Frequently Asked Questions

Like yours and all other residential recumbent stationary bikes, the OrthoBike Hero has a seat, recumbent arms, pedals, a magnetic resistance braking system, and a digital display.

But if we stop here, we could make the same comparison of Albert Einstein and an NFL defensive lineman: they are the same because they are both male and each has a set of arms and legs and a head.

But the similarities aren’t interesting, it’s the huge differences, right?

Let’s look at the differences between the OrthoBike Hero and any residential recumbent bike on the market.

This is a typical recumbent stationary bike. It was built for exercise, for people with normal flexion or bend in their knees. You can tell because the pedal cranks are 7 inches long.

And there is not much space between the nose on the seat pedestal and the back of the bike.

The OrthoBike Hero, on the other hand, was designed from the ground up for therapeutic exercise. You can tell because it has adjustable, variable length pedals.

And plenty of step-through space.

What’s the major difference between the conventional stationary bike and the OrthoBike Hero?

The major mechanical difference is you can adjust the length of the OrthoBike’s SuperPedals™. That’s really different. But the major difference to you is you can pedal without pain regardless of your knee’s range of motion.

Most of us can’t even think about changing the length of the pedal cranks because we can’t—they are what they are. You need a minimum of about 105° of bend (or flexion) in your knee to pedal your bike without pain.

But you can pedal the OrthoBike Hero at any knee angle between less than 60° and 100°—without pain—because you can change the length of the pedal cranks and adjust the seat. You have to try it to see for yourself how good it feels to be able to pedal without pain!

That’s major if you can’t or don’t want to pedal your bike because it hurts. Pain is everything.

Here is a table that compares the OrthoBike Hero with a common residential recumbent stationary bike. See footnotes below it.

Your recumbent bike is for fitness, not for therapy. Notice all the blanks in the recumbent bike column.

Your PT likely won’t understand OrthoBike. Tell him or her to look at the website and the PT pages.

1 OrthoBike Hero. Hero is home-use OrthoBike.

2 Fitness metrics: speed/cadence, distance, time.

3 Maximum flexion: When pedal is at its closest point to the body and knee bent to max. “Lowest max flexion” occurs when the other leg is fully extended.

4 Prehab to early post-op to home to outpatient to post-rehab to rest-of-life.

5 Passive, Active-Assisted, Active, Resisted.

6 Rider gets positive feedback when seeing progress by milestones, under own control, in pain-tolerance zone and is encouraged to keep going.

7 Therapy metrics: Knee flexion, extension, gait speed.

 

Here is a photo of our SuperPedals™ adjustable variable-length pedals.

You adjust their length by lifting up on the handle, pulling the cranks out or pushing them in, and pushing down on the handle to lock them in.

See the video. https://youtu.be/DnxRrglmKeQ

Look at the numbers on the surface of the pedal crank (from 2-5, can’t see 1).

The higher the number, the longer the pedal crank. The longer pedal cranks require more bend in your knee to pedal all the way around.

The lower the number, the shorter the pedal crank, and the less knee bend you need to go all the way around without pain.

If your knee doesn’t bend very much and you don’t want to or can’t ride your recumbent bike because it hurts, you are stuck. You can only adjust the seat, which you have learned doesn’t get you much benefit.

If you had an OrthoBike Hero, you could adjust BOTH the seat and the length of the pedal cranks to find the perfect combination where you can pedal full rotations without pain.

After you learned cycling therapy with OrthoBike and solved one problem, you can apply this tool the next time you or a family member needs rehab or to prepare for surgery. You/they might be able to postpone or even prevent an operation. You have the therapy tool and know how to use it. It’s not just a bike.

Its short cranks provide amazing strengthening workouts. You can also work on gait speed. The whole family can use it because it meets so many needs. Just keep this versatile tool; you get benefits along the way and never know when you will need it for therapy again. It’s also just a bike!

Personal experience: We prepped for a hip replacement and reduced a torn meniscus non-surgically. We had no idea these problems were going to show up—especially the meniscus that tore in the early morning—but we had the OrthoBike in our home and knew how to use it for therapy—within an hour of the injury.

We avoided meniscus repair surgery and the risks that accompany an invasive procedure, including surgical problems, unforeseeable arthrofibrosis, the hassle of prepping for surgery and the discomfort and time of rehab, the possible stimulation of osteoarthritis, and the almost guaranteed total knee replacement in a few years. It’s been almost 10 years.

