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Cycling with knee injuries?

Old 04-04-16, 07:52 AM
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Svenicus
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Cycling with knee injuries?

Some background: I own a road bike and usually average over 100 miles a week in the summer. I was hit by a taxi on April 2nd (two days ago) and the early indications are that my PCL and maybe MCL are damaged. The severity of the damage isn't known yet but there's very little stability down there so I'm hoping for the best but preparing myself for the worst.

I'm hoping to get some advice on what others have gone through with regards to biking with an injured knee. Have you found that you're able to bike with bad knees? What was harder than before? If you had surgery, how long post-op were you able to get back on the bike?

Thanks y'all!
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Old 04-04-16, 08:11 AM
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Back in 1979, I had a bad accident that almost cost me use of my left knee. Prognosis was that there would be a full knee replacement in about 20 years. Since then, I have tried to led a normal life and build up the strength in that knee and it has worked. About August last year, I took up cycling and found this has been a great way to help an weak knee. However, one day my knees (both) were aching terribly and stairs became difficult for a few days. I rode the bike again and the same thing happened. It was disturbing and odd, but certainly connected to the bike.
To make a long story short, before you ride off into the sunset on your trusted bike, get a professional "bike fit" and use clip in shoes and pedals. Once that is done, ride conservatively and increase distance/time in the saddle as your strength and fitness improve. My guess is that you will find significant improvement and quality of life.
I wish you the best of luck and hope you post your results.

PS, I never did get that FKR and have no issues today. If it weren't for the scars, I would have forgotten about the injury.
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Old 04-04-16, 08:30 AM
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Years (decades) ago, I used to fit bicycles for recovering patients of a local knee surgeon. This was before the scope, so knee surgery involved a much longer recovery process.

The surgeon was a big believer that bicycles were a useful aid in post operative recovery, and I'd see people come in on crutches and ride away.

The basic elements for riding with knee issues.

1- saddle as high as possible, shy of where the knee would straighten completely. Usually we'd go to where the person was reaching slightly and riding with a toe down foot angle.
2- low gears. This is absolutely critical. The bikes were set up with higher gears locked out. The object is to restrict the amount of weight that could go into the knee
3- shorter cranks if possible, to reduce the total flex cycle. Not much of an issue for taller people, but for shorter ones, we fitted some modified childrens cranks.
4- limit hill climbing, and avoid steep hills entirely. This, along with gearing, is adjusted according to strength, but you want to avoid loading the knee when bent
5- changing the pedaling rhythm delaying maximum power until later in the cycle. You want to apply more power when the leg is straighter to the extent you can train yourself to do it.

Foot orientation wasn't an issue back then because it was before step in (clipless) pedals, and the foot could find it's own alignment. With clipless, cleat alignment is critical because a misaligned cleat causes twisting forces in the knee. Also you want to find an alignment that causes the knees to travel straight up and down, rather than wobbling.

So, done right, not only won't cycling hurt the knee, it can be a big part of knee therapy.

So you can keep riding, but listen to your knee, and if you have pain, or notice instability as you ride, stop and have it rechecked.
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Old 04-04-16, 08:49 AM
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As someone who had his fourth knee surgery last Wednesday, I agree with FBinNY. The first thing they do in therapy is get you on the stationary bike. Both my knees need to be replaced and I ride 100+ miles a week. I live on a hill and hills are tough on my knees. I sit and spin a low gear at a low speed up the hill. Everyone passes me up the hill. I make up for it by my menacing speed downhill I just put a roof rack on my car so in a week or so I can drive down to the bike path and just ride on the flat path until I am strong enough to tackle the hill again. I would recommend Speedplay peddles. The float is the only way my right knee can cope. It really works in keeping any twisting pressure off the knee. As far as when to get back on the bike after a injury, my test is when I can stand on one leg (the bad one) I can ride a real bike. Until then it is a stationary bike.
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Old 04-04-16, 10:09 AM
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Originally Posted by FBinNY View Post
done right, not only won't cycling hurt the knee, it can be a big part of knee therapy.
Indeed. "Continuous passive motion" machines have been part of post knee surgery therapy for years. Cycling just adds a "active" component.

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Old 04-04-16, 12:41 PM
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I have had knee issues since I was about 27 (I am 44). I think what started the issue was skiing for many years...Although the dr at the time thought I would develop knee issues even if I hadn't skied. I have chondromalacia in both knees and arthritis. When I originally went to therapy for it when I was 27, I would always be put on the stationary bike as part of my session.

I have since had more discomfort back in October. Went to the Dr. b/c my leg was giving out and was very stiff if I sat too long. They ruled out a meniscus tear and said it's arthritis. I've been going to PT once a week since November. Again, the stationary bike is part of my routine.

The PT I am going to now, the Dr. I went to AND my brother who is a PT as well all have agreed that biking is safe and a good exercise for knees. Hence, I have been taking spin classes at the gym I belong to because it's one of the few classes there that does not bother my knee (ONLY if the tension is high/hard to pedal). So I would also agree that any steep uphills would not feel good.

