Feels Like A Tight Band Around Knee After Total Knee Replacement Surgery

These studies both go to show that muscular trigger points can contribute to pain and stiffness after knee replacement surgery.

Additionally there's a muscle around the back of your called the popliteus.

A recent systematic review has identified that popliteus tendon impingement can also be a cause of persistent knee pain after a knee replacement surgery.

The function of the popliteus muscle before you have a knee replacement is to unlock the knee when you start to bend it.

That function isn't quite as vital once you've replaced the joint surfaces because of the design of modern prosthetic knees.

The popliteus tendon can get injured during surgery, or it can get impinged or "pinched" inside the joint.

Thus, the popliteus can create a feeling of a tight band around the knee.

Because that's essentially what it is.

Although the popliteus isn't as necessary in an artificial knee as a real knee, it is important to consider that rotational component of your tibia during your rehab process.

This isn't something that you'll want to start right after surgery because you still want to give the implant good time to settle in to the bone before your start twisting your knee.

But if you're several months after knee replacement surgery, there are going to be times  in life when you're going to have to pivot and twist.

Your physical therapist can help you restore the rotational mobility of your knee using manual therapy techniques.

You can also do a technique at home where you cross the ankle of your surgical leg over the opposite knee.

Then gently push your thigh outward while pulling your tibia inward.

This is just a very slight glide -  millimeters of motion.

You don't want to be overly aggressive with it. You just want to restore the normal rotational mobility of your knee joint.

Nerves Can Cause Your Knee To Feel Tight After Knee Replacement Surgery

The nerves around your knee can also make your knee feel tight after a knee replacement surgery.

The sciatic nerve runs down the back of your knee, and then it splits into a tibial branch and a fibular branch right behind the knee.

Then those further branch into what are called genicular nerves, which supply the actual knee joint itself.

Those nerves can get nicked or irritated during the surgery.

Sometimes patients will even complain that they have a little bit of numbness around their knee. Often that feeling will improve over time, but sometimes it doesn't go away completely.

In any case, after surgery, those nerves get hypersensitive and irritable.

They're still trying to figure out what the "new normal" is with the knee.

Because a knee replacement isn't exactly like your natural knee.

So they may send your brain some altered sensations telling it that your knee feels tighter than it used to be until they figure out that this is the new "baseline" tension level of the knee ligaments and joint capsule.

So those were the four causes of that tightness or band-like sensation around the knee.

Again those were vascular, capsular, muscular, and neurological.

Next, I'll share some tips that can help improve the feeling of tightness around the knee after knee replacement.

Tools To Help With Chronic Knee Tightness After Knee Replacement Surgery

There are some relatively inexpensive tools and devices that you can buy to help with post knee replacement tightness.

Instrument Assisted Soft Tissue Mobilization (IASTM)

One of the things that I found works great clinically is doing instrument-assisted soft tissue mobilization.

The most common methods used are Graston Technique® (metal tools) or Astym® therapy (plastic tools).

These are proprietary techniques used by physical therapists and chiropractors.

However, instrument assisted soft tissue mobilization has been used for thousands of years.

Gua Sha tools, originally made out of stones, have been used back since ancient Chinese times.

Essentially, you take something with sort of a sharp-ish edge (not sharp enough to cut you), and you just run it along your skin.

People will often describe this as "scraping".

But you don't want to scrape really hard to the point where you see bruises on your leg.

There are people who will go to physical therapy and get this treatment from well-meaning clinicians and come back just incredibly bruised.

The purpose of IASTM is not to mechanically "break up knots", but rather to stimulate a healing response.

The edge of the tool catches on little adhesions in your muscles, ligaments, or joint capsule.

It breaks up small, nonfunctional capillaries and stimulates a cellular response in which your body eats up old unhealthy tissue and replaces it with newer, healthier tissue.

It's good to use IASTM around the kneecap, kind of over the ligaments around the knee, and on the patellar tendon on the calf muscles and thigh muscles.

Using this on all different areas of the knee can be helpful to help restore more of that tissue mobility.

If you are going to use IASTM, just make sure that your surgical incision is well healed. Don't do this over a fresh scar that hasn't closed up well. If you have concerns, see a physical therapist to get treatment instead of doing it yourself.

Exercise Biking

Exercise biking can help with the post-surgical healing and remodeling process.

Whether you use it at physical therapy or go to a gym or have one in your home, using an exercise bike is really helpful.

Having an exercise bike at home can be good though because the more convenient it is for you to do it, the more often you're likely to actually do it.

Exercise biking can help:

• mechanically move fluid around inside the joint capsule.
• stimulate remodeling of the joint capsule and post-surgical scar tissue.
• increases blood flow and circulation which will help flush some of that swelling and bring  nutrients to the area

So using an exercise bike is another really helpful tool if your knee feels stiff or tight after a knee replacement surgery.

TENS / EMS Units

A TENS / EMS unit can also help if your knee feels tight after a total knee replacement.

While TENS doesn't mechanically do anything, it can help neurologically decrease sensation of tightness.

When you use a TENS unit, your brain picks up on that tingling or vibration from the TENS unit rather than the tightness sensation.

Additionally, if you have an Electrical Muscular Stimulation (EMS) function on your TENS unit, you can use it to create a rhythmic muscle contraction.

That functions as a lymphatic pump to help move fluid away from the knee.

Exercise does the same thing, but you can use a TENS unit at rest.

Check out this post about how to use a TENS / EMS unit.

Massage Guns

Finally, you can use a massage gun to help with knee tightness after a knee replacement.

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This helps decrease stiffness in the muscles around the knee, particularly the quadriceps, hamstrings, and calves.

I wouldn't recommend using a massage gun on the popliteus. Your sciatic/tibial nerve are located right in the back of your knee and you don't want to irritate them with a massage gun.

However, just you can use your fingers to gently massage the soft area in the back of your knee (popliteal fossa).

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Reframing The Tight Band Feeling After Knee Replacement

One last tool that you can use if you have tightness around your knee after a knee replacement is a cognitive technique known as reframing.

That's essentially just altering the way that you think about it.

If you think about it as a "problem", something that needs to be addressed, then your, then your brain is going to see the knee tightness as a potential danger.

The International Association for the Study of Pain describes pain as:

"An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage."

Whether the tightness actually hurts or whether it's just bothersome, if you view it as unpleasant and you're worried that it may indicate a problem, your brain is going to pay attention to it.

Your brain is going to tell your nerves to send it lots of information about the "problem" so it can make sure the problem doesn't get worse.

This type of thinking might include self talk like:

• Why is this happening to me?
• What's wrong?
• Has something gone wrong with my surgery?

However if you think about the tightness as as just a normal feeling that people have after a knee replacement surgery, your brain won't focus in on it so much.

In fact, knee tightness usually doesn't indicate an infection or other problem with you your knee surgery.

Your nerves may just need to adapt to the fact that your new artificial knee is different from your old knee.

It's going to feel different, but in time that "different" will be the the new normal.

Furthermore, some of the tips mentioned in this post give you some level of control over the tightness sensation.

When you have control over something, your brain worries less than when you lack control.

And if your brain isn't worried about it, it's not going to ask your nerves to send as much information about the situation.

Conclusion

Hopefully, this post helped give you some peace of mind to know that if it feels like there's a tight band around your knee after a knee replacement surgery, that's very common and likely doesn't indicate a problem with your surgery.

Furthermore. hopefully you learned some tips to help give you control over that tight knee feeling.

If you live in the St. Louis area and need more help for persistent pain or tightness after a knee replacement (even if it's been months or years), tap the button below to request an appointment with one of our specialist physical therapists.

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