Episode 66: What Joint Replacement Recovery Is Actually Missing

In this episode of Three Questions, I take a brain-based look at joint replacement and challenge some of the assumptions we make about pain, recovery, and movement. Surgery can be life-changing, but it doesn’t automatically reset the brain’s maps, compensation strategies, or sensory systems.

In This Episode You'll Hear:

• How proprioception and brain mapping influence recovery outcomes
• What research shows about brain changes before and after joint replacement
• What a more complete approach to pre-op and post-op rehab could look like

Whether you’re preparing for surgery, recovering from one, or helping others navigate the process, this episode will help you think beyond the joint and toward the brain-body system that has been adapting all along.

Links & Resources For This Episode:
Episode 65 - Three Questions with Mariska Breland: Resiliency, Partnerships, and Making Things That Matter
Find a Neuro Studio Teacher Near You
Connect with me on Instagram
Connect with me on Threads

Transcript

Meghann Koppele Duffy: Welcome to Three Questions, where critical thinking is king, and my opinions and research are only here to support your learning and understanding. Hey, I'm your host Meghann, and I'm so honored you clicked on Three Questions today so we can talk about joint replacements. Now, you might be thinking, "I don't need a joint replacement.

I don't work with anybody that needs a joint replacement." But I wanna make this episode a little bit bigger than joint replacement because it's something that happens to every single person, right? Our joint mechanics, maybe they get a little worse as we age, and maybe you're young, maybe you're middle-aged, maybe you're above the age of 65 and you hear all your friends talking about their aches and pains.

I think taking a brain-based approach to this and understanding joint replacement simply from, like, a biomechanical standpoint is a little limiting. So I wanna open all our eyes. I wanna ask three questions, not so we have any answers, but maybe we have questions we can ask to our doctors or questions we can ask to ourselves.

So let's get right into it. Question one: What is happening in the brain before the joint replacement, and does surgery really fix any of that? So something, uh, people don't really like to hear is that- Listen, joints don't get crappy overnight. It wasn't the one thing you did, right? Now, I hate when people say, "Oh, this caused this."

Uh, yes, and... That could be totally true. But what we wanna think about is the body's connected. Everything affects everything. So rather than pick, uh, like pinpointing every single thing in our life, just think every single movement, everything we do, everything we read, everything we experience is going to have an ef- effect on our body.

Our jobs, how we sit, how we drive, how we walk, all right? So rather than blaming yourself for a joint replacement, I want you to think before the joint replacement, what was really going on in the brain? And where I wanna start first is talking about compensation patterns because I don't know about you, but they get a pretty bad rep.

So is it rep or rap? They get a pretty bad rap. Oh, interesting. If you're new to my podcast, there's like a few things I always do. Number one, I always screw up a saying. I either say it backwards, or I say something that doesn't make sense. Uh, for example, I was having dinner with my aunt and uncle yesterday, and I was like, "Well, there's a sock for every foot."

She's like, "I never heard that before." I'm like, "Yeah, I don't really think it's a thing." Okay, something else I do is I pronounce words incorrectly. And so we'll just go with that and have fun. But I would really like to know which one is it, they get a bad rap or rep? Just wondering. All right. Let's get back to the actual episode.

So compensation patterns. Everybody be like, "I know I walk with a circumductive gait, or I hike my hip. My PT told me my pelvis is one degree rotated to the right and 77 degrees to the left," and I'm just like, oy. First of all, we are making a lot of assumptions based off what we see. I've even see people palpate something and say to me, "Oh, your back has excessive lordosis."

And I'm like, "Well, first of all, you're not even touching my spine. Right here, that is not extended. That is flexed." And they'll be like, "Oh my God. I was touching here." I'm like, "Well, yeah, that little piece is extended, but do you not see that scar right there? I had surgery." So this person's not wrong about what they're feeling, but we make a lot of assumptions about what we feel and what we see.

I often say to my students, "Unless I've got like EMG or electrodes on your brain and body, what I'm saying is kind of a hypothesis. I think this movement, this strategy is going to activate this part of the brain." And even with like visceral work, you know? "Oh, I'm mobilizing your liver." Guys. Now, my intention will be that I might be getting deep enough or my hands are changing the sensory environment that can have a positive effect on the liver.

