Using a Stationary Bicycle to Regain Knee Flexion

by James D. Hundley, MD

I have often recommended stationary bicycling as a conditioning exercise for people who had difficulty walking, had poor balance, etc.  It can be boring but watching a sporting event or exciting TV show makes it less so.

On the positive side, it’s convenient, effective, and safe.  You can do it in your own home whenever time permits, day or night, and you don’t have to worry about being run over by a careless driver.

When I had total knee replacement I was determined to practice what I’d been preaching.  The sooner you regain your range of motion, the better it will be and, on a cumulative basis, you’ll experience less pain.  My own surgery was complicated by a femoral DVT that required clot removal and aggressive anticoagulation, the latter resulting in my knee filling with blood making it harder to flex.  I had to get my knee going, so I started using my stationary bike.

At first I couldn’t make a complete revolution, even with the seat fully elevated.  I rocked the pedals back and forth to flex the knee as much as I could tolerate and held it at the forward and backward endpoints for a few seconds, back and forth, back and forth.  Ultimately I was able to make a full revolution, an exciting event for me.

Once I was able to make a complete revolution with the seat elevated, I would ride slowly for five minutes or so until I felt that the knee was “warmed up”.  Then I would lower the seat and push some more.  Over a week or so I was able to progressively lower the seat to its lowest position giving me as much flexion as the bicycle would allow.

This is not to say that I didn’t also have physical therapy and do other exercises, but I truly believe that the bicycle helped me regain my knee range of motion.  I now have 135 degrees of flexion and extension to neutral, and credit much of that to using the bike.

My wife recently had knee surgery and has been using a similar technique.  In her case, however, she is also using the Ortho Pedal, an “add-on” that effectively shortens the crank arm attached to the sprocket.  With this she has made some full revolutions and we’ll gradually adjust the Ortho Pedal to lengthen the crank arm to increase her knee flexion.

Click here to see the Ortho Pedal.  It was initially designed for those with fixed limitation of knee flexion that took them away from bicycling.  With the Ortho Pedal they could resume something that they loved.  I can see how it would work well for that but have also seen it useful in regaining knee range of motion in the acute postoperative stage.

Dr. Hundley is a retired orthopaedic surgeon and the president of OrthopaedicLIST.com.

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