An updated clinical practice guideline on total knee arthroplasty, initially published in 2020, was developed by an American Physical Therapy Association volunteer guideline development group consisting of physical therapists, an orthopedic surgeon, and an occupational therapist. The guideline was based on a systematic review of current scientific literature. Twenty recommendations were formulated. Benefits, harms, feasibility, and role of patient preferences in implementing these recommendations were identified. Recommendations identified current gaps in knowledge and future areas of needed research.

Lesbian, gay, bisexual, transgender, queer, intersex, asexual, and individuals with other related experiences or identities (LGBTQIA+) experience chronic pain and disability at twice the rate as their cisgender, endosex, and heterosexual counterparts. These disparities are shaped by intersecting social, structural, and historical factors, including minority stress, health care discrimination, and barriers to affirming care. While contextualized approaches to pain management have been recommended to address the unique lived experiences of LGBTQIA+ individuals, prevailing pain models largely remain grounded in deficit-oriented frameworks that emphasize vulnerability, maladaptive cognitions, and individual pathology. Such approaches risk obscuring the broader social determinants of health that shape pain experiences and may inadvertently reproduce dynamics of stigma and medical mistrust. This perspective argues for a conceptual shift toward an affirmative, resilience-based approach to chronic pain management for LGBTQIA+ individuals. Drawing on evidence from LGBTQIA+ affirming care, trauma-informed practice, and resilience-based approaches, this perspective proposes a framework that integrates recognition of social and structural inequities with strengths-based principles that emphasize adaptive coping, psychological flexibility, identity affirmation and community connection. It outlines how physical therapists are uniquely positioned to operationalize this approach by fostering psychological safety, supporting meaningful movement and values-based engagement, and addressing contextual barriers to care. By moving beyond vulnerability-focused models and centering resilience as a dynamic, contextually situated process, this perspective offers a pathway for physical therapists to promote equity, empowerment, and more effective pain care for LGBTQIA+ individuals.

Physical therapists are considered movement experts, yet many physical therapists lack the knowledge, training, and confidence to incorporate bioenergetic considerations when prescribing aerobic exercise and resistance training interventions. Additionally, clinical practice guidelines omit bioenergetic considerations reflecting a fundamental gap in how the profession conceptualizes rehabilitation, one that individual clinicians cannot be expected to bridge when clinical practice guidelines themselves exclude the bioenergetic dimensions of health conditions. As this perspective outlines, bioenergetics are essential for propelling human movement and should inform physical therapist interventions. A bioenergetically informed approach to physical therapist interventions empowers physical therapists to design interventions that integrate physiologic systems critical to bioenergetic capacities more fully, optimizing both the mechanical components and fuel systems that power movement. This perspective uses recovery as a model framework to emphasize the benefits of a bioenergetically informed approach, and importantly, it serves as a component of rehabilitation that can be immediately acted on by clinicians, recognizing that optimal therapeutic outcomes require adequate bioenergetic capacity to support the intended applications. While physical therapists have traditionally excelled as biomechanical practitioners who address the structural and mechanical aspects of human movement, the integration of comprehensive bioenergetic principles represents a transformative opportunity to elevate clinical practice by understanding not only the machinery, but also the metabolic systems that fuel optimal performance.