Cycling With a Knee Replacement

an older couple riding bicycles
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If you are suffering from knee pain due to osteoarthritis and are scheduled to have total knee replacement (TKR) surgery, you can still enjoy bike riding after the surgery. Often, you can start riding a stationary bike not long after your total knee replacement during outpatient physical therapy.

Total Knee Replacement Surgery

TKR surgery is performed to treat the pain, stiffness, and loss of mobility caused by severe arthritis or a severe knee injury. Having a TKR can be a painful experience, and you may find that you require physical therapy following the procedure to help reduce pain and improve your strength and range of motion (ROM).

After your TKR operation, you may receive physical therapy services in the hospital. There, you may use a continuous passive motion (CPM) machine to help improve the ROM in your knee. You will also learn exercises to help regain normal strength and mobility in your knee.​ If you are not well enough to leave the house, you may start home-care physical therapy.

Biking can be a great exercise after a total knee replacement. Just be sure to ask your doctor or physical therapist if it is right for your specific condition.

Getting Started

During outpatient physical therapy, your therapist may have you ride a stationary bicycle to help maintain muscle tone and keep your knee flexible. Although many people can start using a stationary bicycle one to two weeks after TKR, it is best to check with your doctor and physical therapist to ensure you don't injure yourself.

For the first couple of weeks, one of the main goals of physical therapy is to decrease swelling and reach a full passive ROM. When riding, it's important to achieve the maximum degree of bending and straightening possible, without putting too much stress on your knee. Follow these steps:

  1. Be sure the seat height is set correctly. To do this, sit on the bike seat with your operated knee straight down and resting on a pedal. There should be a slight bend to your knee when the pedal is at the lowest point.
  2. When starting to pedal the bike, start slowly and in reverse. Most likely, you will not be able to pedal all the way around. This is normal. Just pedal around until your knee that was operated on bends as far as you can tolerate.
  3. When your knee is bent as far as possible, hold the position for a few seconds, before continuing to pedal in reverse. Again, start slowly and allow your knee to straighten. Continue pedaling backward until your knee once again bends as far as possible.
  4. Repeat this sequence of backward pedaling for a few minutes. Ride forward only after your completely comfortable cycling motion is possible backwards.

Most likely, you will find that your knee ROM improves quite quickly with this method and you will soon be able to pedal around fully on the bicycle.

How do you know when you can start pedaling all the way around on the bike? In general, your knee must bend about 90 degrees to be able to fully pedal around on the bicycle. Have your physical therapist use a goniometer to check you knee ROM.

When you have reached 90 degrees of knee flexion (bending), you most likely will be able to pedal fully on the bike. Also, don't be surprised if you find it easier to pedal backward on the bike before forwards. This is a common occurrence after TKR.

Progressing on the Bike

Once you are able to fully pedal on the bike, you may wish to add some light resistance to help improve the strength and endurance of your leg muscles. Check with your physical therapist, and make sure you add a little resistance at a time. Your therapist can help you determine the right amount.

A slight increase in knee discomfort can be expected when increasing the resistance on the bike. If you start feeling a sharp pain in your knee, then inform your physical therapist and decrease the resistance or stop biking.

You can expect to be able to ride a stationary bicycle one to two weeks after your total knee replacement operation. Remember that everyone is different, and your specific condition may require that you wait a bit longer before starting a bicycling program for you TKR rehabilitation.

After about four to six weeks of stationary bike riding, you may be cleared to start riding your bike outside. Be sure to check with your doctor before doing so; you need to make sure it is safe for you to do after your surgery.

A Word from Verywell

While biking may be an important component to regaining ROM after TKR, be sure that you work on other exercises that your physical therapist may prescribe to help improve your strength and functional mobility like walking and stair climbing. By working hard in physical therapy, both on and off the bike, you can be sure to maximize your chances of a full recovery and a rapid return to normal activity.

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Article Sources

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  1. American Academy of Orthopaedic Surgeons. Total Knee Replacement Exercise Guide. Updated February 2017.

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