapsley JE, Snow GL, Woodfield D, Dibblee P, Brennan GP, Hunter SJ. Variation in outcomes and number of visits following care guideline implementation: part 2 of an analysis of 12 355 patients after total knee arthroplasty. J Orthop Sports Phys Ther. 2023;53(3):151-160.

Na A, Coronado RA, Bini SA, et al. Diabetes mellitus blunts the symptoms, physical function, and health-related quality of life benefits of total knee arthroplasty: a systematic review with meta-analysis. J Orthop Sports Phys Ther. 2021;51(6):269-280.

Moseley GL, Butler DS. Explain Pain. 2nd ed. Noigroup Publications; 2015.

Butler DS, Moseley GL. Explain Pain Supercharged. Noigroup Publications; 2017.

In Episode 62, Michelle breaks down what physical therapy actually does after total knee replacement—and why it is much more than just exercises. She explains how physical therapy retrains the nervous system, rebuilds strength, improves movement quality, and guides long-term function. This Episode helps listeners move from passively doing exercises to actively understanding their role in the process. It’s a foundational, myth-busting Episode for anyone preparing for or recovering from knee replacement.

Free newsletter: Total Knee Success Insider

Support the podcast

Medical Disclaimer: This podcast is for educational purposes only and does not constitute medical advice. The content is not intended to replace individualized medical guidance, diagnosis, or treatment. Always consult your surgeon, physical therapist, or other qualified healthcare provider regarding your specific condition, surgical decisions, and rehabilitation plan.

Amazon Affiliate Disclaimer: Some resources mentioned in this podcast may include Amazon affiliate links. If you choose to purchase through these links, the podcast may earn a small commission at no additional cost to you.

Evidence-Based Content Statement: All information presented in this episode is grounded in peer-reviewed research, published clinical guidelines, and current best practices in orthopedic surgery and rehabilitation.

Music Licensing Statement: Intro and outro music for the Total Knee Success Podcast is licensed for commercial use. Editing and production for this episode were completed using Descript.

References:

Arhos EK, Stevens-Lapsley JE, et al. Who’s Afraid of Electrical Stimulation? Let’s Revisit the Application of NMES at the Knee. J Orthop Sports Phys Ther. 2024;54(2):101-110.

Na A, et al. Diabetes Mellitus Blunts the Symptoms, Physical Function, and Health-Related Quality of Life Benefits of Total Knee Arthroplasty: A Systematic Review With Meta-analysis. J Orthop Sports Phys Ther. 2021;51(6):269-280.

Duong V, et al. Predictors of Adherence to a Step Count Intervention Following Total Knee Replacement. J Orthop Sports Phys Ther. 2022;52(9):620-629.

Gränicher P, et al. Prehabilitation Improves Knee Functioning Before and Within the First Year After Total Knee Arthroplasty: A Systematic Review With Meta-analysis. J Orthop Sports Phys Ther. 2022;52(11):709-725.

Graber J, et al. Expert Consensus for the Use of Outpatient Rehabilitation Visits After Total Knee Arthroplasty: A Delphi Study. J Orthop Sports Phys Ther. 2023;53(9):566-575.

Minick KI, et al. Improved Outcomes Following a Care Guideline Implementation After Total Knee Arthroplasty. J Orthop Sports Phys Ther. 2023;53(3):143-151.

Orange GM, et al. Physical Function Following Total Knee Arthroplasty for Osteoarthritis: A Longitudinal Systematic Review With Meta-analysis. J Orthop Sports Phys Ther. 2025;55(1):1-12.

Goff AJ, et al. Physical Therapists Prioritize Providing Education About Exercise Therapy and to Dispel Misconceptions. J Orthop Sports Phys Ther. 2022;52(9):607-616.

Nunes GS, et al. Are Changes in Dynamic Knee Movement Control Related to Changes in Pain or Function? J Orthop Sports Phys Ther. 2023;53(7):388-401.

Bricca A, et al. Exercise Therapy “Wears Down” My Knee Joint: Myth or Reality? J Orthop Sports Phys Ther. 2025;55(7):463-472.

