Total knee arthroplasty (TKA), commonly known as knee replacement surgery, is often undertaken with the hope of resuming pain-free activities. Kneeling is a frequent goal for many patients, yet 60% to 80% report difficulty or an inability to kneel even 1–2 years after the procedure.
There is no evidence that kneeling after knee replacement surgery, when started at an appropriate time, causes harm. However, every individual and situation is unique, so it’s essential to consult your surgeon or physical therapist before beginning a kneeling program.
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Reasons Kneeling Is Difficult After Surgery
- Limited Range of Motion:
Kneeling requires a knee bend of 90–100 degrees. If your knee lacks this range of motion, kneeling becomes impossible and can cause discomfort, not just from the pressure of kneeling but also from the bending itself. Achieving sufficient range of motion is a key first step before beginning a kneeling program. - Discomfort from Swelling, Incision, and Nerve Irritation:
Post-surgical swelling, sensitivity around the incision, and nerve irritation can make the increased pressure of kneeling painful. These factors are common barriers during the healing process. - Fear:
Fear of pain or the belief that kneeling could cause damage often prevents people from attempting it. This fear can amplify pain, creating an additional psychological barrier to progress.
Overcoming Pain and Discomfort
To reduce pain and discomfort when kneeling, it’s essential to follow a gradual process of desensitization. This involves progressively increasing the pressure on your knee over several weeks, with the ultimate goal of being able to kneel on a hard surface with minimal discomfort. This approach can help you return to activities you enjoy, such as gardening, yoga, or playing with your grandchildren.
Starting this process is typically considered safe around six weeks post-surgery, but individual recovery timelines and surgeon preferences can vary. Always consult your surgeon or physical therapist before beginning a kneeling program to ensure it aligns with your specific needs and recovery progress.
Dr. Richard Berger’s Kneeling Protocol
Dr. Richard Berger, an orthopedic surgeon, developed a kneeling protocol. The protocol includes the following steps:
Week 1: Kneel on a couch for 10 minutes a day.
Week 2: Kneel on a couch cushion on the floor for 10 minutes a day.
Week 3: Kneel on a thin pillow or thick carpet for 10 minutes a day.
Week 4: Kneel on a thin carpet or rug.
The Goal is to then kneel on the floor.
Kneeling Is Still Possible, Even Long After Surgery
In 2019, Dr. Richard Berger studied his kneeling protocol with patients 12–18 months post-surgery and achieved excellent results. This demonstrates that even if your surgery was not recent, it’s still possible to regain the ability to kneel with focus, dedication, and the right approach.
Do You Need A More Gradual Process?
If your surgery was more recent, the Berger Protocol—with its 10 minutes of sustained kneeling—might be too painful as a starting point. During my research for this blog, I discovered an alternative protocol that begins more gently and progresses gradually, making it better suited for those earlier in their recovery.
The protocol detailed by Dr. Samantha Smith PT, DPT in her blog, Kneeling After Knee Replacement, is as follows:
Week 1: Kneel on the couch with a pillow under your knee. Kneel for 2-5 seconds for 3 minute. Repeat 2x per day.
Week 2: Kneel on couch without pillow under your knee. Kneel for 3 minutes. Repeat 2x per day.
Week 3: Kneel on couch cushion on ground. Kneel for 5 minutes. Repeat 2x per
Week 4: Kneel on floor with pillow under the knee. Kneel for 5 minutes. Repeat 2x per day.
Week 5: Knee on floor with towel under knee. Kneel for 5 minutes. Repeat 2x per day.
Week 6-7: Kneel on carpeted floor without pillow. Kneel 5 minutes. Repeat 2x per day.
Choosing the Right Approach for You
No matter which protocol you follow, remember that everyone’s recovery journey is unique. Your progress may need to be slower and more gradual than someone else’s, and that’s okay.
The most important step, once your surgeon has cleared you, is to begin. Start where you can, and commit to working on it consistently every day.
We provide in-home consultations in the San Francisco Bay Area. Contact us for a personalized Physical Therapy, Occupational Therapy, or Speech Therapy assessment in the San Francisco Bay Area: Santa Clara, San Mateo, San Francisco, and Marin Counties.
RESOURCES
- Kneeling ability after total knee replacement – Wylde et al, 2019 EFFORT Open
- Most Patients Can Kneel After Total Knee Arthroplasty – Wallace and Berger, 2019 Journal of Arthroplasty
- The Berger Protocol – Dr. Richard A. Berger
- Kneeling After Knee Replacement – 2022 Succeed Courses
Joanne Bedwell, PT is the Resident Blogger at Be Active Be Well. She lives and works in San Francisco with her husband and two (almost) grown daughters. Having over 25 years of experience as a physical therapist, she sees clients in their homes and teaches fitness classes in person and virtually.
DISCLAIMER: This article contains information that is intended to help the readers be better informed regarding exercise and health care. It is presented as general advice on health care and is not intended to be a substitute for the medical advice of a licensed physician. Before beginning any new exercise program it is recommended that you seek medical advice from your personal physician. The reader should consult with their doctor in any matters relating to his/her health.
