06/08/2026
Through No Fault of Your Own
Everyone is compensating for pain, injuries, and surgeries.
Because ~99% of physical therapists (PT) don't address compensation before introducing exercise, those common-knowledge exercises add to the compensation that was present before your knee was replaced.
Note: Muscle tightness is due to your brain protecting your knee joint from going into positions it perceives as being vulnerable to injury. The control center between your ears, in other words, is hardwired to protect, and no amount of pulling at the end of the lever to force your leg to go further is going to change the threat of instability that your brain perceives.
When you stretch your quadriceps (quads), for instance, you don't know which one of those four muscles is tight. That's also the case for the PT.
If the PT you've worked with could confirm which quads were tight, they wouldn't be recommending stretches in the first place.
To say the same thing differently, no version of stretching will ever provide the inputs it takes for your brain to remodel itself, i.e., neuroplasticity.
For your knee that was replaced to function better than it did before the pain or injury, your feet, hips, and spinal column also have to be capable of controlling motion as your feet interact with the ground.
After a knee replacement, some or all of your quadriceps are guaranteed to be neurologically inhibited (underperforming).
When muscles are underperforming, it's due to suboptimal neurological feedback from your brain to your muscles.
Besides restricting the range of motion, truly tight muscles make up the difference by pulling the weight that the underperforming muscles are neurologically incapable of lifting.
When you exercise with the thought that you're increasing strength, the quadriceps that are receiving the appropriate neurological feedback will get stronger. The underperforming quadriceps, on the other hand, will continue to be unable to perform their role effectively.
While it's entirely possible that you feel stronger, you aren't functioning well enough to return to the activities that you enjoy.
The disappointment and discouragement you feel stem from muscles that aren't capable of working together to produce motion like a finely tuned orchestra.
As for your iliotibial band (IT band), your gluteus maximus and tensor fasciae latae (TFL) attach to the band, and fibers from both muscles extend down to the end of your femur, above the joint line of your knee. From there, your IT band attaches to your tibia, the bigger of the two bones that make up your leg.
Along with your gluteus maximus and TFL, all of your quadriceps work together to allow motion of your hip, knee, and foot (at the right time).
Note: when your feet interact with the ground, your knee is responsible for motion in three directions or planes of motion.
How many planes of motion have you been trying to get back?
Answer: The one plane that allows for flexion and extension.
The bottom line: Until the underperforming muscles are confirmed and the neurological feedback to those muscles is restored, compensation will continue to accumulate.