All three of those could be true. I just find making blanket statements just sets yourself up to look like an idiot later or to confuse the hell out of people. So going back to compensation patterns, why do we assume those are bad? Just let that land. When our body is compensating, that is a survival skill.

So if I hurt my left foot and I can't walk, that is going to increases, increase my chances of death, not from the foot. But if I stop walking, that's going to affect my musculoskeletal, my fascial, my organs, my mental health. All of things will happen. Now, that might not happen overnight. It could happen over time.

Now, again, if I was in the wilderness and I hurt my foot and I'm being chased by a predator, I'm definitely gonna die if I can't run. So like if I have a hitch in my giddy up, my brain can compensate around and say, "Screw that left foot. Let's just swing this hip joint or laterally flex so you can get away from that predator, or keep moving so that we get blood flow and nerve conduction."

So one thing I just want everybody to think about. Are compensations bad, or are they a necessary part of life to keep us alive? Now, before you get your panties in a bunch, I want you to think, yes, a compensation pattern can become problematic. Well, I- you're, you're telling me compensations are good, but my compensation of over-mobilizing my knee is why I had to get a knee replacement.

Yes, and... But the problem there was, that became your only pattern. Your brain couldn't compensate around that pattern. You made it so efficient, your brain thought it was the best option, until it didn't. Now you're in pain. And something we don't like to think about, pain science is super interesting. I like more application.

So I like to think of pain as a communication tool. Slight pain is like, "Hey, I'm not really loving this situation. Mind you-- Might you make some changes here?" And I'll probably say, "Not now, brain. I'm very busy. I wanna finish this workout. I gotta get here." Blah, blah, blah. Okay. Brain's gonna say, "All right.

Okay, well, she didn't do it tom- she took a day off. Good. All right. Now she's doing this shit every day. Okay, I'm gonna have to increase pain." Now your brain is punching you in the shoulder saying, "Enough is enough." We still don't listen to it. Why? Because we're busy. We have shit to do. And then pain is gonna say, "Enough.

I'm shutting shit down. We're done." Now, during all this time, your brain should be working together with your body. And a part of the brain, the cerebellum, I call it your error d- error detection s- device or system, right? We got like a GPS system. We got an error device system. Well, let me work on that. And basically, our brain creates...

This is very simple, but enough is enough. Our brain creates a motor map. I gotta walk from here to there, okay? I might scuff my toe. My cerebellum's like, "Whoa, that wasn't the motor map. Let's correct. You need to recruit more and lift your foot higher." So my brain will go, "Ah, let's adjust." We lift the foot higher.

Now, say you have foot drop or weakness or no sensory information in your foot. You got neuropathy. You can't see your foot 'cause everybody tells you, "Stop looking down." So you swing your foot, your, you stub your toe. So your brain knows you stubbed the toe. However, the cerebellum isn't getting the error detection or is getting so much information it cannot kind of go, "Ha ha, I don't know what to do here."

Overloaded. This also happens in hypermobility too. So sometimes the cerebellum is just getting so much information, none at all, and so it can't react appropriately. Okay? So then we're kinda stuck in that movement pattern. And this is why something, uh, my business partner Mariska and I say, who, um, hopefully you checked out the episode last week, was we always add, we don't subtract at the neuro studio.

Don't do that. Stop moving your hip. Okay. If they could do that, they wouldn't be coming to see us. And listen, there's a lot of arrogance in the movement industry and a lot of expertise. I don't think everybody's arrogant. I think people are good at what they do. But they need to realize, me creating a change in your body does not change it at my brain.

It's temporary. I need to give you the tools, your brain the tools, help with motivation to make sure the change happens for you. So saying, "Oh, I can fix that shoulder." Well, hold on. Why did that shoulder get there in the first place? Why was the body not communicating? Why was the cerebellum not adjusting?

So I think just in physical therapy and movement, and don't think I'm... I didn't do this too. For probably half of my 25-year career, I was, I don't know, maybe this sounds dick to say, but I was really great at fixing things. But clients would come in with the same problems, and I remember the client specifically.

