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Soft Tissue Work for Complications of TKA

Soft Tissue Work for Complications of TKA

Total Knee Arthroplasty (TKA), or knee replacement surgery, is a common procedure aimed at reducing pain and improving mobility in individuals with severe knee joint degeneration. While outcomes are generally positive, some patients experience soft tissue complications of TKA that can limit functional recovery.  

For physical therapists, soft tissue work is a valuable part of post-TKA care, helping to address pain, restore range of motion, and improve long-term movement quality. This article explores soft tissue-related challenges following TKA and how physical therapists can apply hands-on techniques to support better outcomes. 

Related CE course for physical therapists: Soft Tissue Work for Complications of TKA 

Understanding postoperative soft tissue complications of TKA 

Soft tissue complications may include: 

  • Scar tissue formation that restricts movement
  • Myofascial tightness limiting mobility and causing discomfort
  • Joint stiffness from periarticular adhesions
  • Painful trigger points in nearby musculature 

These can interfere with a patient's ability to return to activities of daily living, especially if left untreated in the early stages of rehabilitation. Physical therapists are often among the first providers to detect these complications during range-of-motion assessments or functional movement screenings. 

Understanding the source and behavior of these complications is an important part of creating an effective rehabilitation strategy. 

Common soft tissue challenges after TKA 

  1. Arthrofibrosis. Arthrofibrosis refers to the excessive formation of scar tissue around the joint. It often leads to joint stiffness, limited range of motion, and difficulty with functional activities like walking or rising from a chair. 

  1. Myofascial tightness. Patients often reduce activity after surgery, which can lead to tightening of the fascial layers and surrounding muscles. This myofascial restriction can create pulling sensations, discomfort, or pain during motion. 

  1. Patellar tendinopathy or quadriceps tightness. The surgical approach often involves disruption around the extensor mechanism, contributing to patellar pain or quadriceps tightness. These issues can affect gait, stair walking, and patient confidence. 

  1. Soft tissue imbalance. Muscle imbalances, especially between the quadriceps and hamstrings or medial and lateral structures, can lead to abnormal gait patterns and joint loading, increasing the risk of discomfort or compensatory injuries. 

Goals of soft tissue work in TKA recovery 

Soft tissue interventions focus on improving tissue mobility, reducing pain, and supporting joint function.  

The following goals often guide soft tissue treatment plans: 

  • Decrease soft tissue adhesions
  • Improve circulation and lymphatic drainage
  • Restore normal tissue texture and pliability
  • Support muscle activation and neuromuscular control 

These goals align with broader physical therapy objectives of increasing range of motion, improving gait, and enabling patients to return to daily and recreational activities. 

Common manual techniques used by physical therapists 

  1. Myofascial release. This gentle, sustained pressure technique targets fascia restrictions. It helps reduce stiffness around the knee joint and improves mobility in surrounding areas such as the quadriceps, hamstrings, and IT band. 

  1. Scar mobilization. Following TKA, a surgical scar can tether surrounding tissue and contribute to pain or limited movement. Gentle scar mobilization encourages healthy tissue remodeling and reduces hypersensitivity. 

  1. Trigger point therapy. Muscle trigger points — tight bands that can cause referred pain — often develop around the knee, hip, or calf. Releasing these points can reduce discomfort and improve muscle function. 

  1. Instrument-Assisted Soft Tissue Mobilization (IASTM). Using tools like Graston or HawkGrips, therapists can address deeper adhesions and fascial restrictions. This technique often improves outcomes when combined with stretching and active movement. 

  1. Lymphatic drainage techniques. Postoperative swelling can limit mobility and comfort. Manual lymphatic drainage helps reduce fluid buildup and supports tissue recovery in the early stages of rehab. 

Related CE course for PTs: Move Better, Feel Better: A Movement-Based Approach to Soft Tissue Mobilization for the Lower Body 

Timing and progression of soft tissue work 

Soft tissue interventions should be timed appropriately within the healing process. In the acute phase, gentle techniques like effleurage and mild myofascial release may be appropriate.  

As healing progresses and tissue tolerance improves, more targeted mobilization, stretching, and IASTM may be introduced. Therapists should continuously reassess: 

  • Pain levels during and after treatment
  • Swelling and skin integrity
  • Range of motion progression
  • Functional goals and limitations 


Adjustments should be made based on patient response and healing stage. 

Combining soft tissue work with functional goals 

Soft tissue therapy is not a standalone treatment. Its effectiveness is amplified when integrated into broader therapy plans. Some combinations include: 

  • Manual quadriceps release before active knee extension exercises
  • Scar mobilization followed by joint mobilization to improve range of motion
  • Myofascial release prior to walking drills to promote better gait mechanics 

Combining passive and active strategies can lead to improved outcomes and increased patient buy-in. 

Educating patients on self-management 

Empowering patients to care for their tissues between sessions supports long-term progress. Education may include: 

  • Home foam rolling techniques for the quadriceps and hamstrings
  • Gentle scar massage techniques using lotion or oil
  • Use of heat or cold packs for pain or stiffness 

When patients understand how to manage their soft tissues, they often feel more in control of their recovery. 

Addressing patient concerns and expectations 

Some patients may be hesitant about soft tissue work due to discomfort or uncertainty. Therapists can build trust by: 

  • Explaining the purpose of each intervention
  • Demonstrating techniques before applying them
  • Involving the patient in decision-making 


Open communication improves comfort and promotes better outcomes. 

Case example: Post-TKA stiffness and scar adhesion 

A 68-year-old patient, six weeks post-TKA, presents with limited knee flexion and anterior knee tightness. Examination reveals: 

  • Hypomobility around the surgical scar
  • Quadriceps tightness
  • Delayed gait initiation due to discomfort 

Intervention may include: 

  • Scar mobilization with light pressure 
  • Myofascial release to the quadriceps
  • Trigger point release near the vastus lateralis
  • Follow-up exercises focused on knee flexion and gait training 

The aim of the above intervention is for the patient to achieve better flexion, less discomfort with walking, and greater confidence in movement. 

Conclusion 

Soft tissue complications following TKA can interfere with recovery, but they also present an opportunity for focused and impactful physical therapy care. By identifying movement barriers, applying evidence-based techniques, and pairing interventions with functional goals, physical therapists can support meaningful improvements in mobility and quality of life. 

As with all therapy approaches, communication, collaboration, and patient education are just as important as the hands-on techniques themselves. With a thoughtful plan, physical therapists can help individuals recovering from TKA feel better, move better, and return to the activities they value most. 

 

This article was written by Mehreen Rizvi

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