Paddling after a new knee

Howdy all,

Just a quick question for the older folks or the younger folks that abuse themselves, like me. I am slated to be getting a new knee next month. I am curious as to how long after a similar procedure you were able to paddle effectively. What limitations do you find yourself having? I know it’s not going to be this summer that I’m back, and my paddling year is effectively ending at the end of May, but I wonder about the future. If it helps at all, I am a canoeist, mostly solo.

Any thoughts or comments are greatly appreciated.

(Almost) Bionic Matt

I’m hoping you prefer to sit, because your surgeon won’t want you kneeling on the artificial knee. Aside from that, it will depend on how good of shape your knee is in before you go in for surgery. I would say average therapy after that surgery is 6-8 weeks until you’re back to fully functional with normal daily activity. Getting in and out of the canoe will take more balance and strength, and you will probably have soreness after sitting in any one position for more than an hour or so. Those would be the next two big hurdles to get over, and how quickly that will take will vary. I would guess 10-12 weeks could be possible for short trips in a canoe, but after that you’re going to just see how it reacts. Every patient and every knee heals a little differently.

You will recover significantly faster if you have full knee range of motion going in to surgery, with extension usually more painful to get than flexion after surgery. Good strength in your quads will also help. If you haven’t started doing any exercises yet, start working on getting full knee extension and good flexion now, and get those muscles going! If you need any exercises let me know, I can try to point you to some.

I had a total knee replacement in October. I have always been a kneeling paddler. I found at four months I could kneel just fine on a pad in the canoe but tolerated the kneeling position for about 10 minutes( then it wasn’t fine!). I do not have the range of motion necessary to transition from kneel to sit ( it requires more than just kneeling). My orthopedic surgeon said kneeling is fine with a pad. Ask your doc and just don’t ram on it.
You will find kneeling hurts like heck for six months due to scar sensitivity.
The issue as indicated in the post above is you do get stiff when in one position for a period of time. This is normal but will take time to wear off. Yep every knee is different.
Complete recovery would be nice at 6-8 weeks but a year is more realistic. Even now at seven months when the weather goes south my range of motion does too.
I might be transitioning to a sitting paddler though I detest it. I keep working on ROM to get back to kneeling effectively.
In rehab a bike is your best friend. I bike every day. I bought a stationary bike for inside too.

The trouble with seeking advice from docs is there are very few kneeling in a canoe docs.

My limitations are now caused by my OTHER GOOD knee. The operated one is better. I sprained the hamstring tendons in the other one… Man that hurts.

Now temporarily in a pack canoe. We paddled some six miles last Sunday

Thanks for the info! While I am no stranger to surgeries in general (this will be #13) and knee surgeries in particular (this will be #7), I am new to having a foreign body put into a joint (not counting the screws in the shoulder or the bullet that was forcefully put into my hip). As far a kneeling in a canoe, I gave that up a long time ago, even with a pad it just doesn’t really work for me. I have been sitting for quite some time and have grown quite comfortable in it.

I do get really stiff now after a few hours in the boat, and I have found that ibuprofen before and after is my new best friend.

My big concern is getting in and out of the damn boat. Also, aside from pool noodles, do you have any other recommendations for padding the gunnels?

I would use some minicell foam to create knee “bumpers” to pad the gunwales. It is available as a sheet or plank in various thicknesses, is easily cut, and can be shaped to the contours of your knees. Bond it to the canoe with contact cement.

Cautionary Tale Alert. Not trying to be a wet blanket, and my experience isn’t the norm, but I like to share it with folks so that they know that a knee replacement isn’t a 100% thing.

I had a knee replacement 7 years ago. For most people, a knee replacement is a good thing and it increases their ability to be active and decreases their pain. For me it was the worse decision I ever made in my life. I was a fit & active 50 year old at the time of surgery, and I assumed that it would be a good thing to do. Pain in my knee, and decreased ROM was causing me issues. I knew going in that it would be hard work to recover with lots of painful PT. I had a good work ethic and was religious about my PT, but in the end, I had less ROM and more pain in my knee than I had before the surgery. After 2 years post-op my doctor revised my knee. More PT resulted in some modest improvements, and I was about 75% happy with my knee. Then I had what normally would have been a minor slip & fall. Good foot slipped on a wet floor & replacement knee twisted as I fell. Shattered my femur just above the prothesis. The knee joint thankfully was intact, but it took 3 hours in the OR, bone grafting, a 12 inch plate, and a dozen screws to reconstruct my femur. It took 3 months to be able to walk again and a full year to get back on the water. My ROM is now terrible. I can barely bend to 90 degrees, which has made me pretty much a gimp for life. Luckily I had already given up skiing (I live within 20 minutes of Snowbird ski resort in Utah), and I wasn’t a hiker. Being a rafter & paddler has been the best way to enjoy the great outdoors and I’m thankful for that.