Oh, she was might've been my favorite client. I think I saw a lot of myself in her. Um, she didn't have kids, very sassy, lived her life, didn't let anybody push her around. She would call me out on my shit, too. Um, but she would say, "Meghann, here's the deal. I come here for you to fix me. I don't wanna do this at home."

And I looked at her in the face, I say, "I am not your landlord. Treat it like you own it And she was like, she kind of chuckled, and she's like, "Mm, but that's what I pay you for." And I said, "Touché. But listen, I can't be with you all the time. I travel a lot. I need you to take a little ownership in this." And she was like, "All right."

So I want us to think about that as a movement professional, and if you're not a movement professional listening to this, I want you to think when you go to someone and they fix you, I want you to think, "Well, how is the rest of my body and my brain responding to this change?" So back to the question at hand, what was happening to the brain before the joint was replaced?

Let's just talk knees. Knees are a joint that really picks up the slack for others. Our hip joint, the ball and socket, is the second most mobile joint in the body. Our feet have a lot of mobility. And the knees, it's not a basic hinge joint like a door. There's a little rotation. There's, there's stuff going on there.

But it has less range of motion. But because the way we move, the knee can pick up the slack. It's very rare I don't see someone over-mobilizing, rotating at the knee. I had a student yesterday I was working with, and she's like, "Yeah, but I'm, I have really good hip rotation." I go, "Girl." I put my hand on her hip joint, and I moved her foot.

So if you're, if you're listening on the podcast, she was lying on her side. I just had my hand over the joint. So kind of like think about your underwear line. So not on her pelvis, not on her leg. I wanted her to feel that when I moved from her knee down, her hip joint didn't move at all. If my hand moved, she would've been like, "Yeah, I'm moving my hip."

So I took her foot and kind of lifted it off the table. And her whole leg kind of moved a bit. And she goes, "Holy crap." Meg, I'm not feeling any move. I mean, I feel a little bit at my hip, but at the end range I go, I know. That's all kind of happening at your knee, and it's not wrong to move at your knee, but wouldn't it be more efficient to move at your hip?

But here's the problem. Everybody was giving her hip range of motion exercises, but the problem was she didn't change the mapping in her brain, so every hip range of motion exercise, she would over-mobilize her knee first, and then get the hip there. So we were actually reinforcing the pattern. And right now, here's the moment where all my clients go, "Well, what am I supposed to do, Meghann?

Not do my exercise?" And I'm like, "No, no, you're not listening." You want a simple answer to a complex question, and I ain't biting. When in life is there a simple cure or response to anything? I had a really interesting conversation with my sister. We were... I was driving. We were in the c- on the c- in, in the car, on the car, jeez, for like 50 minutes, and we were kinda talking about our family and dynamics, and we were just talking about shit, and I was like, "Yeah."

We were talking about something. I'm like, "Ah, that's kind of how you felt about me when we were younger," and we kinda worked through it. We just had such an honest, open conversation. There was no simple cure to the issues we had as kids, but we worked through it over time, and luckily, pretty freaking lucky, knock on wood, we have a really freaking great relationship.

Very lucky. Um, uh, my sister is also, uh, a deep thinker. Um, oh, God, she's probably gonna listen to this episode. She's probably gonna be mad at me for saying this. She went to school to be a, um, human... Fuck. Excuse me. Development family studies. She would've been an exceptional therapist. Um, that, she chose not to go that route, and I totally think that was a great decision.

Um, but she's really good at talking through things and not putting herself in the situation, making it about other people. Um, so if you ever need to talk to somebody, I'm going to say, uh, call my sister. I'm, I'm sure she'd love to pick up the phone and talk to someone she doesn't know. But, um, back to the task at hand.

There's no simple solution to this, okay? But when you're doing exercises, you've got to pay attention. Think about what your goals at the gym are. If you're just looking to increase endorphins, BDNF, which is brain-derived neurotropic factor, just get your blood flowing, fine. But I had a client yesterday, "Yeah, but, I mean, I, I wanna do my workout, and then I'll do my brain-based exercise."

