Why You Still Hurt After a Hip or Knee Replacement: Understanding the Full-Body Impact of Joint Surgery

Introduction: The Problem Nobody Talks About After Joint Replacement

You finally had the joint replacement you’ve been waiting for—maybe a hip, maybe a knee—and you followed all the right post-op instructions. But months later, something still doesn’t feel right. Your new joint moves better, but now you’re noticing new aches, nerve pain, postural changes, or even discomfort in completely unrelated areas like your shoulder, jaw, or neck.

This isn’t just in your head—and it doesn’t mean your surgery was a failure.

At Movability, we specialize in helping patients who are stuck in this frustrating post-op plateau. Often, the issue lies in how the rest of the body is reacting to a newly replaced joint. Surgery corrects one problem, but it also introduces structural changes that ripple across the entire musculoskeletal system. Without addressing these changes holistically, chronic compensation patterns may develop, leading to new pain and dysfunction.

The Anatomy and Biomechanics of Joint Replacement

When a joint is replaced—especially a unilateral hip or knee—it doesn’t just affect that specific joint. It alters the mechanical axis of the entire limb, the symmetry of the pelvis, and the tension patterns throughout the spine and even into the upper body. The replaced joint often becomes more structurally stable and aligned than the opposite side, which may still have degeneration, wear, or adaptive changes.

Leg Length Discrepancy and Pelvic Tilt

A common side effect of hip or knee replacement is leg length discrepancy (LLD). Even a few millimeters of difference can cause:

  • Pelvic tilt and rotation

  • Functional scoliosis

  • Uneven gait mechanics

  • Asymmetric loading of the spine, hips, knees, and feet

LLD is particularly common in hip replacements and may be either intentional (to improve joint stability) or unintentional. This subtle imbalance forces the body to compensate, which over time can cause stress to accumulate in unexpected areas.

Fascial Tension and Nerve Entrapment

Another overlooked issue after joint surgery is the formation of scar tissue and fascial adhesions. These can tether soft tissue and impair nerve gliding, especially around the surgical site. Restricted nerve mobility can cause symptoms such as:

  • Burning or tingling sensations

  • Localized tightness

  • Deep aching or intermittent nerve pain

  • Referred symptoms further from the surgical site (e.g., into the foot, back, or even upper extremities)

At Movability, we often find that nerve gliding dysfunction is one of the most underdiagnosed causes of lingering pain after surgery.

Symptom Patterns and Clues Often Overlooked

Patients and clinicians alike often assume that pain after joint replacement must be caused by the joint itself—or by under-rehabilitating it. While joint-specific pain can certainly occur, here are a few red flags suggesting that a larger biomechanical issue is at play:

  • You feel fine at the joint—but now have pain elsewhere.
    This may include low back pain, opposite hip/knee pain, or even headaches and TMJ symptoms.

  • Symptoms show up weeks or months after surgery.
    Once the acute phase is over, the nervous system and connective tissue begin adapting. That’s when compensation patterns fully reveal themselves.

  • Rehabilitation has plateaued.
    You made early gains in mobility or strength, but now you feel stuck, and further progress is minimal.

  • You’re starting to develop new asymmetries.
    One shoulder droops, your pelvis feels twisted, or your gait seems uneven.

If any of these sound familiar, it’s time to assess more than just the joint. It’s time to look at the whole system.

Why Conventional Rehab Often Falls Short

Traditional post-op rehab protocols do a good job of strengthening the muscles around the joint and restoring basic range of motion. But they often miss:

  • Whole-body biomechanics

  • Gait analysis

  • Pelvic alignment

  • Compensatory tension in the spine, fascia, and opposing limbs

  • Leg length discrepancies

  • Neurodynamic (nerve mobility) testing

This oversight means patients may regain basic function but continue to feel “off,” develop new pain, or compensate in ways that create new wear and tear. The body doesn’t operate in isolated parts. When one component is changed, everything else has to adjust.

The Movability Method: A Root-Cause Approach to Post-Joint Replacement Pain

At Movability, we don’t just treat the joint. We assess and treat the entire person. Every post-surgical patient receives a head-to-toe biomechanical evaluation that includes:

  • Pelvic and spinal alignment screening

  • Leg length discrepancy testing

  • Postural and gait assessment

  • Nerve tension and gliding assessments

  • Compensatory tension mapping

From there, our team builds an integrated care plan involving:

1. Manual Therapy and Fascial Release

To address soft tissue adhesions, restore nerve mobility, and relieve structural tension patterns above and below the joint.

2. Nerve Flossing and Neurodynamic Rehab

If nerves are restricted due to scar tissue, we use specific mobilization techniques to restore glide and reduce neural tension.

3. Pelvic and Postural Rebalancing

We treat not only the surgical side but also any reactive tightness, weakness, or imbalance in the contralateral hip, lower back, and trunk.

4. Strengthening the Right Muscles

Instead of generic exercises, we target muscles that truly support joint alignment and dynamic function—especially the stabilizers that get overlooked in standard rehab.

5. Custom Orthotics—Designed for the Entire Body

For patients with true anatomical leg length differences or altered gait mechanics, we use precision-made custom orthotics. But unlike most orthotics, which are only designed for the feet, ours are based on:

  • Pelvic tilt

  • Spinal curvature

  • Gait asymmetry

  • Functional leg length

These orthotics help rebalance the entire kinetic chain, reducing stress on the joints above and below. It’s one of the most effective ways to stabilize and prevent future issues post-surgery.

The Goal: Help Your Body Accept the New Joint Without Creating New Problems

A joint replacement is not a finish line—it’s a structural reset. And if your body doesn’t fully integrate that change, compensations can show up elsewhere.

The key to long-term success is to support the entire system. This means:

  • Addressing leg length discrepancies

  • Restoring soft tissue mobility

  • Ensuring nerves can glide properly

  • Rebalancing posture and gait

  • Preventing overuse in other joints

At Movability, we combine the expertise of chiropractors, physiotherapists, naturopathic doctors, and rehab specialists to guide patients through this critical phase. Our root-cause approach is what allows us to solve the unsolved cases—even when other providers have missed the bigger picture.

Conclusion: You Deserve More Than Just a “Successful Surgery”

If you’ve had a hip or knee replacement and still feel like your body isn’t functioning the way it should, don’t settle for “this is as good as it gets.” There’s likely an underlying reason—and it can be fixed.

You deserve more than joint-focused rehab. You deserve care that supports your whole body in adapting to a new mechanical reality.

Contact Movability today to book a comprehensive assessment and experience our results-driven approach.

Sina Yeganeh