A friend of mine had his knee replaced this past year and has also struggled a lot. He has had 3 manipulations under anesthesia because of scar tissue build up, and he still walks with a limp.

I truly hope you are in the majority, and have a great outcome. Be prepared to work hard & push past the pain in PT so that you can achieve the best outcome.

Actually PT and pushing against the pain is old school thought. The new thought is NOTHING for four months. Then build strength again. The old school way resulted in lots of adhesions for people and complication.
Excessive PT and pain causes swelling which delays healing. You cannot bend a swollen hose. Knee is the same… Wait for the swelling to go down.
I can kneel but I need about 145 flexion to go from kneel to sit in a 27 inch wide canoe and its not there yet. It takes about a year to come.
Adhesions are rare and often caused by excessive PT . A hot swollen set of soft tissues is dry and sticky,

Mayo Clinic and Hospital For Special Surgery have initiated PT protocols that stop the intensity of the activity when there is pain. My surgeon recommended NONE save for stretches and heel slides and walk walk walk. The stretches are to stretch out the knee capsule which for years had been not fully extended.
This was Oct 2016

Get a bike, Its a big help. Do intense upper body workouts. That is a big help too. Go paddlng far and fast and often.


That sounds brutal. I have had terrible luck with surgeries on the whole. This will be my 7th knee surgery because everyone says I am too young for a replacement. After trying everything from drugs (legal) to other surgeries, I am at my wits end. Hopefully this is a homerun.

I live in Western Washington so paddling is an easy thing to do up here. I gave up running when I took it from a sign from God that I should because someone shot me in the hind end. I gave up climbing when I had my second shoulder surgery. I paddle now and I have found it to be my very favorite activity of all of them.

I know you said you’re 75% happy, I bet out on the water that gets bumped up quite a bit! Good luck to you!


@ridgw003 said:

That sounds brutal. I have had terrible luck with surgeries on the whole. This will be my 7th knee surgery because everyone says I am too young for a replacement. After trying everything from drugs (legal) to other surgeries, I am at my wits end. Hopefully this is a homerun.

I live in Western Washington so paddling is an easy thing to do up here. I gave up running when I took it from a sign from God that I should because someone shot me in the hind end. I gave up climbing when I had my second shoulder surgery. I paddle now and I have found it to be my very favorite activity of all of them.

I know you said you’re 75% happy, I bet out on the water that gets bumped up quite a bit! Good luck to you!


Yep. On the water is my happy place for sure. Most people do well,and I should add a more positive story. I do have another friend who was back skiing within 8 months of her replacement. She loves her new knee.

" everyone says I am too young"… Armchair experts? Have they all had it? Probably not
Peruse There are TKR patients in their teens. It is likely that the artificial joint now has a lifespan of 30 years.

The hardest part is not the pain . Its the wanting to exercise hard before that new part is ready due to all the soft tissue manipulation. I did do PT but if it hurt we stopped. I couldn’t spend the fall watching Netflix! If you are young its easy to want to overdo it… You will find the balance. You will do PT too hard, pay for it, and have to rest and get antsy… You’ll figure out soon how much is great and how much is not great.

Some people get the operation done nowadays in same day surgery and home that evening.
You will be walking that same day… I was doing stairs that same day… its about technique which they will show you.

Oh never mind the cane stuff. Likely you have a pair of hiking poles. Use them after the operation

I would respectfully disagree with kayamedic on a few points. The new school of though is definitely NOT to do anything for four months, physical therapy should not create swelling, and physical therapy does not cause adhesions (actually the opposite of that). I am a Doctor of Physical Therapy, working in a rural clinic with a largely older population, and I usually have 2-3 knee replacement patients on my caseload.

I have heard statements like these before from a few orthopedic surgeons, and in each case they were from older surgeons near retirement. The new school of thought actually focuses on more movement and therapy initiated right after surgery. It used to be have surgery, wait a couple weeks, then start therapy. Then it shifted to start therapy after the 7-10 day follow-up. Now the surgeons in our region coming out of fellowships are referring patients to start therapy within a day or two of going home, which is usually the day after surgery. The research regarding physical therapy and knee replacements supports starting movement and range of motion exercises soon after surgery. From my experience, the patients that start therapy sooner tend to achieve full range of motion more quickly and with less discomfort than those that wait. (You do need to be careful the first 7-10 days post-op, the knee is still very “irritable” in that time frame, and it is easy to overdo it and increase swelling and pain. Think “uncomfortable, not painful”)

Physical Therapy (and any other activity) CAN cause inflammation and excessive pain, but it shouldn’t. Unfortunately there are some bad apples in every profession, so I don’t doubt there have been therapists that push too hard too fast. All activity, therapy included, should avoid inflammation. You will be uncomfortable with range of motion and stretching, but it shouldn’t be painful. And there is a difference. A good therapist will help you understand the difference and realize how far you can safely push it. If you are having pain, you will most likely also have swelling and inflammation, which will slow down the healing process. But it is possible, and sometimes necessary, to push ROM and strengthening to a point where it is uncomfortable, without causing inflammation.

