Welcome back to The Hip Replacement Podcast.
All right, it is springtime in the US or in the northern hemisphere and that means better weather outside. And even if you're in the southern hemisphere, maybe you're listening or watching in Australia or New Zealand, the weather as you're going into the winter season, I would imagine it's still good enough to get outside and partake in some outdoor activities that you love.
Anyway, the weather should be good enough pretty much everywhere in the world right now to get outside and participate in some great outdoor activities. Get some fresh air, build up some endurance, some V2 max we talked about in previous episodes, or just get outside and have a good time, maybe by yourself, maybe with your friends or family.
So, in this episode, I'm going to talk about a question that a lot of hip replacement patients may have at some point in their recoveries. And that question is, can I ride a bike or can I get back to cycling?
Now, important to note here that I'm not talking about motorcycles. I'm talking about bikes that you actually pedal to produce power to move. Okay? So, regular bicycles.
And I have a fondness for cycling. And here's why. Because it was one of the very few activities that I could do before my surgeries that wouldn't hurt my hip, that I could do that I wouldn't be in a lot of pain.
And cycling provided a sense of freedom. I could move. I could get around. I could just be myself as compared to not being able to walk or run and really being limited in my mobility with walking or running. Cycling was completely different. I could ride my bike as much as I wanted and not be in pain.
So cycling is something I fell in love with a long time ago and it's because I was simply able to do it and it gave me a sense of freedom and even after surgery there's a lot of benefits. There's a lot of reasons to cycle. It's low impact and it's nonweightbearing and it may give you a sense of freedom that lets you feel like you can get out and do stuff and be normal again. Whereas walking or running may still give you some pain after surgery.
But here's even after surgery, here's two issues that I had to address before I was really able to get back on my bike. And I want to point out that before my surgeries, I was a cyclist for 15 years. Yeah. 15 years. I did a lot of long group, big group rides, 100 plus miles, a couple hundred miles over two days, five 10,000 riders.
So I did a lot of training for those rides and also participating in those rides. So it was a very social thing. It was part of I don't want to say it was part of my identity because I do a lot of different things and I don't want to single one thing out as being part of my identity, but it was just something that I looked forward to. I looked forward to being with other people. I looked forward to having the freedom to move around. And I wanted to get back to cycling after my hip replacement, but I had two massive fears.
And the first thing that I had to address before I could really get back on and feel good about being on a bike again, and those two massive fears were number one, could my hip actually bend enough to spin the pedals. All right? Because at the top of the pedal stroke when your knee is bent the most, that is when the hip is also bent the most. And I was concerned about, okay, as I pedal, would I be injuring my new hip if I did that?
Once I got comfortable with that, I was able to get on the bike and feel good about it again. But it was certainly stiff when I first started back.
And then the second major thing that was concerning that I had to address was that I was afraid of falling. And I think we could all agree that after a hip replacement, a fall is a bad thing. And it's even worse if you are moving at a fast rate of speed like on a bike.
So what I did was I waited a while to give my hip time to heal after surgery. And then I started small and started slow. I started on a stationary bike inside which we'll get into later. And once I got outside, I started alone, not as part of a group. I just rode around my neighborhood nice and gently.
So those are the two things that really I had to address. Okay. But can you ride a bike after a hip replacement surgery? And the shorter answer is yes. Generally, many people or most people can ride a bike. That's of course assuming you already know how to ride a bike. Maybe not the best time to learn how to ride a bike for the first time soon after a hip replacement surgery. Maybe wait a few years or figure out how to ride that bike before the hip replacement surgery. But the short answer is that yes, most people can ride a bike after hip replacement surgery.
But as usual, there's more to it than just yes, you should be able to because the better question is not just can you ride a bike. The better question is what are some of the things to consider when or before jumping back on a bike and how exactly do you do it safely? Because again, I think we can all agree that falling off a bike is a major problem. It could be a big risk and cause major damage if that were to happen. So, what are the things to consider? And that's what I'm going to get into today.
But biking or cycling is a great activity after hip replacement. It's low impact. It can help you build strength. It can improve mobility, get that hip moving a little bit. It's great for a lot of people. And it also feels good mentally, too, because it gives you a sense of freedom. Like I mentioned before, it gives you momentum in your recovery as you build strength and you can create momentum in your life to go and do the things that you want to do again.
And also for me and hopefully for you too, it may help you feel like you're getting part of your life back. It's just one more activity in your quiver or in your chest of activities that you can do after a hip replacement surgery.
Plus, I found that riding a bike or cycling to be a very social activity. There may be a lot of people who think that running or walking is very social because you go and do it with other people. If you think running is social because you can do big group runs, give cycling a try because there are also big cycling events.
And when I say it's social, before a ride, you meet up with people. After a ride, you're meeting up with those people. While you're riding, you're actually talking with those people. You could ride next to somebody and talk. Very social to be with people.