I go, "No, no, no. No, no, no. You're not listening." And then I said, "Excuse me. You are listening. I don't think I'm being clear. Every exercise is a brain exercise. What if you just took these concepts and brought them to your gym exercises?" "I don't know how to do it." I go, "Let's do it right now. Give me one exercise."

She gave it to me. We took a brain-based approach. I kept it simple with her. I'm gonna share with you what I told her. When you're doing exercise, do you feel excessive pressure increase anywhere on your body? She'll be like, "Yeah, here." I go, "All right. Try to do the exercise again without increasing the pressure there or maintaining it."

And then of course she goes, "Well, why would I do that?" I said, "Well, let's just put it simply. If the pressure is really increasing somewhere at your hands, under your feet, in your knee, let's just hypothesize that you're really dumping or over-mobilizing in that joint or area. So let's bring our attention to that pressure increase and ask the brain, 'Hey, can I do this movement without that?'

And the brain might say, 'No.' And you say, 'Okay.'" And I said... She goes, "But what if I don't feel any pressure increases?" I go, "So let it ride. All good." And then I said to her, "Now look in the mirror. I do not want you looking at yourself. If you micromanage your movement, I'm gonna come over here and smack you." I was kidding.

She knew I was kidding. People look in the mirror and they look at their self and they try to Jedi mind trick their moves. So I said, "Watch me in the mirror." And I was just doing a row. Okay? So I had a kettlebell and I was pulling it up to my chin and straightening my arms back down. I go, "What do you see in here?"

"Uh, Meg, I don't know." I go, "Look in the mirror. Look at the, look at that picture behind me. What, what's happening when I'm doing this exercise?" She goes, "Uh, you're lifting and lowering your arms." I said, "Okay. What part of my body shouldn't be moving?" She's like, "Well, I'm assuming no other parts of your body should be moving, just your arms."

I said, "Good. Do you see how my body is swaying closer to that painting?" She goes, "Yeah." I go, "All right. Now I'm gonna do the same exercise. I'm gonna l- look at maybe my ear or my shoulder, and then in my peripheral vision I'm gonna see that painting. I'm gonna keep doing the movement without shifting closer to that painting, and I'm gonna adjust.

If I make an error, I'll adjust." And she goes, "Oh my God, I can see the muscles of your arms working harder." I said, "Yeah, because now I'm not mobilizing at my ankles or shifting my weight. I'm actually locked into my arms. My brain's focused. Did you even notice my eyes focus a little more?" She's like, "Yeah, you just seem like you were in the zone."

I go, "Love that." Boom. So I asked her to just concentrate on those two things and I go, "If you look in the mirror and you don't see any shift or any parts of your body that are moving that or shouldn't, just keep doing the exercise." Not every exercise has to be a moment of learning. Sometimes I call it go and flow.

Some days you just gotta flow, just move with all the movement patterns you have. Let your brain make choices. And other days when you're in pain or things are hurting, you need go. You need new patterns. You need your brain to be engaged. So don't give me this crap, "Oh, I just wanna go to the gym." For what?

What are your goals? And if they say weight loss, I'll be like, "All right. Well, let's break down weight loss. What is going to help you lose weight? Being mindless at the gym is not gonna do that." "Well, aren't I building muscle?" Yeah, but you know how you can build more muscle? You know, using

the proper joints. You know how people say they have glute amnesia, they don't use their glutes? That's a whole bullshit diagnosis. They don't need their glutes to do that exercise 'cause they're using other muscles based off the feedback the brain is getting. And she said to me, "Man, this is, this is a bit more complicated than I thought."

I go, "I know." But this is why I'm always a little angry, because I want people to have this information, but sometimes people just don't have the energy to either listen, hear me, or wanna do the work it takes, and I totally respect that. So let's circle this back to joint replacement. Based off everything I said, I want you to ask yourself, "When I'm getting a joint replaced- Will replacing the joint fix the root of the problem?

No, the joint replacement is fixing the result of s- many problems. So it is critical to understand, and I'm gonna read some research here. This one was done in 2020. Um, this was ba- in Frontiers of Neurology, and it was looking at MRI- fMRI, um, in patients with end-stage knee osteoarthritis, so people who were probably in a shit ton of knee pain.

