Latest / The Total Knee Success Podcast: Your Essential Resource for Navigating Total Knee Replacement / Episode 104: Getting Back on a Bicycle After Knee Replacement What You Need Before You Ride Indoors or Outside

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Episode 104: Getting Back on a Bicycle After Knee Replacement What You Need Before You Ride Indoors or Outside · The Total Knee Success Podcast: Your Essential Resource for Navigating Total Knee Replacement

• 0:00
  Cycling is a realistic goal for many people after
• 0:02
  knee replacement. A 2024 survey included 1 ,029
• 0:07
  people after hip or knee joint replacement. Among
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  those who had cycled before surgery, 94 % reported
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  returning to cycling. Are you ready to get back
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  to what you love after knee replacement? The
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  Total Knee Success podcast is your trusted guide
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  with practical tips, evidence -based strategies,
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  and no fluff. It's not personal medical advice,
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  just solid education to help you manage pain,
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  regain mobility, and get back to living the life
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  you love. Let's dive in. Welcome back to the
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  Total Knee Success podcast. I'm Nichelle. David
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  had ridden bicycles for most of his adult life.
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  He enjoyed an early loop through the neighborhood,
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  a few miles with friends on a paved trail, and
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  settling into a comfortable pace. After knee
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  replacement, David was ready to ride again. Pedaling
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  indoors came first, and it went well. Then he
• 1:02
  stood beside his outdoor bike and realized that
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  riding required much more than turning the cranks.
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  He had to get on, push off, steer, shift, brake,
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  clip out or move a foot off the pedal, and put
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  that foot down before the bicycle tipped. The
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  pedals were only part of the story. David's not
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  a real person, but his story reflects what many
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  people experience after knee replacement. This
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  is the final episode in our four -part travel
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  and outdoor activity series. Episode 101 covered
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  road trips, episode 102 covered flying, and episode
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  103 covered hiking. In this episode, episode
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  104, we're finishing with cycling, from the first
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  -fold revolution on a stationary bike to the
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  skills that help an experienced rider return
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  outside. By the end of this episode, you'll have
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  a better sense of what to consider with saddle
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  height, knee bend, resistance, cadence, gears,
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  mounting, braking, pedals, balance, and the conditions
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  around your first outdoor ride. Cycling is a
• 2:04
  realistic goal for many people after knee replacement.
• 2:07
  A 2024 survey included 1 ,029 people after hip
• 2:11
  or knee joint replacement. Among those who had
• 2:14
  cycled before surgery, 94 % reported returning
• 2:18
  to cycling. Because the study included several
• 2:20
  types of joint replacement, that percentage describes
• 2:23
  the mixed group. An individual with a knee replacement
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  may have a different timeline and outcome. The
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  numbers still offer encouraging evidence that
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  many experienced riders get back on a bike. Two
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  randomized trials looked at cycling after joint
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  replacement, and each helps answer a different
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  question. In 2019, Sattler and colleagues compared
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  an early three -exercise pedaling program with
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  a ten -exercise program after knee replacement.
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  The pedaling group walked farther and performed
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  better on several early functional tests, and
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  some patient -reported scores also favored pedaling.
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  Those early gains are valuable during the first
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  days and weeks after surgery, when people are
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  working to improve their walking and everyday
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  function. In 2010, Liebes and colleagues studied
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  whether adding ergometer cycling to an existing
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  program improved longer -term results. The knee
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  replacement participants reached similar functional
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  results in both groups. Together, the studies
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  show why cycling can be a useful and efficient
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  part of rehabilitation. Pedaling gives people
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  a good way to work on knee motion, coordinated
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  muscle activity and endurance, while the broader
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  program can address strength, balance, walking,
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  and individual goals. David started with stationary
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  cycling early in his rehab when his incision,
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  swelling, and knee motion allowed it. That gave
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  him a stable place to practice pedaling. Outdoor
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  riding came later because he also needed to mount
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  and dismount, steer, brake, and get either foot
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  to the ground quickly. David began on an upright
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  stationary bike. His first goal was to complete
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  a full pedal revolution smoothly without forcing
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  it. His knee needed more comfortable flexion
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  before his foot could move over the top of the
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  pedal stroke. His physical therapist raised the
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  saddle and had him rock the pedals forward and
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  backward through the arc he could control. Each
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  pass brought the crank a little closer to the
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  top. Cyclists describe a crank position like
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  a clock. The top of the pedal stroke is 12 o
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  'clock and the bottom is 6 o 'clock. Your knee
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  bends the most as your foot travels over 12 o
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  'clock. A higher saddle reduces the amount of
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  knee bend required there. A lower saddle brings
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  your knee into deeper flexion and can increase
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  some of the muscular and joint demands of pedaling.