I am planning on getting back onto my mountain bike once Spring is actually here to stay in CT. I used to run (which also hasn't helped my knees over time, I'm sure) and I don't want any further damage so biking/spin will be my new running "get away/alleviate stress" activity.
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Old 04-04-16, 04:02 PM
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Been there and back again. Surgerieson both knees decades ago. Stationary cycling was prescribed as part of my rehab.

Fast(slow)-forward to near present day (okay, about 7 years ago)... took up road cycling again..first on DFs, then trikes, finally 2-wheel recumbents (due to back issues). I've found that cycling is simply THE thing for me as far as keeping my knees from going "stiff" on me - yes, I also have arthritis in both knees. I occasionally use a knee brace for support, routinely use elastic knee wraps and occasionally ride without any support at all - depends on how my knees feel that day.

My point is, once your surgeries are complete and you have talked with your doc('s) and rehab people about YOUR particular rehab, it's kinda up to you to find what works for you. My surgeries were ACL and PCL-related...other guys I know had patella and meniscus injuries... One had a major fracture of his femur head... All of us are currently cycling, some at near prior-to-surgery "knee fitness" levels and others are not there and never wiil be.

Take it as it comes, but push it slightly to find what your "new normal" is. It may take a bit of pushing against your pain threshold to find out... No one can say with absolute certainty.

At least that's my experience and opinion.

Good luck.
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Old 04-04-16, 04:13 PM
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Cycling is a great activity for knees. It is low impact. No matter how hard you hammer, the forces on your joint are less than any other excersize. Now muscles and tendons, they can act up with cycling, but as for cartilage, ligament, and bone, cycling will most likely be a benefit. Just dont overdo it early on. I credit cycling with postponing my total knee replacement from a nasty tibial plateau fracture by a decade or more, and still counting
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Old 04-04-16, 06:24 PM
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I'll give my anecdotal 2cents...I've been strength training since age 11 with no injuries until about 10 years ago (age 42ish or thereabouts) when I decided to go on a super-heavy squat routine. Very quickly the strength of my leg muscles outstripped the ability of my tendons, cartilage etc. to support the weights I was pushing and within a few months I 'blew out' both knees to the point to where walking was painful and more often than not I was wearing some sort of compression knee support to keep the pain under control. Being pig-headed, i did not go to any kind of physical therapy either, so this condition more or less lasted until age 49 when I began cycling. Now, nearly two years later (5200 miles in 2015 and 1700 so far in 2016) both knees are more or less pain free, with an occasional twinge every now and then if I step wrong or do a little too much climbing in one week.

Keith
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Old 04-04-16, 07:22 PM
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I had done some degree of injury to my ACL playing football in high school. A couple of years ago I had an accident and damaged the PCL, MCL, and LCL in the same knee. It was about 2 weeks before I could ride again. As others have said, spin don't mash and take it easy at first. My knees are both deteriorating due to arthritis but I still continue to ride. I believe that cycling is probably about the best knee exercise there is, no impact and no pivioting. I'll keep riding while I can and enjoying it.
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Old 04-21-16, 07:45 PM
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As a followup to my original post, I've had my MRI and the verdict is as follows:

- Completely torn PCL
- Grade 1 sprain MCL
- Small radial tear of meniscus
- Partial tear of popliteus muscle

The good news is that I got on a stationary bike and it didn't feel too bad. I think the popliteus is causing me more issues than anything else as it hurts to bend the leg, but it doesn't look like surgery is in the cards.

Originally Posted by Svenicus View Post
Some background: I own a road bike and usually average over 100 miles a week in the summer. I was hit by a taxi on April 2nd (two days ago) and the early indications are that my PCL and maybe MCL are damaged. The severity of the damage isn't known yet but there's very little stability down there so I'm hoping for the best but preparing myself for the worst.

I'm hoping to get some advice on what others have gone through with regards to biking with an injured knee. Have you found that you're able to bike with bad knees? What was harder than before? If you had surgery, how long post-op were you able to get back on the bike?

Thanks y'all!
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Old 04-22-16, 06:38 AM
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You might want to look at PEDAL assist e-bikes. They are great for bad knees. You can generally apply ranges of assist, turning it up or down to meet your needs. They make the pedal easier to push down, while keeping cadence slow.
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Old 04-22-16, 12:51 PM
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I had knee surgery in 2000 when I was 31 (I turn 48 later this year) due to a complete tear of my ACL and partial tears of the MCL and meniscus. After healing I began running, but over time found that to be very hard on my knee so in 2008 I took up road cycling. Due to military deployments I have been an off and on cyclist since then, but find it much, much easier on the knee. I have developed some arthritis in the knee and find after longer rides (3+ hours) I will have some stiffness in the knee, but nothing too bad. I keep my riding to mainly flat, smooth surfaces so I don't have too many issues and will keep riding for as long as I can.
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Old 04-22-16, 01:21 PM
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Originally Posted by FBinNY View Post
Years (decades) ago, I used to fit bicycles for recovering patients of a local knee surgeon. This was before the scope, so knee surgery involved a much longer recovery process.