Okay? They got a knee replacement. What was interesting is they showed increased activity in the posterior lobe of the cerebellum before the surgery compared to healthy controls. Now, more activity at the cerebellum is not always good. It could've been so much information going to the cerebellum where the cerebellum was trying to figure out what the heck to do, and we all know when there's overwhelm, too many options, and not good, uh, feedback or, uh, what's a better thing in life, or direction, things shut down.

What was interesting about this research, these changes persisted one week after the joint was replaced. We didn't change what was going on in the brain. So the cerebellum wasn't waiting for the surgery. It had already be try- it was trying to rewrite the script. Now, here's why I never like to sit on one decision.

So what I was interested and what I'd like to see follow-up research, how long... They didn't really follow up with these people after. How much longer was the cerebellum overactive? Did it readjust? Was there moderate cerebellar activity or no activity at all? Was... And each person's different. Some people, with that new hip replacement, listen, it's metal.

It's different. The joint is changed. If they have a good supportive brain and body and healthy tissue, their brain might've been like, "Okay, now based off this sensory information, I can adjust to these movement errors." Those are the people who do great after knee replacement surgeries You know who I see in my clinic and I talk to all day long?

People who are still in pain or after they get the knee replaced, they have to get the other knee replaced or the other hip or the other shoulder. Why? Because when you need a right knee, hip replaced, you know what the first thing I look at is? The other three quadrants, your, your shoulders and your opposite hip.

I wanna see who is not supporting that knee or that hip that needs to be replaced. Why is that joint doing more? I'm gonna add, not subtract. I have never in my 25-year career worked with someone with a joint replacement that the other side of the joint, hip or their upper quadrant or lower quadrant, was functioning correctly, and I don't like the word correctly, optimally.

There was no joint differentiation, meaning when they were trying to move their shoulder, they were also moving other joints. And in-- Well, let me not get ahead of myself. Okay, let's look at this next study before I move on. Another study found that some disordered brain, um, condu- um, connectivity did normalize after surgery.

Um, this new, um, connectivity disruptions also emerged, emerged post-operatively, so other people had, um, conduction issues after. So the brain doesn't just reset, guys. I wish it did, okay? Then in 2018, a little further back, they found actually structural brain changes in people with knee osteoarthritis both before and six months after total knee replacement.

There was higher gray matter density in the amygdala and midbrain, and they associated this with persistent pain after surgery, meaning the brain physically changed due to years of the faulty joint. Now, this is not always bad or good, but this can lead to central sensitization. It's happening at the brain.

Often when we see pain patterns, the map of the pain gets bigger, okay? So someone, it's just going to the... almost like the brain maps a bunch of joints together so that whole area is in pain. And when the pain spread and we get in a chronic pain pattern, it steals focus. It is very hard to create a new pattern.

It is not impossible. I say this to my clients in chronic pain, "It is not possible. It is possible, but it is very hard. But I promise I will be here to support you. We need to communicate. If you have a level one pain when we're doing something, it's not the right pattern. We get into the weeds. We've gotta get into it."

And sorry, I'm a little congested today. Ah, this makes me so upset. I've had so many clients in chronic pain that in the studio, the moment they feel pain-free, it almost feels... You see it in their face, their eyes, confusion, sadness, happiness. There's a lot of emotions. Chronic pain sucks. So if there's someone in your life who's really miserable or seems like doom and gloom, maybe they're in pain.

You try being in pain every single day. I've had a lot of hard conversations with clients. I've had to call clients' parents. I've had to call clients' caregivers, and I have always chosen to make that call because I would rather be wrong and the patient never speak to me again than being right and not intervening And them making a decision they can't take back.

I think I'm beating around the bush, but I, I think, um, I've made myself clear on that. Um, luckily, it- I can count it on one hand, but we, we've gotta take pain more seriously. Okay? Don't roll your eyes at people with pain, even if they look perfectly healthy, even if their MRI is perfectly clean. There is research over and over again that MRIs and reports do not always show up how pain does.

Meaning... What is on my finger? God, I get distracted so easily. Um, meaning I have seen clients with kind of clean MRIs who are in such pain, and I have clients who I have seen MRIs and I'm like, "Yo, how's your back?" And they're like, "No back pain. Nothing." Their brain has been able to compensate around it in a healthy way, and my job is to make sure the brain can continually compensate around it.

