Brighton Physiotherapy for Knee Pain: What Helps Before and After a Knee Replacement

By Matthew Bennett

Advice can often be conflicting: rest it, move it, push through the pain, get surgery, avoid surgery. We can clear up the confusion..

We asked one of our Sundial physiotherapists Sakshi Maheshkar to share what advice she would give to someone with chronic knee pain.

Sakshi explained, “NICE guidelines tell us that the best way to help knee osteoarthritis is exercise-based physiotherapy. Even if you’re waiting for surgery, it’s important to keep moving in a sensible way. Coming to see a physio sooner rather than later means you will get the information you need, the exercises that you can do and advice about how to manage the pain. This is true whether you’re waiting for a knee replacement or recovering from one.”

Why exercise comes first, not surgery

It’s not surprising that a natural reaction to chronic knee pain is simply to stop moving. After all, a worn, painful joint would seem to be crying out for rest. In fact, the pain of knee osteoarthritis stems not so much from the state of the cartilage as from muscular weakness and loss of control around the joint. Strengthening the muscles that support the joint helps to manage how weight is distributed and how movement is controlled.

Most important are the quadriceps. These are a group of four muscles which run down the front of the thigh and control how you extend (straighten) the knee. You use them every time you get up from a chair or walk up a slope. Weak quadriceps mean that it’s the joint taking the strain instead of the muscles doing more of the work. Your physio at Sundial will work with you to strengthen this muscle group, whether that’s for pre-habilitation (before surgery) or rehabilitation, after surgery.

If you’re waiting for a knee replacement

You may have got to the point where surgery for a knee replacement is being lined up. What might surprise you is that pre-operative physio can significantly enhance recovery after surgery.

A course of “pre-habilitative” targeted strengthening exercises before your knee replacement operation has been shown to improve recovery times, manage pain and enable you to return to health earlier than otherwise.

Some studies suggest that it can reduce the rate of complications after surgery and even lead to a shorter hospital stay. The benefits of pre-op physio are most apparent in the first six months after the operation. Beyond that timescale, people who do not undertake a planned programme of strengthening exercises tend to catch up with those who have.

What this really means for you is that the wait for surgery does not have to be an empty space. You might have months before an NHS appointment becomes available but you can be proactive about treatment and start managing your recovery, not just your daily symptoms, before you even have the knee replacement.

After surgery: rebuilding function safely

Recovering from knee surgery involves a lot more than bed rest. In fact, you might wish at first that you could stay in bed: after your operation, you’re likely to be asked to get up and stand by your bed, and even walk about (with appropriate supports, of course). When you get back home, you’ll be sticking to the structured rehabilitation that your hospital recommended but a treatment plan and close monitoring by a Sundial physio in the later stages of healing can really fine tune your recovery. Small adjustments in your exercises can make a real difference to how quickly you regain confidence and strength in your joints.

Knee pain when you don’t plan to have surgery

The painful symptoms of an osteoarthritic knee can fluctuate rather than steadily getting worse, so perhaps surgery may not be something on your horizon. An assessment, targeted strengthening exercises and monitoring by our physiotherapists are often enough to manage knee pain for years, provided the joint is strengthened and stabilised.

Corticosteroid Injections

Here at Sundial, we can provide corticosteroid injections to calm painful flare-ups in the joint, which provide relief for several weeks. They’re not a long term solution but they do set up a window of opportunity to begin strengthening exercises with our physio. This in turn can start to stabilise the knee and help you get back to a more normal life. Dr Dan Hammond offers anatomically-guided injections (non-ultrasound) at Sundial Queens Road by arrangement.

Low Level Laser Therapy

Sundial offers another gentle, non-invasive help for your recovery using the stimulation of correctly-dosed light energy, known as low level laser therapy (LLLT). This process works best in conjunction with rehab exercises, delivering a boost to healing and reducing inflammation and pain. As part of your wider treatment, your physio or chiropractor may suggest LLLT as a complementary therapy alongside your structured exercise programme.

