Pedal your way to knee health

Bicycle riding is not just a fun aerobic way to stay fit. A new study published in the American College of Sports Medicine’s journal, Medicine & Science in Sports & Exercise indicated that people who bike ride on a regular basis are less likely to have osteoarthritis and pain in their knee by the age of 65 than those who don’t bike.

The study included 2,607 men and women between the ages of mid-40s and 80 with an average age of 64 years old. None were athletes and all of them had elevated risks of developing osteoarthritis in the knee due to excess weight, family history or previous injury. Bikers in the study were 21 percent less likely to have symptoms and X-ray images of osteoarthritis compared to those who didn’t have a history of bike riding.

Orthopedic surgeon John Willis, MD, at Cape Cod Orthopaedics & Sports Medicine in Hyannis often advises patients to take up cycling because it is really good exercise for the lower extremities. Several times a day he talks to patients about using biking as a way to rehab a knee.

“There’s a couple of reasons it is a really good thing,” he said. “Number one, it’s kind of low impact. You can get as hard of a workout as you want on a bicycle, but it’s a nice fluid type motion which doesn’t involve a lot of pounding, so it doesn’t really hurt the lower extremities.”

Keeps You Balanced

The other thing he really likes about biking, for knees in particular, is knees can get in trouble if they are unbalanced. Patients can become unbalanced when they are recovering from an injury, leaving one knee strong and the other knee weak. That causes problems for both your knees and your back. Cycling tends to equalize the knees from side to side and the weaker knee eventually catches up to the good knee.

“If you are running and you have a weak leg, you’re probably going to be putting a lot of stress on your back and your hips and cause other issues. But a bike kind of takes it out of the equation a bit because it allows the weaker leg to continue to be active without threatening other things,” Dr. Willis said.

In addition to equalizing strength from side to side, it also balances the strength from front to back, he said. When you’re in cycling position, your hamstrings extend your hips and your quadriceps extend your knee so you are co-contracting muscles on the front and back of the leg, which is very good at stabilizing the knees.

“If you are recovering from ligament injuries or things like that, you want to equalize the strength of your hamstrings and your quadriceps,” Dr. Willis said. “Biking is unique in that it does that naturally.”

Another benefit of biking is it helps move synovial fluid to lubricate the joint. Dr. Willis had one patient who was an avid cyclist before his knee surgery. Three weeks after the surgery he stopped doing physical therapy and hopped on his bike instead.

“He probably had one of the easiest and nicest recoveries I’ve ever seen from a partial knee replacement,” he said. “So, there is some magic that happens when you’re on those two wheels with regards particularly with the knee.”

What Kind of Bike?

As far as choosing a bike, unless speed is your desired goal, Dr. Willis recommends a bike where you are seated more upright rather than crouched over. It’s important to get the right fit, which a professional bike shop can help you determine. If the seat is too low, you risk putting additional stress on your knee and kneecap. If the seat is too high, you are apt to rock from side to side, which can irritate your back.

“It doesn’t apply to everyone, but a general rule of thumb is if you are sitting on the seat and you put your heel on the pedal and the pedal is at the bottom of the stroke your leg should be straight with your pelvis level,” he said. “When you transfer your heel to your toe, there should be just about a 10-to-20-degree bend to your knee.”

Dr. Willis and his wife are avid cyclists themselves. He used to have a racing bike, but he finds himself using it less and less in favor of his new fat bike. He and his wife recently biked 17 miles on Sandy Neck Beach and the surrounding areas and they biked all over Nantucket on the bike trails over the Memorial Day weekend.

“A fat bike has really, really fat tires and it’s very stable on the trails,” he said. “You don’t go very fast, but you get a really good workout and it’s a really fun and comfortable ride. And the other thing is you can ride it on the beach which is crazy to me.”