“Just a little more. Push it further. Go on. A little more…” This is the refrain from the physical therapist as I work on bending my knee. One more degree of bend, and another, and another as I work toward a magical goal of 120 degrees.

“You’ll need to work hard at PT,” were the words spoken by just about everyone I told about my pending knee replacement operation. And the expectation is that this will hurt. In the hospital I was offered extra pain meds before PT. When I told the in-home PT that pushing for more flexion was making my pain spike into the 7 to 8 range on that 10 point scale where 10 = intolerable pain, her response was “Good, that’s what should be happening.” Say what??? Her goal is severe pain???

The day after surgery I was strapped into a passive motion machine for an hour which repeatedly bent my newly operated knee to 60 degrees then to 90 degrees, flex and straighten, flex and straighten, over and over. That same day I was wheeled down to the therapy room and put through my paces—ankle pumps, quad sets, and bending. “We want you at 110 degrees of bend before you leave tomorrow,” the therapist said. “And you’re going to lock me up and make me stay if I don’t achieve that?” I thought.

“No pain, no gain.” The warrior’s approach to recovery. This is a very American approach. Push through pain to achieve your goals.

I take part in an international online forum for people who have had knee and hip replacements and from reading other participants’ posts, I’ve discovered a different perspective on recovery.

Yes, keeping the new knee joint moving is essential for a good recovery. But this can be done gently. In the first weeks of recovery, the focus can be on letting traumatized soft tissue heal and moving just enough to keep things from freezing up—bend to the point of pain and slightly beyond then stop.

This seems like such a sensible approach but when I mentioned it to the PT she looked horrified. “You’ll never get flexibility back unless you push hard!” she said.

I’m in my fifth week of recovery. On the days that the PT is here to measure me I push a bit—it’s hard to resist those cries of “just a little more”—but on other days, I follow the gentle approach. I spend a lot of time with my leg elevated and an ice pack on. I stroll around the house and take short walks outside. Every time I get up I spend a few minutes gently bending my leg but never to the point of extreme pain. And with this approach, right on schedule, I reached that magic goal of 120 degrees of bend.

Seems like there’s a life lesson in all of this. I’m reminded of my forays into floor waxing. My house has oak floors and when I first moved in they needed to be waxed regularly (I’ve since had them refinished). I rented a power floor buffer and had to learn just the right amount of pressure to apply to control the machine—too much pressure and it took off across the room at warp speed, dragging me behind and gouging the floor.

Sometimes less is more. Sometimes the motto should be “No pain, more gain.” The trick is knowing when to push through and when to back off and let healing happen.