The most current research regarding physical therapy after knee replacements is finding that the more strength you have after the surgery, the better you will be doing one year after surgery. More specifically, the more quad strength, with vastus medialis oblique being the muscle usually referenced. A good functional reference is this: continue with your strengthening until you can go down stairs with good control and proper knee alignment, with enough strength that you don’t need to use a handrail. That ensures you have good eccentric strength in the quads, which takes more strength and control than concentric exercises.

Sorry, that may have gotten a little too long! Good luck with your surgery, and feel free to contact me if you need need anything more specific.

I appreciate the feedback from everyone. A bit of a backstory for me. I spent 15 glorious year in the military. When I was much younger, I could easily jump off something twice my height. I am now realizing the error of my ways. After 12 surgeries so far (6 knees, 2 shoulders, a wrist, a bullet removed from my hip, and a couple other smaller ones), I am pretty good with the PT. I can damn near tell the therapist what I should be doing and when. My problem now is that since I am so young, a spry 36, no surgeon has been willing to go down the replacement path. My current Ortho guy realizes that we have tried literally every remedy we can, and this is our last, best, hope.

As far as paddling, I am a canoeist at heart. I have tried those little boats that people crawl into, didn’t like em. They feel claustrophobic. I love my little solo boat now and am looking to move into a larger Penobscot 164. I think the greater width will allow more movement of the knee during trips (this is what I tell my wife).

My surgery isn’t for a month. We have a trip to Disney with the kids and I have a 20K canoe race between now and then. We are calling it my knee’s farewell tour.

I wish you all nothing but the best and thanks again for your well wishes and advice.

Paddle On,

(Almost) Bionic Matt

Oh I never said be couch potato. I did do gentle PT but never to the point of excessive swelling… Work smarter not harder.
I was out of hospital the day after and walking half a mile after a week. But if my knee hurt I stopped rather than “working through the pain”.
I waited till four months to strengthen You see my muscles were pretty good pre op as I could climb lots of stairs to get into my house and was biking and paddling to the end.
What I needed was some healing… There were bone ends sawed off and glued and appliance screwed in.

Now my “good knee” that does not need replacement got hyperextended coming off a bike last week… that really hurts.

Matt you will like Disney better if you cow to a mobility device… just for now… Lots of walking… Rent it off site. The ones rented in the park are dastardly expensive. I did the same prior to getting my new knee…

this has been a good thread for me to read. I’v still got my original knees and hips. I’m 55 years old and am contemplating getting some parts replaced- did lots of wear and tear when I was younger - c1ing, teleskiing, spelunking, backpacking . I’m just trying to decide how bad it needs to get before I do the replacement route. I limp through the hallways at work (hard tile floors), have to sit down to tie my shoes in a weird yoga position and I pretty much accept the fact that I’m going to get wet whenever exiting out of the kayak. It’s just hard to get the legs out when they stiffen up after boating. Also I’ll gladly accept help when it comes to lugging boats to and from the water . Yet when I’m actually on the water, in current, I feel like I can move again!

I recently took an ACA instructor class . I only came away with L2 certification . Chris Wing, the instructor, noted that “Much of my deficiency is due to physical limitations and less to do with
course material, comprehension, and use of vernacular.”

Now I tell my friends, "I’ll have you paddling flatwater in no time!

by the way chris and lydia do an excellent job at H2O Dreams if you are looking for ww certification

The time will come when you realize how much that your joints are affecting your life. Sooner or later you will be fed up. I do think that boat ramps ought to come with a Hoyer lift or a walker… Its funny watching people try to walk after exiting their craft. I am very fond of some FL paddlecraft ramps that come with rails…

Congratulations on your L2 cert. We need instructors at those crucial entry levels to foster future aware boaters.

Just like Kayakmedic said, you’ll know when it’s time. I knew because my family started planning activities around my knee. It really is a pain in the ass to have a body part dictate your life like that. I guess I had a body part dictating most of my life in high school too, but that was a lot more fun.

Disneyland ended up being fun, if not really painful. I was hurting pretty good at the end of every day.

Hoping to get one more day of paddling in before surgery!

Matt, thank you for your service. It has cost you more than most are willing to pay.
I like your “damn the torpedoes” attitude. Keep on keeping on!

Thanks String,

I just figure that at my age, I might as well just go all out. Hell, if they’re cutting it out anyway, might as well just wreck it completely. Ok, maybe not completly, surgery is less than two weeks away so I have to be off all medication, to include ibuprofen (the paddler’s best friend?). So far though, the farewell tour has included Disneyland, a river race (last place but I still finished), and is about to include a short camping trip. If you’re gonna do it, do it right!