Getting Back on a Bicycle After Knee Replacement – Episode 104
Cycling after knee replacement can begin with a milestone that looks simple from across the room: one comfortable turn of the pedals. That first full revolution asks your knee to bend at the top of the pedal stroke, extend toward the bottom, and coordinate the movement smoothly.
A stationary bike provides a stable place to work on that motion. Outdoor riding adds another layer. You also need to mount and dismount, balance, steer, shift, brake, turn, watch the surface ahead, and place either foot on the ground when needed. This article explains how those pieces fit together as you move from indoor pedaling toward outdoor riding.
Listen to Episode 104
Have you recently had a total knee replacement, or are you preparing for surgery and wondering what recovery will really be like? Welcome to the Total Knee Success Podcast, your resource for total knee replacement recovery and life after surgery. Hosted by Michelle Losurdo, a trusted doctor of physical therapy and board-certified orthopedic clinical specialist, this show is designed for anyone considering, preparing for, or recovering from knee replacement surgery.
In about the time it takes to put a cold pack on your knee, each episode shares practical total knee surgery tips, evidence-based guidance, and clear strategies to help you manage pain, improve mobility, and thrive through the healing process. You’ll learn about post-operative knee rehab exercises, approaches to knee replacement physical therapy, and real-world tools for building confidence, improving sleep, maintaining a healthy diet, and regaining natural movement. From time to time, you’ll also hear patient perspectives and success stories that encourage you along the way.
Michelle also highlights the mindset and motivation strategies that make a lasting difference in recovery—helping you stay positive, focused, and resilient. And if you’re a family member, friend, or caregiver supporting someone through a knee replacement, you’ll find valuable insights here, too.
Please remember: Michelle is not your personal therapist and does not know you. This podcast provides general education and opinion only. Always consult your healthcare provider before making changes to your recovery plan. This podcast is not related to her clinical or teaching roles.
If you’re ready to feel stronger and more confident on your journey—or if you’re supporting someone you care about—this is the total knee replacement podcast that will help you succeed—one step at a time
In Episode 104, Michelle explains how to progress from stationary cycling to outdoor riding after knee replacement. Through David’s story, she covers the first full pedal revolution, saddle height, cadence, resistance, spinning versus grinding, upright and recumbent bikes, trainers, flat and clipless pedals, mounting, starting, braking, turning, gears, hills, e-bikes, and choosing a first outdoor route.
Read Episode 104 article & resources
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Listeners will learn why comfortable pedaling is only one part of being ready to ride outside and how bike handling, balance, and a person’s response help shape the next step.
You might like this Stable Trainer. I love this cushioned seat (saddle) cover, and here’s the easily mounted phone holder style I use on my bicycle.
Book! Making Sense of Pain After Knee Replacement
Book! Walking Like Yourself Again After Knee Replacement
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Resources at totalkneesuccess.com
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Medical Disclaimer: This podcast is for educational purposes only and does not constitute medical advice. The content is not intended to replace individualized medical guidance, diagnosis, or treatment. Always consult your surgeon, physical therapist, or other qualified healthcare provider regarding your specific condition, surgical decisions, and rehabilitation plan.
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Evidence-Based Content Statement: All information presented in this episode is grounded in peer-reviewed research, published clinical guidelines, and current best practices in orthopedics and rehabilitation.
Music Licensing Statement: Intro and outro music for the Total Knee Success Podcast is licensed for commercial use. Editing and production for this episode were completed using Descript.
What you will learn
- Why the first full pedal revolution can be a meaningful step
- How saddle height affects your knee through the entire pedal stroke
- Why cyclists distinguish spinning from grinding
- What changes when you move from a stationary bike to your own bicycle
- How pedals, frame style, bike handling, route choice, and an e-bike can affect an outdoor return
Why stationary cycling is often a useful starting point
Stationary cycling lets you work on repeated knee motion, muscle activity, and endurance without also managing traffic, trail conditions, or the balance demands of a moving bicycle. Research has found benefits from pedaling-based rehabilitation after knee replacement, including early improvements in function and knee motion. Those early gains have value because they can make everyday movement and the next stage of activity feel more accessible.