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  A saddle height that works well allows your knee
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  and hip to move through the entire pedal stroke
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  without reaching or crowding. At six o 'clock
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  your knee generally keeps a small bend while
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  your foot stays securely on the pedal. Pelvic
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  rocking can happen when the saddle is too high
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  and you can't do the full bend, or too low and
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  you can't reach the pedal. Reaching for the bottom,
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  pointing your toes, or hiking one hip at 6 o
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  'clock can suggest a saddle that's too high.
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  Feeling crowded near 12 o 'clock or lifting a
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  hip to get the crank over the top can suggest
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  a saddle that's too low for your current knee
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  motion. David kept rocking the pedals forward
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  and backward, moving a little farther each time.
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  When the crank finally moved over 12 o 'clock,
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  his leg continued all the way around. In the
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  clinic, I often hear a little yelp or a surprised
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  laugh at that moment. It happens because the
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  person's knee bends a little farther than it
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  has before, and once the crank crosses the top,
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  the pedal keeps moving. Take your time and use
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  the other leg to gently coax the pedal through
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  the tightest point, one pass at a time. David's
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  first full revolution happened backward. Some
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  people find backward pedaling easier at first,
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  even though the crank follows the same path and
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  requires about the same knee bend. Once the movement
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  felt familiar, he continued backward and then
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  tried forward pedaling. Once the full revolution
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  was comfortable, David worked on cadence and
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  resistance. Cadence is how quickly the cranks
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  turn, usually measured in revolutions per minute
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  or RPM. Cyclists call an easier gear with a comfortable
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  cadence spinning. A hard gear that slows the
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  cadence feels more like grinding. David kept
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  the resistance light. Researchers measured forces
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  inside knee replacements during cycling and found
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  that those forces increased when people pushed
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  harder against the pedals. In everyday terms,
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  a harder gear asks the quadriceps to work harder
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  and sends more force through the knee replacement.
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  Too much resistance, especially early on, may
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  contribute to pain or swelling and make the pedal
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  stroke less smooth. David focused on an easy
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  gear, a comfortable cadence, and gradually added
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  time before increasing resistance. An upright
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  stationary bike positions the pedals below you
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  and feels closer to a traditional bicycle. A
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  recumbent bike places the pedals in front of
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  you and adds a wider seat and back support. That
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  extra support can feel steadier, while the lower
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  seat may take more leg strength to stand up from.
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  On either bike, adjust the seat so your knee
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  and hip can move through the pedal stroke without
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  reaching, crowding, or rocking your pelvis. If
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  you are considering an indoor cycling class,
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  remember that the music, group pace, resistance
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  changes, standing climbs, and quick transitions
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  can make it much harder than riding on your own.
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  Treat the instructor's cues as options. You can
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  stay seated, keep the gear easy, and skip an
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  interval. A class fits better once you can adjust
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  the bike pedal comfortably for the expected time
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  and control the resistance yourself. Once David
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  was comfortable indoors, he put his own bicycle
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  on a stable trainer. That gave him time with
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  his familiar saddle, handlebars, shifters, brakes,
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  and pedals while the bike stayed upright. If
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  you plan to return to your own bike, a trainer
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  can also reveal whether getting on, getting off,
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  or reaching the controls is harder now than it
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  was before surgery. Before taking the bike outside,
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  he had a bike shop check the fit. and mechanical
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  condition. Riders often use a quick ABC check
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  before a ride. Air in the tires, brakes working,
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  and the chain and drive train moving properly.
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  David also checked that his helmet sat level
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  and fit securely. A helmet is essential outdoors,
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  and a bicycle in good working order gives a rider
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  reliable steering, shifting, and braking. Pedal
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  choice affects how easily you can put either
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  foot on the ground. Flat pedals let you lift
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  your shoe straight off. Clipless pedals, despite
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  the confusing name, attach a cleat on your shoe
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  to the pedal and require a deliberate twist to
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  release. After knee replacement, that twist and
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  quick foot placement may feel less automatic,
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  especially when knee motion, strength or balance
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  is still changing. Experienced clipless riders
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  can rehearse the release on a trainer. Flat pedals
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  can simplify the first outdoor rides when getting
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  your foot down quickly is the priority. Your
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  frame also changes how you get on and off. With
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  a high top tube, you may need to swing one leg
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  over the saddle or frame while balancing on the
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  other leg. A step through frame gives you more
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  room and may require less knee bend and single
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  leg balance. David practiced the movement beside
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  a stable support so he could decide whether his
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  usual way of mounting still felt dependable.
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  David's first outdoor session happened in an
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  empty -level parking lot with a friend present
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  for moral support and safety. He held both brakes
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  while getting on, positioned one pedal for the
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  push -off, and started in an easier gear. He
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  practiced riding a straight line, making wide
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  turns, stopping smoothly, and placing a foot
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  down. He looked through each turn instead of
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  staring at the front tire. Before he added distance,
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  David practiced stopping. After knee replacement,
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  the harder part may be moving your foot off the
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  pedal and trusting that leg when it reaches the
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  ground. He practiced braking, placing either
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  foot down and making a firmer stop at a modest
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  speed. Those skills felt dependable before he
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  left the parking lot. David also made sure he
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  could look ahead and around him without losing
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  his line. That brief check told him whether he
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  had enough balance and attention for a real ride.