Knee health, balance and staying steady on your feet

Weakness around the knees and hips in older people is unfortunately a high risk factor for falls. If you’re coping with knee pain and are in the over-60 category, our physiotherapy team will focus not just on strengthening the joints with the right exercises, but also on balance and gait. Your assessment will include a look at how you walk, stand up from a chair and turn round. Your single-leg standing pattern can help to assess your balance, as well as simple tests like getting up from a chair and walking a short distance. All these help to paint a picture of how knee instability might be affecting your daily activities.

What to expect from an assessment at Sundial

A first appointment focuses on understanding you, your knee and your current level of function. <Sakshi> explains how a physio session for chronic knee pain might go at Sundial.

“I wouldn’t assume that you need an X-ray before treatment: instead, I would start by assessing how your knee moves and have a careful look at how strong the supporting muscles are. I would also discuss with you precisely which movements are causing you difficulties, whether that’s climbing or descending steps, getting up from a low chair or walking any distance. I’d then tailor an exercise programme for you, one which takes into account your strength and pain levels. Every time you come for treatment, we’d be discussing how things are going and making sure the plan remains right for you. I think it’s important that exercises are realistic and personal because not only should you be able to do them, you should want to do them too.”

If knee pain has been holding you back, whether you’re waiting for surgery or recovering afterwards, Sundial physiotherapists offer a way to get back to your old self.

Frequently Asked Questi0ns: Knee Pain, Physiotherapy and Knee Replacement

Do I need surgery to fix knee osteoarthritis? Not necessarily. NICE guidelines recommend exercise-based physiotherapy as the first line of treatment for knee osteoarthritis. Many people manage their symptoms for years with the right strengthening programme, without surgery ever becoming necessary.

Why does exercise help if my joint is worn down? Much of the pain from knee osteoarthritis comes from weakness in the muscles supporting the joint, particularly the quadriceps, rather than from the cartilage itself. Strengthening these muscles helps the joint absorb weight and movement more evenly, which reduces pain.

I’m waiting for a knee replacement. Is there any point starting physio now? Yes. Doing targeted strengthening exercises before surgery (known as “prehab”) is linked to faster recovery, better pain management and quicker return to normal function afterwards. The benefits are most noticeable in the first six months post-surgery, so using your waiting time well can make a real difference.

What happens after a knee replacement? Recovery starts almost immediately, with most people asked to stand and walk (with support) soon after their operation. Once home, following a structured rehab plan and having a physio fine-tune your exercises as you heal helps you regain confidence and strength more quickly.

Will I need an X-ray before I can start physiotherapy? No. An assessment usually begins by looking at how your knee moves and how strong the surrounding muscles are, along with which everyday movements are giving you trouble. Your exercise plan is then built around this, not around an X-ray.

Can injections help with knee pain? Corticosteroid injections can calm a painful flare-up in the knee for several weeks, but they’re not a long-term solution. They’re best used as a window of opportunity to start a structured strengthening programme with a physiotherapist. At Sundial, these injections are given by Dr Dan Hammond using anatomical landmarks rather than ultrasound guidance.

I’m over 60 and worried about falls as well as knee pain. Can physio help with that too? Yes. Weakness around the knees and hips is a known risk factor for falls in older adults, so alongside strengthening exercises, a physio session will typically include work on balance and gait to help you feel steadier on your feet.

About Matthew Bennett, Chiropractor Brighton

Matthew Bennett is the founder and principal chiropractor at Sundial Clinics Brighton, established in 1991. With over 35 years of clinical experience, Matthew qualified from the Anglo-European College of Chiropractic in 1987 and served as President of the British Chiropractic Association for four years. As a Fellow of the Royal College of Chiropractors and former team chiropractor for Brighton and Hove Albion FC and the British Alpine Ski Team, Matthew combines evidence-based chiropractic treatment with sports performance expertise. His authority in musculoskeletal health has been recognised through national media appearances, expert witness roles and contributions to professional publications. Matthew’s commitment to clinical excellence ensures patients receive the most effective chiropractic care in Brighton.