TKR Recovery back to cycling

[Fluttershy]

Hello! Right total knee Oct 4. Had lots of swelling and pain but it’s getting less. I am 6 weeks now and starting my next phase as my scar is healed and knee bending ok. Still lots of issues with hamstring tendons catching on back/side of knee but can now do a bit of stationary bike riding (on a road bike mounted on a trainer). Did I see somewhere there is a group for cyclists here? I’d love to get back into recreational racing (Gran Fondos and hill climbs) and it would be nice to hear how other cyclists got through their recoveries.
Thank you and happy healing to all!

 

[Layla]

Hello and Welcome to BoneSmart! Congrats on your new knee and thanks for joining us.
I will leave our Recovery Guidelines along with a link to the cycling thread I believe you're referencing.
Best Wishes as you continue your healing journey!
Cycling club for us

KNEE RECOVERY GUIDELINES

As you begin healing, please keep in mind that each recovery is unique. While the BoneSmart philosophy successfully works for many, there will be exceptions. Between the recommendations found here, your surgeon's recovery protocol and any physical therapy you may engage in, the key is to find what works best for you.

1. Don’t worry: Your body will heal all by itself. Relax, let it, don't try and hurry it, don’t worry about any symptoms now, they are almost certainly temporary.

2. Control discomfort:

rest​

elevate​

ice​

take your pain meds by prescription schedule (not when pain starts!)​

don't overwork.​

3. Do what you want to do BUT

a. If it hurts, don't do it and don't allow anyone - especially a physical therapist - to do it to you​

b. If your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again.​

4. PT or exercise can be useful BUT take note of these

the BoneSmart view on exercise​

BoneSmart philosophy for sensible post op therapy​

5. At week 4 and after you should follow this

Activity progression for TKRs​

The Recovery articles:
The importance of managing pain after a TKR and the pain chart
Swollen and stiff knee: what causes it?
Energy drain for TKRs
Elevation is the key
Ice to control pain and swelling
Heel slides and how to do them properly
Chart representation of TKR recovery
Healing: how long does it take?

Post op blues is a reality - be prepared for it
Sleep deprivation is pretty much inevitable - but what causes it?

There are also some cautionary articles here
Myth busting: no pain, no gain
Myth busting: the "window of opportunity" in TKR
Myth busting: on getting addicted to pain meds

We try to keep the forum a positive and safe place for our members to talk about their questions or concerns and to report successes with their joint replacement surgery. While members may create as many threads as they like in a majority of BoneSmart's forums, we ask that each member have only one recovery thread. This policy makes it easier to go back and review history before providing advice.
@Fluttershy

 

[Fluttershy]

Thank you Layla!

 

[Fluttershy]

Hello cyclists! I just learned of this forum. Might be the wrong time of year for action here (unless there are some southern hemisphere folks?).

Great photos @Axx72!

I’m only about 6 weeks post op first TKA, just started about a week ago doing gentle rides on the Rouvy app. Started at 5 minutes and am up to about 15. I tried to add some power but I think I need to back off time and power, as I lost some flexibility and am swollen past few days.

I’ve worked hard on ROM the past few weeks as my mental health needed me to be able to ride a bike! I’m about 5-125, but a few days ago had been able to passively push to almost 135. My OS thinks I can get another 5-10 degrees. Having relatively short legs means I need a bit more bend than all the giraffe riders out there. I even bought 165mm cranks for my 2 road bikes a couple years ago (helped my OA lots). Alas, my last mtn bike of the year a year ago I felt a very nasty stabbing pain when I pushed power. Since then it has been downhill and a year of limited mileage, unable to do any steep climbs. It was soul crushing as hill climbs (Type B Endorphin junkie fun) had been something I loved. I’ve ridden a mtn bike all my life, but discovered road riding in my 40’s and got into doing Fondos and even tried a couple of hill climb races. I’m really missing feeling the burn.

Any words of wisdom?

Given where I’m at (10-15 minutes pedalling about 50 rpm, 50-70 watts)…is a bike holiday in Italy this spring a realistic goal? I would be over 7 months in recovery. My husband has wanted to do this for years. My OS is optimistic.