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  David chose a short, flat, separated paved route
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  for his first ride. The quieter setting reduced
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  the extra demands of traffic and loose surfaces.
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  He brought a friend and turned around when his
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  steering, braking, and leg control still felt
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  dependable. That route gave him room to notice
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  how his knee handled repeated pedaling, starting
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  and stopping, while he settled back into riding
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  outside. Hills can turn an easy ride into higher
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  force pedaling. Consider saving them until level
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  riding is going well without a lasting increase
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  in knee pain or swelling, and you can keep a
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  comfortable cadence in an easy year. David added
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  gentle slopes later and walked the bike when
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  a steeper section required more force or control
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  than he wanted to use on that particular day.
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  An electric assist bicycle can be a useful option
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  after knee replacement. The motor can reduce
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  how hard you need to push on hills or into a
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  headwind. which may help while you're still building
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  leg strength and endurance. The bicycle is heavier
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  and may accelerate quickly. You may consider
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  practicing assist levels, starting, stopping,
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  and handling the extra weight in a controlled
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  area before taking it on a trail or road. Pay
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  attention to how your knee feels during the ride
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  later that day and the following morning. A temporarily
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  stiff knee or some muscle fatigue can follow
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  a new activity. Increasing pain with every revolution,
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  repeated swelling, loss of motion, a new limb,
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  or symptoms that continue into the next day may
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  indicate that the bike setup, resistance, duration,
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  or outdoor demands exceeded your current capacity.
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  Changing one variable for the next ride can help
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  you see how your knee responds. Pain at the front
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  of your knee can be influenced by a low saddle,
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  heavy resistance, or another part of the bike
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  fit. Discomfort behind your knee can occur when
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  the saddle is high enough that you reach through
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  the bottom of the pedal stroke. Pain location
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  offers a starting point for looking at the setup.
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  Persistent symptoms, repeated buckling or declining
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  function, they deserve an evaluation that considers
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  the bike fit, riding load and other possible
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  causes. Those changes can also make pedaling,
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  braking or steering less dependable. If that
• 12:56
  happens during a ride, stop in a controlled place.
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  A fall that causes an injury or leaves you suddenly
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  unable to bear weight warrants prompt medical
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  guidance. David eventually returned to his familiar
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  paved trail with friends. His first few rides
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  were shorter than the route he used to complete,
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  and the distance increased after the handling
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  skills in his knee response stayed consistent.
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  The part he had missed was still there. The sound
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  of the tires on the pavement and the feeling
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  of moving through the world under his own power.
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  He regained his confidence through each ride.
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  For outdoor riding, a properly fitted helmet
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  is essential. A padded seat may make early rides
• 13:36
  more comfortable, and a secure phone holder can
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  keep navigation visible without riding one -handed.
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  A stable trainer and flat pedals may also simplify
• 13:45
  early practice. These are all optional tools
• 13:48
  and I'll include a short list in the show notes.
• 13:51
  Some are Amazon affiliate links, which means
• 13:53
  I may earn a commission if you purchase through
• 13:55
  them. Thank you. If you'd like more information
• 13:58
  between episodes, you can join the free Totally
• 14:01
  Success Insider email newsletter. The link is
• 14:05
  in the show notes. This ride closes our travel
• 14:08
  and outdoor activity series. We have planned
• 14:11
  the drive, navigated the airport, researched
• 14:13
  the trail, and now moved from the first pedal
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  stroke to an outdoor ride. The common thread
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  is learning the demands of the activity, preparing
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  for those demands, and keeping the experience
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  itself worth coming back to. In episode 105,
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  we'll begin a four -part series on falls, balance,
• 14:32
  and everyday independence with getting up after
• 14:35
  a fall. We'll cover cautions to consider after
• 14:38
  a fall, ways to get help, and options for moving
• 14:41
  toward a stable surface. Episode 106 will look
• 14:45
  at why balance can still feel altered after knee
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  replacement. Episode 107 will build a broader
• 14:51
  fall prevention plan and episode 108 We'll explain
• 14:54
  how carrying groceries, laundry, and other everyday
• 14:56
  loads changes your balance and the demands on
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  your knee. Thanks for joining me. I'm Michelle
• 15:02
  and this has been the Total Knee Success Podcast.
• 15:09
  This podcast is for educational purposes only.
• 15:13
  Discover more at TotalKneeSuccess .com and be
• 15:16
  sure to subscribe and share because every step
• 15:19
  forward takes you closer to living the life you
• 15:21
  love.