A 2024 survey of 1,029 people after hip or knee joint replacement found that 94 percent of those who cycled before surgery reported returning to cycling. The study included both hip and knee replacements, so the percentage is not a personal timeline or guarantee. It does show that returning to cycling is a realistic goal for many experienced riders.
Work toward a comfortable pedal revolution
At first, your available knee motion may allow you to rock the pedals forward and backward without completing a full circle. That movement can help you explore the range you have that day. As your knee bends more comfortably, the pedals may eventually travel over the top and complete the revolution.
Your knee bends the most when your foot passes the top of the pedal stroke, around twelve o’clock. Raising the saddle reduces the amount of bend needed there. Some riders find that a backward revolution feels available before a forward one. The direction can change how the muscles coordinate the motion, even though your knee still travels through a similar range.
The goal is a smooth revolution within a comfortable range. Forcing the pedal over the top can lead to hip hiking, twisting, or a sudden push that changes the quality of the movement.
Set the saddle for the entire pedal stroke
Saddle height has to work at both the top and bottom of the circle. A higher saddle may make twelve o’clock easier because your knee does not need to bend as far. If the saddle is too high, you may reach for the pedal at six o’clock, point your toes, rock your pelvis, or hike one hip. If it is too low, your knee may feel crowded at the top and your hip may lift to move the pedal through.
A comfortable setup usually leaves a small bend in your knee at the bottom while allowing your hips to stay level through the full revolution. A physical therapist or experienced bike fitter can help you assess the setup when your own bicycle, leg length, knee motion, or riding position makes the adjustment less obvious.
Understand cadence, resistance, spinning, and grinding
Cadence is how quickly the cranks turn, usually measured in revolutions per minute, or RPM. Cyclists often call an easier gear with a comfortable cadence spinning. Pushing a hard gear at a slow cadence feels more like grinding.
Research using instrumented knee implants found that forces increased as cycling power increased. At the same power, a faster cadence reduced peak forces. That is why an early stationary-bike setup often combines a light load with a comfortable cadence: it supports a smooth pedal stroke without asking you to push heavily against the pedals. Duration can increase gradually before resistance or gearing becomes more demanding.
Choose the stationary bike that works for you
An upright stationary bike more closely resembles the body position and handling of many outdoor bicycles. A recumbent bike offers a wider seat and back support, which some people prefer when getting on and off an upright bike feels awkward. Either style can support repeated pedaling when the seat position allows a comfortable full revolution.
The better choice is the bike you can enter, adjust, pedal, and exit with control. The name on the machine matters less than the fit, resistance, and quality of your movement.
Bridge the gap to your own bicycle
A trainer holds your own bicycle upright indoors. It lets you rehearse your familiar saddle, handlebars, shifters, brakes, and pedals before balancing outdoors. A bike shop can also check the fit and mechanical condition of a bicycle that has been stored.
Before an outdoor ride, complete a quick ABC check: air in the tires, brakes working, and the chain and drivetrain moving properly. Wear a properly fitted bicycle helmet and choose clothing or laces that cannot catch in the chain or crank.
Think about pedals, frame style, and getting a foot down
Flat pedals allow your shoe to lift straight off the pedal. Clipless pedals connect a cleat on your cycling shoe to the pedal and require a deliberate twist to release. Experienced clipless riders can rehearse clipping out with either foot while the bicycle is secured on a trainer. Riders who want the simplest exit may prefer flat pedals during the transition outdoors.
A step-through frame can reduce the knee bend and single-leg balance needed to mount and dismount. Whatever frame you use, practice getting on, getting off, and placing either foot on the ground in a controlled setting before adding traffic or a busy trail.
Practice bike handling before adding distance
An empty, level parking lot gives you room to practice starting in an easy gear, riding a straight line, making wide turns, braking smoothly, stopping, and putting either foot down. Keep your eyes ahead through turns instead of watching the front wheel. These skills deserve attention even when stationary pedaling already feels comfortable.
For an early outdoor ride, consider a short, flat, familiar route with a smooth surface and little traffic. A separated paved trail may reduce the number of decisions you have to make at once. Save steep hills, loose gravel, crowded paths, and quick technical turns for a later stage.
An electric-assist bicycle can reduce the effort required on hills or into a headwind. Its extra weight and quicker acceleration also change mounting, stopping, and handling. Practice the assist settings and braking in a controlled area before riding on a road or trail.