And when I'm looking at compensation patterns, my friends, I'm not looking for any pattern. I'm looking for a good alternative. Okay? Um, I've got a bunch of more studies, but I, I think we're getting to the point. Um, this one was interesting. Last one I'm gonna share. Um, in 2019, this was a systematic review, different than kind of a clinical double-blind variable, um, research.

Um, but they found no consensus in the literature on whether proprioception actually improves or worsen after total knee replacement. No consensus, meaning proprioception doesn't change overnight. And if you don't know what proprioception is, basically it's our brain's way of knowing where the hell we are in space.

How does our brain know where we are in space? Our skin, the pressure, the sensation, the glide, the tension. Our muscles, same. Fascia, tendons, joints. So we all know as we age, gain weight, bodies change, proprioception's gonna change. Okay? Now, if you have chronic pain, we can't just think proprioception's gonna change.

And what's worse about proprioception, I will die on this hill, is people believe what they feel I've never straightened a client and they be like, "Thank you so much for straightening me. I feel so much better." Why? Because when I straightened them based off their alignment, I did not take into account their proprioception.

So their proprioception was telling them the tilted pattern was straight. When I move them straight, I've taken them out of their proprioceptive map. Their brain thinks it's wrong. So I say to them, "I'll take pictures. Look in the mirror. Who are you gonna believe? Your eyes, me, or your proprioception?" And I- they go, "Oh, I believe you."

I go, "But you can't. Your proprioception is, is yelling. We've got to make changes there." And guys, I don't want this podcast to be too long. If you want actual help to change your proprioception and movement, we have, I have resources for that. You can reach out to me. I have trained teachers all over the world how to do this, and I think we're in 25 countries now.

I can match someone to your personality, what you like, time zone, stuff like that. If you don't wanna work with me, that's fine. I've got a guy, I've got a girl, I've got someone I've got a Vay Anybody you need, I got them. We'll help you. But just moving, doing what you're doing now that's causing you pain, we've gotta make a change.

Okay? So can you answer the question right now? What is happening to your brain before the joint is replaced, and does surgery fix any of that? Surgery fixed the actual joint. And let me tell you, am I against joint replacement? Absolutely not. Because when you need a joint replacement, it means you've sped through a lot of yellow and red lights.

I'm not mad at you. That joint is deteriorated. You have less options throughout your body. If we can replace and fix that joint, we can then remap and give you that joint back. So if you are in pain right now, go see someone to see if there's more options for your body to put off the replacement. But do not wait.

If your friends are saying, "Hey, what's wrong? Are you okay?" That means you're limping. You're compensating so much that people can see. You are losing options by the day. Surgery is not you giving up, but surgery is not a quick fix, okay? I wish it was. Trust. So question two, why is post-op rehab almost entirely focused on the replaced joint when the whole body reorganized around it for years?

Riddle me that. And if you are a physical therapist listening to this, I need you to let that land. "Well, I, I, I, I have to work on range of motion and with insurance." Bullshit. Sorry. I have PTs saying, "Well, you, you get an hour with clients. I only get 15 minutes." I go, "Yeah, but I can get hip differentiation in 30 seconds.

So can you." Do you need help documenting for insurance? Call me. I'll help you. We can get this done. Every PT I know, and if you're a PT listening to this podcast, I apologize. I'm preaching to the choir. We all have to get together and be better at communicating to this to others. 'Cause let me tell you, those others are making us all look bad.

But we can't just keep talking to each other. We're preaching to the choir here. We gotta get it out there more. We gotta not shame people, 'cause you don't think we did shit before we knew? Okay? So if you're a patient, stop focusing on range of motion. I said it. I got another hill I'm gonna die on. This happens every session.

"But Meghann, my range of motion decreased." I go, "Yeah. Before, you were moving three joints. Now you're moving one. Let's do the math. If you were moving three joints and now you're moving one, should the range of motion increase or decrease? Decrease." Yes, and now I'm going to work, going to work on increasing the range of motion of that joint.