In Episode 61 of the Total Knee Success podcast, Michelle explains why consistency is more important than intensity after knee replacement. She explores how the body adapts through repeated effort over time and why inconsistent patterns can slow progress. The episode provides a practical framework for building steady improvement and sets up a deeper understanding of physical therapy in the next episode.

Free newsletter: Total Knee Success Insider

Support the podcast

Before surgery? free2weeklaunch

The Knee Replacement Game Plan

totalkneesuccess.com

Medical Disclaimer: This podcast is for educational purposes only and does not constitute medical advice. The content is not intended to replace individualized medical guidance, diagnosis, or treatment. Always consult your surgeon, physical therapist, or other qualified healthcare provider regarding your specific condition, surgical decisions, and rehabilitation plan.

Amazon Affiliate Disclaimer: Some resources mentioned in this podcast may include Amazon affiliate links. If you choose to purchase through these links, the podcast may earn a small commission at no additional cost to you.

Evidence-Based Content Statement: All information presented in this episode is grounded in peer-reviewed research, published clinical guidelines, and current best practices in orthopedic surgery and rehabilitation.

Music Licensing Statement: Intro and outro music for the Total Knee Success Podcast is licensed for commercial use. Editing and production for this episode were completed using Descript.

References:

Duong V, Hart DL, Stratford PW, et al. Predictors of adherence to a step count intervention following total knee replacement. Phys Ther. 2022;102(3).

Minick KI, DeJong AF, Piva SR, et al. Improved outcomes following care guideline implementation after total knee arthroplasty. J Orthop Sports Phys Ther. 2023;53(4):1-10.

Capin JJ, Khandha A, Buchanan TS, et al. Variation in outcomes following care guideline implementation after total knee arthroplasty. J Orthop Sports Phys Ther. 2023;53(4):1-11.

White DK, Tudor-Locke C, Felson DT, et al. A telehealth physical therapy intervention to increase physical activity in adults with knee osteoarthritis. Arthritis Care Res (Hoboken). 2025;77(1):45-54.

Gränicher P, Mäder U, Angst F, et al. Prehabilitation improves knee functioning before and within the first year after total knee arthroplasty. J Orthop Sports Phys Ther. 2022;52(3):1-11.

Clear J. Atomic Habits: An Easy & Proven Way to Build Good Habits & Break Bad Ones. Avery; 2018.

Fogg BJ. Tiny Habits: The Small Changes That Change Everything. Houghton Mifflin Harcourt; 2019.

Miller WR, Rollnick S. Motivational Interviewing: Helping People Change. 3rd ed. Guilford Press; 2013.

In Episode 60 of the Total Knee Success podcast, Michelle explains why strength plays a central role in outcomes after knee replacement and how muscles drive movement and function after surgery. She clarifies the difference between joint mechanics and muscle capacity, helping listeners understand why progress may feel limited even when the joint is healing well. The episode emphasizes progressive strength building and sets up the importance of consistency in the next episode.

Free newsletter: Total Knee Success Insider

Before surgery? free2weeklaunch

The Knee Replacement Game Plan

totalkneesuccess.com

Medical Disclaimer: This podcast is for educational purposes only and does not constitute medical advice. The content is not intended to replace individualized medical guidance, diagnosis, or treatment. Always consult your surgeon, physical therapist, or other qualified healthcare provider regarding your specific condition, surgical decisions, and rehabilitation plan.

Amazon Affiliate Disclaimer: Some resources mentioned in this podcast may include Amazon affiliate links. If you choose to purchase through these links, the podcast may earn a small commission at no additional cost to you.

Evidence-Based Content Statement: All information presented in this episode is grounded in peer-reviewed research, published clinical guidelines, and current best practices in orthopedic surgery and rehabilitation.

Music Licensing Statement: Intro and outro music for the Total Knee Success Podcast is licensed for commercial use. Editing and production for this episode were completed using Descript.

References:

Graber P, et al. Expert consensus for the use of outpatient rehabilitation visits after total knee arthroplasty. J Orthop Sports Phys Ther. 2023;53(6).

Dandis RB, et al. Latent class analysis to predict outcomes of early high-intensity physical therapy after total knee arthroplasty. J Orthop Sports Phys Ther. 2021;51(10).

