Best Position To Sleep After A Total Knee Replacement

You should sleep flat on your back with a pillow under your heel after a total knee replacement if you are experiencing difficulty achieving full knee extension.

This position allows the knee to remain in full extension throughout the night which will reduce the chances of knee joint contractures.

If you cannot sleep flat on your back continue reading for alternative recommendations.

In the video below I discuss three sleeping positions and the challenges of side sleep.

What is the best sleeping position after a total knee replacement?

While there is no single best position to sleep in after a total knee replacement the position that allows you to sleep most comfortably would be the best position for you. 

💚 Side Sleep – This can be an extremely effective sleep position after a total knee replacement especially for individuals with low back pain. If you are experiencing spinal stenosis or other degenerative changes in the spine you may feel most comfortable in a side sleeping position. 

💔 Side Sleep – The concern with side sleeping is the tendancy to keep the knee flexed for prolonged periods of time and the lateral stress the position may place on the sides of the knee.

💚 Back Sleep – also known as supine is the most commonly recommended sleeping position after a total knee replacement. In this position the knee may be positioned on a wedge or incline to help elevate the leg to reduce swelling while keeping the knee in extension throughout the night.

💔 Back Sleep – The greatest challenge with sleeping in this position is for individuals who experience increased low back pain or have difficulty breathing. A wedge under the leg as well as a wedge under the torso may help reduce these symptoms.

💚 Belly Sleep – also known as prone is the least common sleep position after total knee replacement. While it may be excellent to improve knee extension it may be uncomfortable on the incision.

💔 Belly Sleep – Sleeping on your stomach after a total knee replacement can increase pain and stiffness in the leg as well as in the low back and neck. If you would like to sleep in this position consult your physician for further advice.

Why is it hard to sleep after knee replacement?

Getting quality sleep after a total knee replacement may seem impossible. The most common reasons include pain, swelling, and nerve related symptoms. It is important to consult your physician if you feel that your pain medication is not adequately controlling your pain levels. The better you can describe your pain the better your doctor may be able to choose the best medication. Nerve pain may require a different medication than pain attributed to the incision.

Anxiety, Sleeplessness, Pain

Anxiety plays a major role in sleep disturbance. This article explores the relationship between sleep disturbance and anxiety. Other research also suggests interrupted sleep increases pain sensitivity.

Taking time to research sleep improvement strategies may prove helpful in reducing sleep disturbances, reducing pain intensity, and improving your recovery.

* Post from Total Knee Replacement Support Group

How do you sleep after a knee replacement?

“Not well” is the most common answer I hear in the clinic. Some clients will sleep in short episodes of 1-2 hours while others sleep in blocks of 4 hours. The best advice is to find a position of comfort and sleep as long as the position will allow. If you are unable to sleep in a bed, it is common to sleep in a recliner or on a couch for the first couple days or couple weeks. Some patients find sleeping in a recliner or couch allows them to maintain the best knee position while not worrying about waking a spouse.

How soon after knee replacement can I sleep on my side?

While there still is no definitive research suggesting when is the best time to start sleeping on your side, one practical answer is to consider your range of motion. If you are gaining range of motion during the day in both flexion and extension then sleeping on your side or back is less important. If you find that you are not gaining range of motion into extension then positioning yourself on your back with the knee in full extension throughout the night may be beneficial.

Should I sleep with my leg elevated after knee surgery?

Elevating the leg is primarily intended to reduce swelling. Believe it or not, there are some patients who do not experience excessive swelling after surgery and for those patients it is not as important to elevate the leg. If you are struggling to manage swelling then this article will explain why 45-degrees or more of hip flexion is so important to reduce swelling.

Is it bad to bend your knees while sleeping?

It depends. If you are finding that your knee won’t straighten to full extension during the day or while you are walking then keeping your knee flexed throughout the night might slow your progress. On the flip side however, if you find that you need to increase knee flexion, then bending your knee while you sleep might help improve knee flexion.

Why is pain worse at night after knee replacement?

Pain most often increases as night mainly because activity decreases. Your knee is going through major changes during the post surgical recovery phase of a total knee replacement. The immune system is helping repair and build tissue. This is a chemical reaction. You may have come to realize that doing too much is as bad and painful as doing too little. Night is one of the few times you will be sedentary for more than 1-2 hours and as a result the knee will stiffen and pain often increases due to the lack of movement.

How do you get out of bed after knee replacement surgery?

Sometimes getting in bed is harder than getting out of bed. Weakness in the hip and thigh makes flexing the hip to get the surgical leg into bed a monumental challenge. Regardless of whether you are getting in or out of bed, the recommendation is to use a log roll position. Turn to your side facing the edge of the bed. It is preferred to have the surgical leg resting on top of the non-surgical leg. As you slide both feet and lower legs off the side of the bed your hands will push your torso up so you will be sitting in the middle edge of the bed.

What helps knee pain while sleeping?

Besides managing your medication and taking them as prescribed, a couple non-medication methods of managing pain at night is a gentle massage using a rolling pin or other massage device. You can also try some gentle stretches and a little walking or biking 15-20 minutes before bed. Some clients report a warm shower helps to calm the body and if you enjoy any kind of soothing music or medication ritual that quiets the mind and prepares the body for sleep then it is definitely recommended.

Why do people put a pillow between their knees?

A pillow between the knees is commonly used by clients to reduce low back pain. After a total knee replacement a pillow between the knees can help support the surgical knee and balance the stress placed on the knee while positioned in side lying. The most common advice is to place a large enough pillow between the knees that the surgical knee is inline with or slightly higher than the surgical side hip.