…because OrthoBike was in our home and we knew how to use the tool when we needed it.

We also work out with OrthoBike. We shorten the cranks for intense forward and backward workouts at high tension, for cardio, strengthening, and gait. We can lengthen the pedals and spin them at > 100 RPM for interval training and spinning exercise.

The whole family uses it. Each of us sets the pedals and seat where we want to work out.

Just keep this versatile tool; you get benefits along the way and never know when you will need it for therapy again. It’s not just a bike. 

A little Yes, a lot No.

We are impressed with its design and all the tech, and the business that makes it available. We have watched the company since the ROM3 days.

The OrthoBike and the ROMTech Portable Connect both have adjustable pedal cranks which allow people to start cycling exercise immediately after a total knee replacement or other knee surgery. Cycling early in rehab gives a huge benefit over CPM.

That’s the one similarity; here are the differences.

 

Yes, the OrthoBike Hero was designed to fit in your home. It is lightweight and can be easily transported. It has wheels on the front foot and a handle on the back seat so you can tilt it up and roll it wherever you want. The seat and bike can be slid together to make it compact and someone who can manage about 50 lbs. can easily pick it up in their arms to carry it up or downstairs.

It’s all about making the best possible care available to you, depending on your needs. There are some patients who need OrthoBike therapeutic exercise every day, multiple times a day, for weeks and sometimes months at a time—difficult knees! Having it at home gives you a “Home PT 24/7” and tailors the therapy and experience to your specific needs.

Yes, and they like it because they can exercise safely while sitting. Research shows that gait speeds faster than 3 ft/sec dramatically decrease the risk of falling. OrthoBike gait speed programs teach the brain and walking muscles to fire faster.

The seniors who follow the OrthoBike programs of flexion and extension (where necessary), strengthening, and gait speed improve their strength to rise from a sitting position, increase their gait speed dramatically, improve balance, and grow their confidence.

And it doesn’t hurt to pedal OrthoBike, regardless of knee range of motion.

Yes, with a little assistance in the beginning. At the lowest tension knob setting there is no resistance, the pedals start, move, and stop freely because there is no massive flywheel, and the maximum knee flexion is less than 60°. There is no pain, so no guarding. The quads soon start doing what they are supposed to do.

The same thinking applies to patients whose knees are replaced within a short time span. They can rehab one while preparing the other, at the same time.

You can use it to move hips with limited ROM. One THA patient had it in his home for prehab. On the morning of his surgery, he did a 15-minute high-intensity interval training ride using short cranks that he already knew did not cause him pain.

A bilateral hip replacement patient with some ankle drop incrementally increased his hip flexion over a month of multiple daily workouts with OrthoBike.

A woman who suffered hip pain for six years rehabbed for almost a year at home with OrthoBike after a single hip Femoroacetabular Impingement (Cam) arthroscopic correction with debridement. She incrementally improved her hip flexion and had something she could do daily to keep her brain and body healthy. 

All they need to start their journey of progressive recovery is a quick explanation of the roadmap and how to operate the adjustable pedals and seat. And instruction in backwards pedaling. They get it in 15-20 minutes and become experts over time in managing their therapy.

Then it becomes a love affair as they see the progress they are making. It’s not just the physical but the emotional impact. They love the control and knowing where their knee is and where they are taking it. They love accomplishing early flexion of their knee in a common and familiar movement. They love OrthoBike because they are grateful it was available to them in their time of need. The testimonials are great. (Who loves a conventional recumbent bike?)

Exercise and stretching are important for arthritic joints, and cycling is a low-impact and effective means of getting repetitive exercise. The foundations and other online sources always recommend cycling exercise. The problem they don’t address is that a conventional stationary bike’s pedal cranks may be too long for many people to be able to pedal with causing serious pain.

This is where OrthoBike’s adjustable variable-length pedal crank arms and seat allow it to swoop in like a superhero to save you! You can dial-in the bike to match your pain-free pedaling ROM.

The idea is to remove pain from your exercise. That’s a good thing for OA and RA patients.

Once you experience for yourself that you can pedal the OrthoBike without pain, you may discover the desire to start working out because of renewed hope. What do you think that would do for you physically and emotionally, to be able to pedal for 10-30 minutes every day without pain?

[See also:]

Exercise and stretching are important for arthritic joints, and cycling is a low-impact and effective means of getting repetitive exercise. But the conventional fitness bike requires too much ROM to rotate its pedals without pain. The knee needs about 110° of flexion (with 14” hip arc) to comfortably cycle with a conventional stationary bike, and that is too painful for many of these people. Pain is so inhibitory.