The surgeon was a big believer that bicycles were a useful aid in post operative recovery, and I'd see people come in on crutches and ride away.

The basic elements for riding with knee issues.

1- saddle as high as possible, shy of where the knee would straighten completely. Usually we'd go to where the person was reaching slightly and riding with a toe down foot angle.
2- low gears. This is absolutely critical. The bikes were set up with higher gears locked out. The object is to restrict the amount of weight that could go into the knee
3- shorter cranks if possible, to reduce the total flex cycle. Not much of an issue for taller people, but for shorter ones, we fitted some modified childrens cranks.
4- limit hill climbing, and avoid steep hills entirely. This, along with gearing, is adjusted according to strength, but you want to avoid loading the knee when bent
5- changing the pedaling rhythm delaying maximum power until later in the cycle. You want to apply more power when the leg is straighter to the extent you can train yourself to do it.

Foot orientation wasn't an issue back then because it was before step in (clipless) pedals, and the foot could find it's own alignment. With clipless, cleat alignment is critical because a misaligned cleat causes twisting forces in the knee. Also you want to find an alignment that causes the knees to travel straight up and down, rather than wobbling.

So, done right, not only won't cycling hurt the knee, it can be a big part of knee therapy.

So you can keep riding, but listen to your knee, and if you have pain, or notice instability as you ride, stop and have it rechecked.
+1 I agree with all of this. I have adapted in each area listed, except the crank length.

The best thing is to start off slow and don't overdue the exertion through that knee.

I have had a litany of leg surgeries (ACLs, MCLs, menisci(sp?), and more) and I have always rode a bike as soon as I was allowed. Either a stationary, or stationary recumbent and eventually onto a spin bike and then on the road.

One thing to be aware of is the dismount. You want to make sure you do not come down hard or at a weird angle and tweak that knee. But as you cycle the muscles surrounding the joint will strengthen it.

Are you doing regular physio? This helps to isolate the muscles that you need to stabilize the knee. After the physio gives you a diagnosis and program see if they work with a kinesiologist in the gym to get strong.

Last edited by joeyduck; 04-22-16 at 01:24 PM.
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Old 04-22-16, 01:44 PM
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I've 'dislocated' my right knee on multiple occasions. The first was Spring of 1975, then again in winter of '76-77 when I was attending Ohio State. OSU wanted to do a total knee replacement of my right knee. What was the MTBF (Mean Time Between Failure - aka 'Lifespan') of replacement knee back then? 6-8 years. NFW (No F'n Way!!!) was I gonna go through that BS (that one should be obvious ) for the rest of my life! I rode my bike instead to build up the strength in the muscles/tendons of the knees. That was 40 years ago, and although I now have arthritis in both, they are still my original knees!

I still ride. I still commute by bike (nice weather only, thankyouverymuch). I still ride the occasional Century...

As joeyduck noted above, watch those twisting moves!!!!
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Old 04-23-16, 06:43 AM
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Originally Posted by FBinNY View Post
Years (decades) ago, I used to fit bicycles for recovering patients of a local knee surgeon. This was before the scope, so knee surgery involved a much longer recovery process.

The surgeon was a big believer that bicycles were a useful aid in post operative recovery, and I'd see people come in on crutches and ride away.

The basic elements for riding with knee issues.

1- saddle as high as possible, shy of where the knee would straighten completely. Usually we'd go to where the person was reaching slightly and riding with a toe down foot angle.
2- low gears. This is absolutely critical. The bikes were set up with higher gears locked out. The object is to restrict the amount of weight that could go into the knee
3- shorter cranks if possible, to reduce the total flex cycle. Not much of an issue for taller people, but for shorter ones, we fitted some modified childrens cranks.
4- limit hill climbing, and avoid steep hills entirely. This, along with gearing, is adjusted according to strength, but you want to avoid loading the knee when bent
5- changing the pedaling rhythm delaying maximum power until later in the cycle. You want to apply more power when the leg is straighter to the extent you can train yourself to do it.

Foot orientation wasn't an issue back then because it was before step in (clipless) pedals, and the foot could find it's own alignment. With clipless, cleat alignment is critical because a misaligned cleat causes twisting forces in the knee. Also you want to find an alignment that causes the knees to travel straight up and down, rather than wobbling.

So, done right, not only won't cycling hurt the knee, it can be a big part of knee therapy.

So you can keep riding, but listen to your knee, and if you have pain, or notice instability as you ride, stop and have it rechecked.
No wonder you are so wise my friend. You are old.
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Old 04-24-16, 07:43 AM
  #17  
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You're lucky that its just your collateral ligaments. I ripped my meniscus two years ago from doing speedwork (sprinting at a track), and it hasn't healed and most say it isn't going to. I refuse to get surgery. I wrap it with an ace bandage and it is fine, even on long rides. I can't run anymore, though.
Get a knee brace or just go cheap like I do with an Ace bandage, and go easy on it for a month or two.
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