We met a man walking with crutches across a driveway to the parking lot as we pulled an OrthoBike clinic model bike on its cart to our car after giving a demo. He jokingly asked if he could have one at home! We talked and found out that he had scheduled a total knee replacement within a month. We explained briefly the OrthoBike’s adjustable pedal cranks and seat and the extraordinary benefits for rehab after a total knee replacement. He told us he had already seen bikes at the outpatient clinic where he would be getting physical therapy rehabilitation after his surgery. He didn’t think there was an OrthoBike on the floor. We suggested he ask about that deficiency, but he did not seem to fully grasp why he should. I decided to write this post to help explain the matter.
Stationary Fitness Bikes in Outpatient Clinics
All therapists and doctors, both clinicians and researchers, agree that cycling is the best dynamic exercise for the knee. All outpatient orthopedic therapy clinics invest in stationary exercise bikes.
The bikes in the clinics are fitness products used in gyms or sold for residential use online. They have 6.5–7-inch pedal crank arms that require a minimum of 100–105° of knee bend or flexion to complete a pedal rotation with little pain.
If your knee is stiffening and it hurts too much to pedal your stationary bike, you can’t pedal the bike in the clinic, either. If you are in rehab after surgery, you look at the big bike and your fear can go through the roof because you know you can’t pedal that bike with your operated knee. So, the therapists work on your knee on the table, stretching, massaging, and manipulating it with their hands to increase its flexion and extension. Their goal is to prepare you to pedal the bike by manually increasing your knee flexion. Depending on your fitness and the condition of your knee, it will take 2–4 weeks of painful manual rehabilitation after surgery to achieve it. But by the time your knee bends to about 105°, you are almost ready to be discharged, so cycling on their bike gives you little therapeutic value. Advanced patients warm up and work out on the fitness bikes.
Rocking Back-and-Forth: Ouch!
Your PTs might seat you on the recumbent fitness bike in the early days and ask you to rotate the pedals forward and backward as far as you can (“rocking”) as another method of stretching your knee to increase its flexion and extension. We have been told that you stop going forward when it hurts, and stop coming back when it hurts—hurt-hurt, hurt-hurt…a hard stop of pain over and over until you can finish this wonderful exercise or refuse to continue. If your foot ever slips off the pedal (typically no heel straps or heel cups), you will join that select group whose screams are heard all over—you won’t be the first. Is this really what you want? Is this the best they’ve got?
Finally Time to Ride—Are You Ready?
When your knee’s flexion has progressed far enough, the PTs put you back on the big bike. You haven’t done any cycling for weeks, maybe years. Suddenly, you and your knee are confronting what both have been dreading since you started rehab.
Of course, the PT won’t put you there unless he or she is confident you are ready. But if you fear the pain or actually experience that awful pain, you could freeze up and refuse to do any more. Maybe you have arthrofibrosis and they haven’t figured that out yet. Maybe you are highly pain-averse and hold back. The PT might judge that you must get all the way around now to progress and then force your knee through that maximum pedaling bend. That sudden lightning bolt of pain might be “good for you,” but you may never forget the pain somebody else caused you—and screams announcing one’s feelings about the matter are not uncommon. We know one woman who refused to return to get her second knee replaced for three years because of exactly that experience. When she was discharged, she told the PT she was never coming back.
There’s now a better way: pedaling complete rotations from the beginning, in your pain-free zone as your flexion increases little by little, in addition to the PT’s manual therapy, so your brain and knee are both ready to confront the big bike.
OrthoBike: The Therapy Bike
OrthoBike is nothing like the fitness bikes. It was designed for therapy from the ground up and was never in a gym.
You can start pedaling the OrthoBike within 24 hours of surgery, possibly uncomfortably but pain-free. That’s right, starting at less than 60° of knee flexion, by setting the pedals at their shortest position and adjusting the seat, and then completing pedal rotations, watching in wonder as your knees bob up and down in that familiar pattern. None of this painful rocking back-and-forth business because the therapist doesn’t have a bike with short-enough pedal cranks. You’ll increase the bend or flexion of your knee a little at a time as you ride the OrthoBike for the next several weeks, under your control, at your pace. When it is time to get on the big bike, you and your knee are both prepared and excited for that milestone.
That is exactly what happened to the woman I mentioned earlier. After three years of increasing pain, popping pain pills, and limiting her activities, she relented and had the second knee replaced. When she came to the outpatient clinic the next day, she told the PT there was no way she was going to get on the big bike again. He had just received a prototype of the OrthoBike and she agreed to test it. She was elated to discover that she could pedal complete rotations with no pain at the shortest pedal cranks on day two post-op. Within two weeks her knee’s flexion had increased to the 100–105° range. Her fear of the pain of pedaling the big bike had gradually dissipated with many revs of pedaling at increasingly longer crank arms. When invited to mount the big bike, she was happy to do so—a very different experience from three years ago! She knocked it out of the park and was discharged a week later. She loved the OrthoBike for how it helped her overcome her fear and gave her control. As she told us: “My leg went around. I did it myself…it’s great, absolutely great. I just wish you had had the OrthoBike three years ago! I wouldn’t have had to go through all that torture!”
OrthoBike is a better way for rehabbing knees, and OrthoBike Hero brings it home. Every patient who uses it loves the OrthoBike. Nobody loves the fitness bikes; they are just bikes, which is all the clinician can offer you. Talk to your doctor and PT about when you get to start riding the bikes in the outpatient clinic and ask why you can’t ride sooner if cycling exercise is so good for your knee.