The Rehabilitation Medicine Group

18/01/2026

Welcome to The Rehabilitation Medicine Group.

This page is for people whose pain has persisted longer than expected — particularly after knee replacement or with conditions such as spinal canal stenosis.

Many people are told that surgery has gone well, scans look fine or that tissues have healed, yet pain continues to affect walking, sleep, confidence or daily life.

This experience is more common than most people realise.

Persistent pain does not necessarily mean that something has gone wrong.
Often, it reflects how the nervous system adapts after injury, due to osteoarthritis or following surgery, becoming more sensitive and protective over time.

At The Rehabilitation Medicine Group, we focus on pain rehabilitation:

- understanding why pain can persist
- explaining pain in clear, non-alarming ways
- and sharing evidence-based strategies used in rehabilitation medicine when recovery has not followed a straight forward path.

This page is educational.

It does not provide individual medical advice, diagnose conditions or replace care from your clinicians.

Our programs are developed by Dr Nathan Johns, a specialist Rehabilitation Medicine Physician and are based on contemporary pain science and clinical research.

If you’re here to better understand pain, you’re in the right place.

28/10/2025

The Kneed trial results:

Now available to the public: https://thermg.com.au/kneed/

26/10/2025

Should you push through pain after a knee replacement?

For as long as I've been practicing in rehabilitation medicine (25 years), patients have been encouraged to push through their pain (keep going despite increasing pain) after surgery to achieve a better knee bend (range of motion).

But is this the right thing to do? 🤔

There are 3 different strategies for exercise and pain...

(i) 😣keep exercising even though pain is increasing (no pain-no gain)
(ii) 🐢stop exercising before pain increases (pacing)
(iii) 🙈 don't exercise if you have pain (avoidance)

This has not been studied after knee replacement, but has been studied with chronic pan conditions:

🙈 The avoidance strategy (iii) is the least successful and should itself be avoided.

😣 The no pain - no gain strategy (i), whilst better than avoidance, may contribute to muscle inhibition (reduced range of motion due to pain) and the learning that exercise leads to pain. This may lead to sensitisation and persistent pain.

🐢My preferred choice is pacing, especially if pain lasts more than 3 months after surgery. This is to keep exercising, but stop before pain increases. This means that you have to do multiple exercise sessions rather than doing it all at once.

💻The Kneed online pain rehabilitation program teaches the pacing strategy and this, I believe, is one of the fundamentals to reducing pain after knee replacement.

🎓Further studies on Kneed will investigate whether people who successfully reduced their pain used this strategy.

Learn more about Kneed 👉 https://thermg.com.au/kneed

24/10/2025

🦵Why does pain persist after knee replacement?

Knee replacement surgery can be life-changing — but for some people, pain doesn’t fully go away. In fact, around 1 in 4 people continue to experience moderate to severe pain months (or even years) after surgery.

So why does this happen? 🤔

Persistent pain isn’t just about the knee joint itself. It’s often the result of a mix of factors that interact in complex ways:

🦠 Osteoarthritis pain before surgery: the longer you’ve lived with knee pain, the more sensitive your nervous system may become.

🧠 Sensitisation and personal risk factors: things like long-term pain, stress, poor sleep, or anxiety can make the body’s pain system more sensitive.

🔪 The surgery itself: even when surgery goes well, the body and nervous system can experience significant changes.

⚠️ Post-operative complications: our research found that this increased the risk of severe pain

⚡ Neuropathic pain: nerves themselves can be injured or sensitised, leading to burning or shooting sensations.

Persistent pain doesn’t mean your surgery “failed” but it means that your pain system has changed and it needs extra care and retraining. 💪

The Kneed pain rehabilitation program helps people understand and reduce their pain safely and from home.

You can learn more about pain rehabilitation approaches here: https://thermg.com.au/kneed/

23/10/2025

😴💤 Is poor sleep making your knee pain worse?

If you’ve had a knee replacement and still find yourself awake at night — you’re not alone. Many people experience sleep problems before and after surgery, and here’s the problem:

👉 Lack of sleep can actually increase pain sensitivity, making recovery even harder.

Research shows that pain and sleep are closely linked — when one gets worse, so can the other. It can become a frustrating cycle: pain keeps you awake, and being awake keeps you in pain.

💡 The good news?
Small changes in your sleep routine and how you think about pain can make a real difference.

That's why Kneed, our online program for people with pain after knee replacement, includes modules on sleep, relaxation and understanding pain.

👉learn more at: https://thermg.com.au/kneed/

22/10/2025

Does inflammation cause pain? 🤔
Not exactly — but it does have a strong role to play.