I cannot tell you how many clients doing knee extension and flexion and trying to get full end range with no- No hip centration, no reflexive stability at the hip when they're just isolating the knee. Shoulders are a mess. Visual and vestibular system aren't integrating. Eyes are looking all over the place.

So you're creating a pattern that is no integration with the system. Yeah, I know this is annoying, but this is why we have jobs and why AI will never replace us. You heard me, AI. But I appreciate the help you're trying. It's critical. We need to be able to look at every client, find their sensory gaps, adjust to them, adapt, fill their sensory gaps so their brain can create a motor output.

What if we looked at that joint? "Okay. All right, buddy, you did a lot of work for a lot of years. We thank you for your service. I want you to take a little break here. I'm gonna do some passive range of motion so we don't lose range of motion, but I'm gonna make sure the rest of the team is supporting you."

I do this with spasticity as well. "Oh, people are just forcing range of motion." I go, "You don't need to force that. Get their spine to stabilize reflexively. Don't you dare tell them to pull in the abs. That's not reflexive. Give them feedback." I demo it. This is why I love doing this when I go to neuro clinics, and they're like, "You can't change pa- spasticity."

I had a neurologist look me in the face and say, "You can't change proprioception." And I go, "All right, come here. Stand up." And I had him do something, and he goes, "Well, I'm not sure that changed proprioception." I go, "Well, who cares? You're moving better." And I asked him before, "W- tell me where you have joint pain or something."

Now, did I integrate that change? I just wanted to show him something was possible. But here's the thing, all you people telling me what I do is impossible, you're wasting time. Stop trying to prove me wrong. Try to find the holes in my work and tell me, and we'll work together so we can get better. Stop setting limiting beliefs for people.

One of my current clients now, he's family to me. When he finished outpatient PT... inpatient PT and outpatient, the PT sat down and told his parents, "You've gotta realize that this might be it." And I'm so glad his parents, one of them came in to me and said, "Is that true? I'm so pissed." I go, "No. They set limiting beliefs for your son.

I will never do that. But it's up to your son when he's done. If he doesn't wanna do this anymore, you gotta let him live. His life should not be around stroke recovery. He's got a lot to do in his life." Okay? So we've gotta give people the options, but we need to be all better together. I feel like I'm yelling at you guys.

Please understand it's just the tone of my voice, how I speak, and comes from passion. If you feel attacked in this episode, I would love you to think why you feel attacked about this and how you maybe can communicate what you do to me better so we can work together and figure out solutions. Um, I just think it's gonna take all of us.

So I got a different question three. Um-

I'm just looking at some more research. Hmm. Uh, speaking of my sister, she was like, "I love when you do science stuff, but sometimes I'm like, 'Enough with that.'" And I was like, "Well, my audience is science people." And she's like, "Well, you can let other people in." So based off Kim's feedback, let's change this question, 'cause it was gonna be what is br- a brain phrased, a brain-based approach to joint replacement look like?

I'm gonna answer that very quickly. I'm gonna ask you to think about it. What I'm gonna say is not just movements on the replaced joint. I want to see how the rest of the body's responding to that joint, supporting it, how the kinetic chain is moving. Is there energy flowing through the body? Is there any disruptions?

Is the visual and vestibular system integrated? Have you actually changed their proprioception? 'Cause movement doesn't change proprioception without clear changes in sensory feedback. That's where we need to think about it. But I'm changing question three because clients ask me this all the time: Do you think I should get my knee replaced?

And only you can answer that question. Maybe clients are asking you, "When should I?" Well, when you feel like you are in p- enough pain. Ah, no. Guys, if you're in pain, you gotta make a change. And do me a favor, make a change when the pain is low level. It's easier to make a chain when the pain- change when the pain is low level.

I yell at one of my clients all the time. He was having pain in his wrist. "No, no, no, it's getting a little better. It only hurts this time." I go, "Hey, we've gotta keep that up. I gotta keep you golfing." He actually needs a j- kn- knee replacement, but he does the work. He really does the work. So I said to him, "Do not wait, and if I see you limping, if I see you cringing, if I see you making a face, I'm gonna say it's time."