 

[Roy Gardiner]

Hello @Fluttershy welcome to the recovery side. I've moved your thread here from the specialist cycling thread because many more people will see it and perhaps comment and suggest things. I hope that's OK.

I’m about 5-125, but a few days ago had been able to passively push to almost 135

That's very good, please don't push it

I tried to add some power but I think I need to back off time and power, as I lost some flexibility and am swollen past few days

Correct. Overdoing it will cause regression, and is very easy to do. Here's what I worked out for using a bike to improve ROM.

• Set the bike to zero resistance
• Set the saddle low enough so that a single rotation is a challenge; difficult but not painful. When a rotation becomes easy right from the start, lower the saddle a max of 1cm.
• Gently turn the pedals, through discomfort but without pain.
• Continue until the knee is 'warmed up' and the rotation is now easy, or for 2 minutes, whichever is the shorter time.
• Repeat several/many times a day, but don't go mad. Diminishing returns will apply; my guess is that half a dozen reps would be enough
• Do not pedal fast or for more than 2 minutes, this is a stretching exercise, not training.
• And if you get any pain or swelling in the 24 hours after doing this, cut it down until you don't

Here is a bit more chat and some pix and how 'healing' and 'training' are different

Given where I’m at (10-15 minutes pedalling about 50 rpm, 50-70 watts)…is a bike holiday in Italy this spring a realistic goal?

Absolutely. I was back to training in six months, and my ROM after 6 weeks wasn't where yours is

See also

My BILATERAL TKR Recovery Diary

 

[Axx72]

Hey @Fluttershy!

Welcome to the other side! Like you, I have been an avid cyclist for many many years. Since the age of 20, my cycling passion has been infallible.

Having knee replacement was both scary and exciting. I began serious riding/training again about 10 months post TKR. I am now training for long-distance bike- packing in the 2000km per trip distance.

I think as your confidence returns, if your knee is ok with it, mountain biking can be a reality again too. My mantra is to listen to my knee. If it doesn’t like what I’m doing then I back off and let it recover. That advice came directly from my surgeon when he told me that cycling is arguably the best recovery exercise forTKRs

Roy’s list above is very thorough and all very good advice. A couple items I might add are alternating one leg spinning for 5 min each, obviously easier if you are using toe clips or clipless setup. Also try spinning backwards for five minutes at the end of your session as it actually works different muscles and allows some active release of normal power stroke muscles. Heat before, ice after is also super helpful for muscular recovery.

As for the Italian trip, sounds absolutely amazing!!! Everyone’s recovery is different. Hard for anybody to answer a readiness question. You kind of have to decide a few months in advance I would say. Modify it if you need to, and there are always options to take it easy in any situation.

Ride on!!!

 

[Fluttershy]

Absolutely. I was back to training in six months, and my ROM after 6 weeks wasn't where yours is

You guys just made my day! Offering hope. And thank you for moving the thread and for sharing all that information, which I will take some time to review and digest. I’m thinking should change title to “Recovery back to cycling”? Or other suggestion?

A couple items I might add are alternating one leg spinning for 5 min each, obviously easier if you are using toe clips or clipless setup. Also try spinning backwards for five minutes at the end of your session as it actually works different muscles and allows some active release of normal power stroke muscles. Heat before, ice after is also super helpful for muscular recovery

Thank you! This is great info and I will try it . Makes sense.

 

[Fluttershy]

I use Time brand pedals/cleats for road bike. Flats on mtn bike (tried Time clipless until a fall while unable to unclip). I like those pedals because they allow a good amount of movement and my knees liked that. But they have no way to adjust how stiff they are clipping in and out. I’ve just left my right bike shoe attached to the pedal as I’m not ready for the torque of unclipping.
How long was it before y’all felt comfortable with unclipping?

 

[Axx72]

To be honest, internal rotation, took the longest time to become comfortable without irritation. Arguably a solid year. I practised rotation tension on my knee by dismounting my spin bike while still clipped in. I would do a couple reps of clipping in, and then rotating externally(heel in) as opposed to the normal direction to unclip, which is rotating internally or heel out.