🔥When your knee becomes inflamed, your pain system becomes more sensitive. This sensitivity helps you notice and protect your knee — it’s your body’s way of saying, “Take it easy, I’m healing here!” Inflammation also brings in special cells that repair damaged tissue.

🦵as another example, think about if you rolled your ankle — it might not hurt much at first, but about half an hour later it starts throbbing and swelling. That’s inflammation dialing up your body’s awareness.

🕒The good news? Inflammation naturally starts to resolve about 18 days after injury or surgery and is usually complete within 6 weeks.

⏰Sometimes, though, your pain system stays sensitive, on high alert, and protective habits (like limping or avoiding movement) can hang around — contributing to ongoing knee pain even after the tissues have healed.

💡 Kneed helps you understand these changes and retrain your pain system — so your knee (and you) can get back to moving with confidence.

21/10/2025

Understanding pain - When the Alarm's On but the Engine's Fine 🏎️

⚠️ Imagine your car’s warning light flashing on the dashboard.
It’s there to keep you safe — to let you know something might need attention.

🤷‍♀️ You take your car to the mechanic, but even after the problem’s fixed, the light stays on. The car’s system stays on alert, even though there’s nothing wrong under the hood

🧠 Pain can behave in the same way. After a knee replacement, your body may have healed — but your brain’s “warning light” can stay switched on. The system that’s meant to protect you can become overprotective, with pain persisting even when the danger has passed.

🌿 The good news? You can learn how to reset that system — calming the alarm and turning the warning light off. That’s what Kneed helps people do: understand pain, and take gentle steps toward recovery.



👇 Learn more:

Online pain rehabilitation for persistent pain after knee replacementWhy wait to get better?Choose Kneed to reduce your pain, improve your walking and start enjoying life again!Get started What makes Kneed unique?   Kneed is the first evidence-based online pain rehabilitation program for pe...

20/10/2025

What burnt toast can teach us about pain...

🚨Sometimes when we burn toast, we set off a fire alarm, warning us that we are in danger. But even when the toast is found to be ok - the alarm continues.

🧠Our brain can work the same way. Pain is like that alarm, it warns us of possible danger. But sometimes, the alarm keeps sounding long after the danger has passed.

🦵 3 months after a knee replacement, even though the knee has healed, and the danger has passed, the brain's sensitive alarm system can keep going.

🌿 The good news? You can help calm your pain system and turn the volume down. Understanding how pain works is the first step towards changing it.


https://thermg.com.au/kneed/

19/10/2025

Why does pain continue after a knee replacement when your surgeon says that the surgery went well?

Pain isn’t just about what’s going on in your knee — it’s about how your body and mind work together.

Pain is influenced by more than tissue healing; it’s affected by how your nervous system functions, your emotions, your sleep, and even your stress levels.

So even when your surgery has gone well, pain can sometimes linger.

Kneed has been designed to help you understand pain and take control of it.

https://thermg.com.au/kneed/

replacement

02/10/2025

Just published!

🦵💻 New research on tackling persistent pain after knee replacement!

Up to 1 in 5 people continue to live with moderate to severe knee pain months (and even years) after surgery. Current care options often fall short.

That’s why we developed Kneed – an online pain rehabilitation self-management program built on a biopsychosocial approach.

📊 In the Kneed pilot randomised trial:

✅ Participants (average age 68) found Kneed easy to use and helpful for managing pain & function
✅ 50% of Kneed participants reported being “much” or “very much improved” after 8 weeks
✅ Improvements were reported in function, mental health and quality of life

This shows that digital pain management can be both acceptable and potentially effective – especially for older adults living with persistent post-surgical pain.

A larger trial is now needed, but these results are an encouraging step forward.

Acces the Kneed program here: https://thermg.com.au/kneed/

👉 Read the full study here: https://journals.sagepub.com/doi/full/10.1177/02692155251375382

Objective Moderate to severe persistent pain can affect up to 25% of people after a knee replacement for osteoarthritis. The aim of the trial was to test the fe...

17/08/2025

If you still have pain after your knee replacement, check out this video from Dr Nathan Johns containing his TOP 5 tips to reduce pain 👩‍⚕️🧑‍🎓🚀🏋️‍♀️🧘‍♀️ 👇👇👇

Dr Nathan Johns is an Australian Rehabilitation Medicine Physician with over 25 years of experience treating people who have pain after a knee replacement.In...

08/08/2025

Kneed, an online pain rehabilitation program for people with persistent pain after knee replacement is now available online as a free sample module 😀 or you can purchase the full program at www.thermg.com.au/kneed

Video: https://youtu.be/2XDP5xOBl5Y?si=7la0OLJj0QCwGHxB

Moderate to severe pain after a knee replacement is a common problem affecting as many as 25% of people 6 months after surgery.Dr Johns discusses Kneed, a ne...