That depends. If you get it for, say, three weeks prior to surgery, your joints are prepared for surgery. Then you will know the bike and how to do therapy for the next three weeks of rehab. That should be sufficient for “normal” knees that heal quickly.

Six to eight weeks of daily exercise after surgery may be sufficient for many difficult knees or if you really don’t like pain and want to take it slow and easy. It can take 2-3 months of daily exercise for an arthrofibrotic knee to regain full extension, flexion, speed, and strength. One patient had the OrthoBike at home for almost six months as he slowly reduced arthrofibrosis and a severe gait asymmetry.

Some people struggle with the price of six to eight weeks of rental. We don’t understand it. What’s the value of their knee to them? Put it in perspective: how much did their new TV cost? When it breaks, they throw it away.

Some people should keep it to control the scar tissue monster and to push back on the insidious encroaching of normal aging on their joint tissues!

Our intent is to help you become an expert in OrthoBike therapy. It is not very difficult. Basic training takes about 20 minutes and then you are in charge of your therapy.

We will talk with you and provide online training. Your customized roadmap is the key.

We want you to have a great experience and learn to sing the OrthoBike “Anthem of Praise” for yourself!

One orthopedic surgeon in Lancaster, PA, endorses the OrthoBike and refers patients who do not make progress with traditional therapy. These are generally patients with arthrofibrosis and often following multiple procedures.

There are surgeons in Allentown, PA, who have written scripts for home use of the OrthoBike for patients who required additional exposure to the specific therapeutic exercise it offers. Several surgeons are affiliated with a hospital system that includes integrated physical therapy facilities, and all of their patients get therapy on the OrthoBike.

Absolutely. You can adjust the pedals and seat to match your knee’s ROM, no matter how limited it is. You can even set the bike so you can pedal if your knee flexion is less than 50°. The reason you are asking this question is you want to do your best to prepare your knee for surgery. That’s the right attitude and OrthoBike is the right tool.

The great benefit of the OrthoBike’s short pedals and recumbent seat is you can mount the Hero and start rotating those short pedals within 24 hours of surgery. You will be so relieved to see your operated knee going up and down, doing what it is supposed to do, right from the beginning of rehab.

You start pedaling with passive motion at no resistance for a little while as the non-affected leg helps rotate the pedals and move the knee. Very soon the affected leg’s quadricep muscles start firing and providing active motion. There is a natural progression from passive to active-assisted to active and resisted. You will love it. 

If you want to get deep into the science, you can read this brief review of the scientific literature regarding short-cranks and adjustable-length pedal cranks.

The notion of a short pedal crank for earlier application of an ergometer to orthopedic rehabilitation therapy was studied and reported almost 30 years ago. A short-crank ergometer continues to be used at the Hospital for Special Surgery (HSS) in New York City. It is listed with traditional interventions in several orthopedic rehabilitation handbooks.

This is not a new subject or novel device; it is a modified ergometer that makes the known benefits of ergometer-based exercise available earlier in the rehabilitation course.

Goodwin and Cornwall (1988) determined that patients with restricted knee ROM could use an ergometer with a shorter pedal shaft (crank) because the shorter pedal cranks did not significantly affect the phasic activity of the involved lower extremity muscles or change the therapeutic characteristics of the ergometer. They made the following recommendation:

“The shortened pedal shaft used in the present study has direct application to rehabilitation. Using a shortened pedal shaft, patients with restricted ROM of their knees would be able to use a stationary bicycle. These patients would consequently be able to receive both the musculoskeletal as well as the cardiovascular conditioning available from a bicycle ergometer…The adjustable pedal shaft used in this investigation allows a versatile piece of equipment to become applicable to an even greater patient population.”

 

In 1991, Schwartz et al. reported on a novel short-crank ergometer and a mathematical model that calculated knee flexion and extension angles from lower limb dimensions and ergometer settings. Their upright ergometer was equipped with four specially machined crank sets whose pedal crank length varied from 80 mm to 170 mm (3.1 to 6.7 inches). They also showed that they could calculate the knee flexion angle and ROM for any patient at every seat height across a series of increasing pedal crank lengths. This table could guide therapists in setting goals and applying cycling therapy to a specific patient’s rehabilitation.

