I frequently analyze and consider the structure and activity of my treatments. The first analysis that I make is “am I doing the right thing at the right time?” Total knee replacement is one condition that makes this question vital and important. In 22 years of treating this condition, I have found that therapy can greatly help or hinder someone’s outcome. My approach is to work in order on several things that are keys to success. First, I spend a long period of time addressing the edema and pain that occurs with this type of surgery. I work hard on reducing swelling with various techniques including massage, elevation and body movements. Only after we have begun reducing pain and edema do we move on. The second step is to begin working on motion in the knee. The old images of someone being stretched on the rack are completely outdated and wrong. The approach needed for successful total knee outcomes is gentle stretching performed for a longer duration. Strong and aggressive stretching almost always results in increased inflammation, pain and setbacks. If we can encourage a person stretch regularly at home and then attend therapy for a regular period of time after surgery they almost always have a good outcome. Once someone has obtained good range of motion it is vital to restore strength. Several excellent studies show that people with a total knee that did not receive physical therapy had significant leg weakness and overall decreased function. Performing strengthening and range of motion activity is a delicate balance. The knee has only a certain capacity for activity each day. Too much work on strengthening can result in a knee that is inflamed and swollen. By following these steps we see continued success with total knee replacement.