So you will know when it's time. Instead of worrying about the time, let's talk about what we sh- can do. I'm gonna talk to patients here. Prior to the knee replacement, I want you get- getting the rest of your body moving beautifully. Maybe in all your workouts, every exercise you do, you're going to leave that re- the joint that needs to be replaced out of the equation.

Limit movement at that joint and try to get other parts of your body moving without that knee hurting. Find someone who can help you with this. And if you're like, "I wanna try it myself," I love that. Curiosity is what is going to cure you You are the only person that can change your brain and body. I am here as a translator.

I'm not a dictator. I am not your landlord, your doctor, your surgeon. They cannot fix you. You have to. But we have to be here to help and be the translator because you might not see or feel the movement problems. Okay? So that's pre-op. Don't stress yourself out. Don't overwork out. Move well. I used to work out like a crazy person.

I work out less. I do brain-based movement. I'm the strongest I've ever been. I impressed a professional athlete last week because he's like, "Yeah, but I'm gonna get weak." And I go, "Do I look weak?" And he was like, "No, Meg, I didn't mean it like that." I go... And I pick- took a 45-pound dumbbell and told him to press it over his head, and he couldn't.

And then I took it, and I did. And I didn't do that to be a jerk, but I wanted to show him that the research we're seeing on strength, muscle hy- hypertrophy, all that stuff is limited. We've gotta look at the change of the brain. People who get stronger, their brain can adapt to that load. Not everybody's brain can adapt to every load, so we have to address that.

Okay? So make those changes. Be curious. During surgery, stay positive and realize you- your life's work cannot be undone in two months. Okay? Your life's work, your body, your mind will not get lost in two months, three months, whatever your recovery is. Everybody's different. Keep your brain active. Move other parts of your body.

Can I rotate without moving my leg? Can I do this? Be a curious mover. Please take the time to recover. Your brain and body need time to heal. Rushing that is not good. That doesn't mean be still and not move. Be curious. Challenge your brain. And number three, when you're at post-op PT and stuff like that, pay attention to the rest of your body.

You cannot rely on your PT or me to know everything that's going on. If your shoulder feels funny when you're doing your exercises, you've gotta speak up. "Hey, what should... I feel like this little movement here." And if your PT says it doesn't matter, or your Pilates teacher, go find somebody else. They are not wrong.

They are not dumb. They just don't have the knowledge you will need to cross the finish line. Okay? It takes a team approach, and I want you to know not one workout, not one exercise is going to be the tipping point for your joints. It's the cumulation. My goal of doing this podcast was I want to encourage people to take ownership on their body, understand a little bit more how the brain mapping works And to give you the power that there are things you can do.

While being clear, they are not easy. I will be very clear. But it's not that hard. It's just like learning a new language. It's hard at first, but then you get the hang of it. So you've gotta ask yourself, are you willing to do the work it takes to learn this new language? And the answer might be no, and that's fine.

But like I used to say to my dad, "Then don't complain to me that you're in pain if you're not willing to do the work it takes." And that's changed. He comes in weekly for his sessions. And I actually noticed in his session last week, I was like, "Dad, you're really get- you're getting a lot stronger." And if a man who has never worked out a day in his life, who has pretty serious prostate cancer, and they've had to really lower his testosterone levels, if he can build muscle strength, whether it's neurologically or whatever, you can do it.

I laugh. I'll say to my dad, "Rotate to the right." He arches his back, you know. Uh, and n- it's just not his thing, so it's possible. And I wanna be here to support you the entire way. If you're a movement professional, I want you to think about these things. Do not change what you do. Add them in. Reach out. We have courses where you can learn.

You can call me. We can book a session and break things down. We don't wanna throw the baby out with the bathwater. Good post-op exercises are important, but doing them from the targeted joint, critical. And the final thought I want to leave you with, I don't want you to fix one thing in the short term that creates problems 10 years down the road.

My goal for you is that your brain and body can compensate effectively and safely no matter your age, no matter your situation. That is my goal for you. That is my goal for you. Create your own goals. Think about how you can best support your body. If you're getting a joint replacement, I hope this was helpful.

And if you have follow-up questions, you know where to find me. Thanks, guys, and I'll see you on the next episode