They echoed Goodwin and Cornwall when they claimed that their custom short-crank ergometer made the benefits of lower body ergometer cycling available earlier in post-operative rehabilitation:

“The…custom cycle ergometer can be used on early postoperative knee patients who are unable to ride a conventional cycle ergometer because of a lack of knee motion or on patients who require a limited arc of motion in their postoperative therapy protocol.”

These authors accepted the intrinsic value of applying the ergometer to early knee rehabilitation therapy.

John T. Cavanaugh, one of the authors on the previously cited paper, continues to employ the short-crank ergometer at HSS. He specifically added it to the list of interventions following meniscal tear reconstruction surgery in a paper published in 2012:

As flexion ROM improves to greater than 85°, select OKC and CKC exercises are introduced to the therapeutic exercise program. Bilateral leg press and mini-squats are performed inside a 60°−0° arc of motion. Quadriceps isometrics are performed submaximally at 60° of flexion. Stationary bicycling is added to the rehabilitation program by utilizing a short crank (90 mm) ergometer. (Cavanaugh and Killian 2012, emphasis added)

Citing this paper, several handbooks and guides for orthopedic rehabilitation therapy (see References for two examples) recommend the short-crank ergometer in the treatment protocols at early stages (knee flexion 80-90°) following several specific knee reconstruction procedures.

Under the proper conditions, a 2-inch pedal crank can limit maximum knee flexion during pedal rotation to about 60°. At this flexion angle the ergometer is accessible to the immediate post-operative knee like the CPM machine. Indeed, it provides early motion, which, as Millet et al. (2003) stated, “is key for the successful rehabilitation of the postoperative arthrofibrotic knee.”

Adjustable-length pedal crank. Kelln et al. (2009) demonstrated promising results with the use of an ergometer fitted with variable-length pedal arms in the early post-operative rehabilitation of patients after partial meniscectomy. A built-in, easily adjustable, and rugged adjustable pedal crank system could provide a wide range of pedal crank lengths (i.e., knee flexion angles) and could meet the requirements of an outpatient therapy clinic for quick set up.

The short crank ergometer papers made substantial contributions on early lower extremity therapy to the literature. They demonstrated novel equipment and its equivalency to conventional ergometers and quantified the relationship between knee flexion angle and bike settings.

The authors showed that shortened pedal cranks allowed them to apply an ergometer earlier in the course of mobility rehabilitation. They stated that they believed there were benefits. The effectiveness and acceptance of the idea are demonstrated by its continued use at HSS and recommendations in physical therapy handbooks.

The variable-length pedal crank assembly makes the short-crank ergometer easily available. It has been applied to accelerated rehabilitation following partial meniscectomy. Local clinical and home-use experience with the OrthoBike™ OB1 has demonstrated the value of its variable-length pedal crank, integrated seat, and dual action lever arms in acute-stage rehabilitation following TKA and ACL reconstruction surgery.

The short-crank ergometer has not been studied as thoroughly as the concept of continuous passive motion but is likely a better fit for acute-stage rehabilitation with better long-term outcomes.

References

Goodwin C., Cornwall MW. Effect of an adjustable pedal shaft on ROM and phasic muscle activity of the knee during bicycling. J Orthop Sports Phys Ther. 1988; 11:259-262.

Schwartz RE, Asnis, PD, Cavanaugh, JT, Asnis, SE, Simmons, JE, Lasinski, PJ. Short crank cycle ergometry. J Orthop Sports Phys Ther. 1991; 13: 95-100.

Cavanaugh JT, Killian SE. Rehabilitation following meniscal repair. Curr. Rev. Muscoloskelet Med. 2012; 5:46-58.

Kelln BM, Ingersoll CD, Saliba S, Miller MD, Hertel J. Effect of early active range of motion rehabilitation on outcome measures after partial meniscectomy. Knee Surg Sports Traumatol Arthrosc. 2009; 17:607-616.

“Handbook of Postsurgical Rehabilitation Guidelines for the Orthopedic Clinician”, Hospital for Special Surgery. Elsevier Health Sciences. 2008. ISBN 978-0-323-04939-9.

“Fundamental Orthopedic Management for the Physical Therapist Assistant, 4^th Edition”, Robert C. Manske. Elsevier Health Sciences, St. Louis, MO. 2015. ISBN 9780323113472.

Millett PJ, Johnson B, Carlson J, Krishnan S, Steadman JR. Rehabilitation of the arthrofibrotic knee. Am J Orthop. 2003:32:531-538.