“I’ve had a knee replacement and the physio is only doing exercise with me. Is the right?” It is very common for exercise only approaches after total knee arthroplasty, especially in the NHS, but in the private sector I have seen many patients that are struggling to get anywhere with their exercise only approach. In these cases, I need to add in some manual therapy techniques to help their pain, swelling and mobility. I have also commonly employed Neuromuscular electrical stimulation (NMES) to improve muscle function, as many of these patients are inhibited neuromuscularly. Now, I do this in real practice at our clinics, and it works very well, but what does the evidence say about it? So, is a combination of hands-on treatment and exercise better than just exercise in total knee replacement?