Use your knee’s response to guide the next ride
Notice how your knee responds during the ride, later that day, and the following morning. A temporarily stiff knee or muscle fatigue may follow a new activity. Increasing pain, repeated swelling, loss of motion, a new limp, or symptoms that continue into the next day can mean that the setup, resistance, duration, terrain, or handling demands exceeded your current capacity.
Change one variable at a time so you can tell what helped. You might shorten the ride, choose a flatter route, reduce resistance, adjust the saddle, or return to controlled handling practice. Stop in a safe place if pain, weakness, swelling, or a change in balance affects your ability to control the bicycle. Seek prompt medical guidance after a fall that causes an injury or leaves you suddenly unable to bear weight.
Helpful cycling products to consider
A few pieces of equipment can make indoor practice or an outdoor return easier to organize. Depending on your bicycle and goals, you may want to compare a stationary bike or compact pedal exerciser, an indoor bicycle trainer. I love this cushioned seat (saddle) cover, and here’s the easily mounted phone holder style I use on my bicycle.
Mini Exercise Bike with Bluetooth App, Pedal Exerciser While Sitting for Office Workers & Seniors, Leg Machines for Home Exercise & Recovery
Amazon disclosure: As an Amazon Associate, Total Knee Success may earn a commission from qualifying purchases at no additional cost to you. Browse Total Knee Success recommended products on Amazon.
If walking quality is also part of your goals, Walking Like Yourself Again After Knee Replacement offers additional guidance for rebuilding a natural, confident walking pattern.
The goal is more than turning the pedals
A comfortable pedal revolution is an important milestone. Outdoor cycling also depends on balance, bike handling, braking, turning, surface awareness, and the ability to respond when the unexpected happens. Building those pieces one at a time can help you return to the rhythm, freedom, and enjoyment that made you want to ride again.
For more knee-replacement education between episodes, join the free Total Knee Success Insider newsletter.
References
- Driesman AS, Johnson RM, Yang CC, Miner TM, Dennis DA, Jennings JM. Return to cycling after total joint arthroplasty. J Arthroplasty. 2024;39(11):2686-2691.e2. doi:10.1016/j.arth.2024.05.041.
- Sattler LN, Hing WA, Vertullo CJ. Pedaling-based protocol superior to a 10-exercise, non-pedaling protocol for postoperative rehabilitation after total knee replacement: a randomized controlled trial. J Bone Joint Surg Am. 2019;101(8):688-695. doi:10.2106/JBJS.18.00898.
- Liebs TR, Herzberg W, Rüther W, Haasters J, Russlies M, Hassenpflug J. Ergometer cycling after hip or knee replacement surgery: a randomized controlled trial. J Bone Joint Surg Am. 2010;92(4):814-822. doi:10.2106/JBJS.H.01359.
- Kutzner I, Heinlein B, Graichen F, et al. Loading of the knee joint during ergometer cycling: telemetric in vivo data. J Orthop Sports Phys Ther. 2012;42(12):1032-1038. doi:10.2519/jospt.2012.4001.
- Hummer E, Thorsen T, Weinhandl JT, Cates H, Zhang S. Knee joint biomechanics of patients with unilateral total knee arthroplasty during stationary cycling. J Biomech. 2021;115:110111. doi:10.1016/j.jbiomech.2020.110111.
- Bini RR, Hume PA, Croft JL. Effects of bicycle saddle height on knee injury risk and cycling performance. Sports Med. 2011;41(6):463-476. doi:10.2165/11588740-000000000-00000.
- Wang Y, Liang L, Wang D, et al. Cycling with low saddle height is related to increased knee adduction moments in healthy recreational cyclists. Eur J Sport Sci. 2020;20(4):461-467. doi:10.1080/17461391.2019.1635651.
- Hummer E, Thorsen T, Zhang S. Does saddle height influence knee frontal-plane biomechanics during stationary cycling? Knee. 2021;29:233-240. doi:10.1016/j.knee.2021.01.026.
Medical disclaimer: This article is for general educational purposes only and is not medical advice, diagnosis, or individualized treatment. Consult your orthopedic surgeon, physical therapist, or another qualified healthcare professional before beginning cycling, returning to outdoor riding, or changing your exercise program.