Time Road pedals are very nice because of the float. It’s always harder to unclip from mountain bike pedals for sure.

Again, everybody heels at different rates… might be faster for you.

 

[Fluttershy]

I feel like recovery is going to be slow. Over 6 weeks in. I took a day off biking other than a couple minutes of stretching and adjusting saddle height. I tried unclipping either way - stopped because it felt like it would hurt if I tried more.

It’s a roller coaster emotionally. Some days I can see the positives and accept the slow pace. Other days I still regret the surgery (even though the alternative would have meant a life of inactivity). Every day and night is painful and my quads so atrophied. I’m having trouble falling asleep because of this pain radiating from knee down outside of shin and into the top of my foot. Can’t figure out why. But I’m guessing my dysfunctional weak quads are part of it. I have a lot of stuck tissues around top of kneecap. And a hamstring tendon at outside of knee that catches on back of bones at knee joint. Those things make walking uncomfortable. I’m not getting much more than 1000 steps most days.

 

[Dmcfad2]

I feel like recovery is going to be slow. Over 6 weeks in. I took a day off biking other than a couple minutes of stretching and adjusting saddle height. I tried unclipping either way - stopped because it felt like it would hurt if I tried more.

It’s a roller coaster emotionally. Some days I can see the positives and accept the slow pace. Other days I still regret the surgery (even though the alternative would have meant a life of inactivity). Every day and night is painful and my quads so atrophied. I’m having trouble falling asleep because of this pain radiating from knee down outside of shin and into the top of my foot. Can’t figure out why. But I’m guessing my dysfunctional weak quads are part of it. I have a lot of stuck tissues around top of kneecap. And a hamstring tendon at outside of knee that catches on back of bones at knee joint. Those things make walking uncomfortable. I’m not getting much more than 1000 steps most days.

Hi. I am right behind you. My TKR was on 10/19, so one month today. I think I am a slow healer. I have friends who have done this surgery who are much further along than me. I am in good physical shape, not overweight, worked out all the time before this surgery, so I thought I would recover quickly. My knee had other plans.
I love my spin classes and my goal is to get back there. I don’t feel I could do them yet. I understand the roller coaster ride. I am the same. I get very achy at night and it feels like a giant toothache in my knee. I think it is just part of the healing recovery, I can’t sleep past 5am and sometimes can’t fall asleep. Yesterday I cried all day and wondered why I did this surgery. This morning I feel some improvement. I woke up less stiff with less achiness. I just want to encourage you. We will get there.

 

[CatieViv]

I am a week ahead of you. This recovery is going to take time. My surgeon said younger people aka us have higher expectations. Now I know what he means. We still have baby knees and need to remember that this is a year long recovery. You will get there. You too @Dmcfad2

I haven't been able to ride my bike for over 5 years because of this knee. Now, with this revision and TIME, I will do it! Continue to come here and rant whenever you need to. There's good people here.

 

[Fluttershy]

Thank you @Dmcfad2 and @CatieViv
It really helps to have others walking the journey also. Each journey is unique but every story I read I learn something from. We got this!

Today was a day of rest, and lots of time rolling around on the floor, easy stretching etc. yesterday I did too much driving, shopping and standing, eating in a cafe…2 hours with feet dependent/down was too much, even with compression sleeve/socks and I hurt.

Today I discovered just how effective lying on soft carpet floor with legs straight up a wall is for taking swelling down much faster than my usual technique (feet above knees, toes above heart). 20 minutes like this with gentle quads massage….and I swear my knee was closer to my bum after!

 

[teacheri35]

Wall work is awesome. I will go to the wall tomorrow! We often do wall work at yoga.

 

[Fluttershy]

A really cool thing happened tonight. I was watching TV and had been digging around the inside edge of my kneecap. All around it the kneecap felt more pliable, so I seized the opportunity to work it.

Anyway, later I went to change my leg position and this involved lifting my leg…and for the first time since before surgery it didn’t feel like it weighed 100 lbs and I didn’t feel a stinging painful sensation. So then I did some short arc quads, then long arc quad (knee straightening)….and again the leg felt lighter and knee straightening felt - gasp - almost normal!