Bricca A, et al. Exercise therapy wears down my knee joint: myth or reality? Br J Sports Med. 2025;59(2).

Goff AJ, et al. Physical therapists prioritize providing education about exercise therapy and dispelling misconceptions. J Orthop Sports Phys Ther. 2022;52(7).

Gränicher P, et al. Prehabilitation improves knee functioning before and within the first year after total knee arthroplasty. J Orthop Sports Phys Ther. 2022;52(3).

Minick KI, et al. Improved outcomes following care guideline implementation after total knee arthroplasty. J Orthop Sports Phys Ther. 2023;53(4).

Capin JJ, et al. Variation in outcomes following care guideline implementation after total knee arthroplasty. J Orthop Sports Phys Ther. 2023;53(4).

Orange GM, et al. Physical function following total knee arthroplasty: a longitudinal systematic review. J Orthop Sports Phys Ther. 2025;55(1).

In Episode 59 of the Total Knee Success podcast, Michelle explains what actually influences outcomes after knee replacement beyond the surgery itself. She discusses the role of preoperative strength, rehabilitation consistency, movement patterns, overall health, and expectations in shaping results. The episode helps listeners understand how to focus on the factors they can control to support better function and long-term outcomes.

Free newsletter: Total Knee Success Insider

Before surgery? free2weeklaunch

The Knee Replacement Game Plan

Medical Disclaimer: This podcast is for educational purposes only and does not constitute medical advice. The content is not intended to replace individualized medical guidance, diagnosis, or treatment. Always consult your surgeon, physical therapist, or other qualified healthcare provider regarding your specific condition, surgical decisions, and rehabilitation plan.

Amazon Affiliate Disclaimer: Some resources mentioned in this podcast may include Amazon affiliate links. If you choose to purchase through these links, the podcast may earn a small commission at no additional cost to you.

Evidence-Based Content Statement: All information presented in this episode is grounded in peer-reviewed research, published clinical guidelines, and current best practices in orthopedic surgery and rehabilitation.

Music Licensing Statement: Intro and outro music for the Total Knee Success Podcast is licensed for commercial use. Editing and production for this episode were completed using Descript.

References:

Gränicher P, Mulder L, Lenssen T, Scherr J, Swanenburg J, de Bie R. Prehabilitation improves knee functioning before and within the first year after total knee arthroplasty: a systematic review with meta-analysis. J Orthop Sports Phys Ther. 2022;52(11):709-725.

Minick KI, Hunter SJ, Capin JJ, Stevens-Lapsley JE, Snow G, Woodfield D, Dibblee P, Brennan GP. Improved outcomes following a care guideline implementation: part 1 of an analysis of 12,355 patients after total knee arthroplasty. J Orthop Sports Phys Ther. 2023;53(3):143-150.

Capin JJ, Minick KI, Stevens-Lapsley JE, Snow G, Woodfield D, Dibblee P, Brennan GP, Hunter SJ. Variation in outcomes and number of visits following care guideline implementation: part 2 of an analysis of 12,355 patients after total knee arthroplasty. J Orthop Sports Phys Ther. 2023;53(3):151-158.

Na A, Coronado RA, Oppermann AL, Jupiter DC, Lindsey BA. Diabetes mellitus blunts the symptoms, physical function, and health-related quality-of-life benefits of total knee arthroplasty: a systematic review with meta-analysis. J Orthop Sports Phys Ther. 2021;51(6):269-279.

Orange GM, Hince DA, Travers MJ, Stanton TR, Jones M, Sharma S, Kim S, Wand BM, Murphy MC. Physical function following total knee arthroplasty for osteoarthritis: a longitudinal systematic review with meta-analysis. J Orthop Sports Phys Ther. 2025;55(1):1-10.

Jette DU, Hunter SJ, Burkett L, Langham B, Long A, Fritz JM, Stevens-Lapsley J, Bade M, Christiansen CL, Meissner P, et al. Physical therapist management of total knee arthroplasty. Phys Ther. 2020;100(9):1603-1631.

Dweck CS. Mindset: The new psychology of success. New York, NY: Random House; 2006.