Jefferson physical therapy researcher Christopher Keating is investigating new ways to ease pain, rebuild strength and take the guesswork out of recovery.
Recovering from joint surgery or a sports injury isn’t as simple as replacing a worn-out part and waiting to heal. For many patients, chronic pain and muscle weakness linger long after surgery, making everyday tasks — from walking to climbing stairs — unexpectedly difficult. For athletes, the stakes can be just as high, with recovery timelines and return-to-play decisions often based on guesswork or gut instinct.
Christopher Keating, an associate professor in the department of physical therapy, hopes to change that. Working at the intersection of rehabilitation science and patient-centered care, he’s investigating smarter physical therapy strategies that not only target physical recovery but also take into account how people experience and respond to pain, both physically and psychologically. In this Q&A, Dr. Keating discusses the leading-edge rehab techniques he’s exploring and shares how he’s training the next generation of healthcare professionals to think critically.
How would you describe your research to the person riding the elevator with you?
My research is about helping people move better and feel less pain after things like joint replacement surgery or sports injuries. Think about someone who just had their knee or hip replaced. Even with the new joint, they often struggle with weakness and pain that makes simple things like walking or climbing stairs hard. My work looks at smarter ways to do physical therapy to build strength and reduce pain without putting too much stress on the healing joint.
What are some of the problems that injured athletes or people who undergo these surgeries deal with?
After surgeries like a total knee replacement, many patients have significant muscle weakness that doesn't go away easily, sometimes losing up to 85% of quadriceps strength in the first month. This weakness, combined with persistent pain, makes getting back to normal life difficult. My research looks for ways to improve strength and reduce pain more effectively than traditional methods.
Likewise,athletes face a high risk of injury, and deciding when they can safely return to playing at full intensity, especially throwing, is often based on time or simply avoiding pain, which might not be enough. My research seeks to find objective ways to measure readiness to throw again and potentially lower the risk of reinjury.
What sort of physical therapy techniques are you investigating now?
I look at techniques like restricting blood flow during gentle exercise. I also study how to make sure athletes, like baseball pitchers, can safely return to their sport after an injury, using physical tests and even looking at how their body's pain system responds to treatment to figure out when they're truly ready. One specific question being explored is whether changes in how sensitive someone is to pressure pain after a hands-on treatment called spinal thrust manipulation can help predict how fast a baseball pitcher can throw. This investigates if their body's response to this treatment could be a useful sign of how ready they are to return to high-intensity throwing after an injury. We found that it does play a role in improving the prediction of a pitcher's velocity in combination with the medicine ball toss.
Sometimes, I also work on making sure we know exactly why someone is hurting, using tools like ultrasound, because pain isn't always from the most obvious source. Basically, it's about using science to improve how people recover and get back to doing what they love.
What drew you to physical therapy research?
What really got me interested in this was seeing that something as common as pain affects people in very different ways. Some folks get better relatively quickly, while others have pain that sticks around for a long time. It made me think that maybe just focusing on the physical problem wasn't the whole story.
It seemed like people's thoughts, feelings and beliefs about their pain might be really important factors that we weren't fully appreciating or measuring. So, I started to explore how we can better understand not just the "ouch" of pain, but also things like people's fears about using their arm, how they cope with the pain in their mind, and their overall outlook on their recovery.
What is the best memory you have from conducting your research?
You know, a lot of research involves careful planning and looking at numbers. But one of the most impactful memories I have is actually from talking with someone who had been dealing with persistent pain for a long time. I was at an outpatient clinic, and they were describing their experience. What really struck me was how they explained that the pain wasn't just a physical sensation; it was also causing them a lot of frustration and preventing them from enjoying their hobbies, like gardening, playing with their kids, or taking care of a loved one. Hearing them describe how the pain impacted their whole life, not just their leg, really highlighted the importance of the kind of research I'm doing. It wasn't a big, dramatic event, but that conversation truly connected the dots between the numbers we collect and the real human impact of pain.
What’s a surprising statistic about physical therapy?
I also study recovery after hip replacements. Some patients undergo hip replacements via a surgical method called the Direct Anterior Approach (DAA), which is intended to be less invasive. Surprisingly, only about 22% of patients actually follow the traditional movement restrictions recommended after surgery. Even more surprising, some studies suggest patients who didn't strictly follow these restrictions might have reported feeling happier and walked independently sooner. This calls into question how necessary traditional restrictions are with this modern surgical method. My research explores optimal rehabilitation strategies and methods for these patients.
What’s something you’re passionate about outside of your research?
Who’s a role model or someone who shaped your journey? Is there a piece of advice that stuck with you or that you try to pass on to young researchers?
Someone who was a significant influence on my research journey was Dr. Paul Howard, who was my adviser during my DPT work here at Thomas Jefferson University and currently at the Sidney Kimmel Medical College. He provided fantastic guidance and support throughout the entire process.
One piece of advice that he shared with me that has really stuck, and that I try to pass on to young students, is to always stay curious and keep working on your craft through lifelong learning. Even when you think you have a good understanding of something, there’s almost always more to learn, and it’s that constant curiosity that drives good research and helps us find new and better ways to help people. It's like being a detective — you always need to be looking for more clues.