It stiffened a bit later, but is still feeling good.

It blows my mind how the nerve signals around the knee can get so mixed up when the tissues aren’t moving normally. And then one stuck part releases and suddenly the muscle memory turns on again.

So I’ll keep working on freeing up those stuck tissues. It gives me hope that once my locked up quads finally decide to release what I think must be some kind of crazy glue that the OR tourniquet gremlins injected into them….maybe …just maybe …they will start firing and I won’t have lost as much strength as I think I have.

I'm needing less daytime ice (as long as I elevate lots and use compression). It seems that letting the tissues get warm is good for them at this stage.

 

[Dmcfad2]

Can you share how you manipulate the kneecap? How do you start? Just gentle pressure and trying to move it? I remember my physio did that in our last in home session. She said it was a little stuck.

 

[Axx72]

I am a week ahead of you. This recovery is going to take time. My surgeon said younger people aka us have higher expectations. Now I know what he means. We still have baby knees and need to remember that this is a year long recovery. You will get there. You too @Dmcfad2

I haven't been able to ride my bike for over 5 years because of this knee. Now, with this revision and TIME, I will do it! Continue to come here and rant whenever you need to. There's good people here.

Yesssss! Many of us who just want to get back to normal life/fun. Many have been there, many are going through and many who are planning on knee replacements. We are all in it together and will get there together. I love the camaraderie, experiences and advice many bring to the table.

 

[Cyclegal]

@Fluttershy hang in there! Doc warned us this is a long process, and pre op we are like "yeah" but then when we start moving a leg that doesn't want to move, and need a walker etc. we get impatient! Have to keep an eye on the prize, that at some point we will be riding better, stronger and longer than pre op!

My doc doesn't want me on the bike (stationary or road) x 3 months though I can do the bike in PT. Will hike / bike and maybe do some yoga.

It sounds like you had a breakthrough (or as we cyclists say a fitness bump) yesterday. Wooohoo!

Liz

 

[Fluttershy]

Can you share how you manipulate the kneecap? How do you start? Just gentle pressure and trying to move it? I remember my physio did that in our last in home session. She said it was a little stuck.

Pretty much what you said. Leg relaxed in as much extension as possible. When flexed, kneecap sits more tightly in groove, but when extended it has more play. I grasp around outside of kneecap and apply pressure in a direction going towards my toes…while gently contracting quad (creates a shear force to help the skin separate from the next layer of tissues below). I move it side to side by grabbing onto quads tendon and quads. Also below trying to move patella tendon around. Of course every knee different and best to ask PT to teach patella mobilizations. I’ve had a lot of PT over the years and learned self management tricks from them.
I was told also - compare the “good” knee the TKR knee. Feel how kneecap moves freely on the good side (assuming it is still good); ideally they should end up feeling comparable.

My OS emphasized patellar mobilization for me. I suspect it is key to this “tight band” thing I feel. And probably my pain and inflammation as it isn’t moving anywhere close to as freely as it does on my “good” (but crackly arthritic) knee. At least my new knee doesn’t sound like a goat chewing on tinfoil!

 

[Fluttershy]

@Fluttershy hang in there! Doc warned us this is a long process, and pre op we are like "yeah" but then when we start moving a leg that doesn't want to move, and need a walker etc. we get impatient! Have to keep an eye on the prize, that at some point we will be riding better, stronger and longer than pre op!

My doc doesn't want me on the bike (stationary or road) x 3 months though I can do the bike in PT. Will hike / bike and maybe do some yoga.

It sounds like you had a breakthrough (or as we cyclists say a fitness bump) yesterday. Wooohoo!

Liz

Hey Liz, thanks for the encouragement! So true how the pre and post surgery perspectives can change…and a little perspective reminder is needed sometimes!

I’m curious why your surgeon advised no riding until 3 months? I know each surgery is unique, different surgeons, different techniques (eg cementless, etc.).
My knee is cemented. OS said it’s ok to bike now, starting gradually…but just modify based on how I react 24 hrs later of so.

As much as I want so badly to crank hard and rebuild strength, I’m back to the gentle, low cadence for maybe 5-10 min. Motion lotion.