And it's very helpful in our recovery. It's very helpful for our mental state, for our confidence, for our psyche to be with other people and be communicating with other people. And all of those things matter as part of our recoveries because recovery from a hip replacement is not just about healing the joint. It's also about getting back to living, feeling alive, not just having a healthy hip.
We don't want a healthy hip for healthy hip sake. We want a healthy hip to get to the lifestyle to achieve a further lifestyle or to get back to the lifestyle that we had before. And cycling is just one piece of that.
My family and I vacation or holiday every year in South Carolina in the United States on a little island called Hilton Head Island. And it's very laidback. And one of the things that I like about that island is that a lot of people ride bikes and they all look like they're having a good time. There's a lot of trails. Some are covered in this beautiful canopy of trees so it's in shade and people just there's rental bikes all over the place. Every resort, every hotel seems to have bikes that people can use and they just go out as a family or as a couple or with a friend or even by themselves and just ride along the trails. And it's absolutely incredible to see. It's incredible to do. It's very relaxing and it's great exercise, too.
So, love seeing, love being on Hilton Head Island in South Carolina and seeing a lot of the bike riders. Very therapeutic for me just to be even on a bike.
But hopefully I haven't convinced you to go jump on a bike right now. All right. But before you get too excited and run off and jump on that bike and just go out the door or out the garage or wherever, let's slow down for a second and talk about a couple things that really need to be taken into consideration for safety and just things to think about so that you can have the best experience on the bike and even determine if you should be there in the first place.
Number one, first thing to consider, can you even get on and get off the bike? So, mounting and dismounting. And what I mean by that is you have to be able to lift your leg a certain height to actually get on the bike. All right? So, you could bend a bike over low to the ground, but you still have to lift your leg over that bike somehow. So, can you swing your leg over?
And that was one of the things, one of the limiting factors for me as well. I was like, "Wow." I can't even get my leg over this to get on. But once I was able to do that and it was a good gauge to tell me that, okay, now it's time to now my body feels good enough to go start riding a bike because I could get my leg over the bike to get on the bike and also get off the bike.
All right, so mounting and dismounting.
Number two, second thing to consider, are you going to go outdoor or are you going to ride indoor on a stationary bike? And there's a big difference between riding a stationary bike and riding an outdoor bike. But a stationary bike is usually the safest place to start. Why? Because it doesn't move and it removes a lot of the risk. You're not dealing with traffic. You're not dealing with other bikes. You're not dealing with other people. You're not dealing with uneven ground or sudden stops or sharp turns or potholes or gravel or rocks or dogs or any other distractions that you might have out in the real world.
And a stationary bike lets you work on the basics. Lets you work on the motion of spinning your legs, spinning the hip. It helps build strength and endurance in a much more controlled setting. And most gyms and health clubs have some type of stationary bike. And I remember that my physical therapist had a stationary bike in the clinic and I would ride the stationary bike there as part of the warm-up when I was going through my physical therapy very gently.
Outdoor biking, it's a different animal. It's not just about whether you can spin your hip in a circle. It's about whether or not you can get on and off the bike safely. If you can balance the bike because it's moving. If you stop or slow down, can you keep your balance and put your foot down? Can you react to surprises? And can you avoid falling?
So that's a very different standard between indoor and outdoor cycling.
So how soon after surgery can you ride? Timing matters here. Some patients, like me, I was able to do it in a clinic, several months after my surgery. But a lot of people will be able to use a stationary bike pretty early in their recovery, and others may need more time. It has to do with how mobile that hip is, whether or not the bone has healed. All right? But check with your surgeon and your physical therapist on the timing.
Although I wanted to get back to riding, I wasn't racing to get back on my bike after surgery. And frankly, it's because I was scared again. I didn't want to fall. I didn't want to be around other people and I didn't know if I'd get my leg over the bike.
But after several months, after I was walking a little more comfortably, after I had more strength in my legs, more control over my legs, less pain, I got on a stationary bike. And we had one at home. And the reason we had one at home and I was able to use it at home is because I bought my wife a stationary bike for Christmas one year.
That might sound bad, getting your spouse a piece of exercise equipment for Christmas or a birthday. As if I'm sending a message to her, like a subliminal message like, "Hey, get some exercise, wife." But that's not it at all. It sounds worse than it is. Come on. It's not like I got her a vacuum cleaner or a mop or something like that. That would have been bad. But this was an exercise bike.
And the reason I got her an exercise bike for Christmas is because we were going to do a big group ride in April. We did it every year. And over the winter, it's hard. Where we were living in Texas at the time, it's hard to get outside. A lot of rain, a lot of cold, a lot of wind, just not very fun. So, I wanted her to be able to ride inside. Plus, she was traveling a lot to go to a different state for business school. So, she would not have a lot of time to get outside on weekends anyway to ride because she was traveling. So, I got her the bike to ride at home.
And honestly, she rode it pretty consistently and she was in the best riding shape of her life going into that ride. And she was a much stronger rider that year than I was. So, the bike worked. Please don't give me a hard time about getting my wife a piece of exercise equipment. I know it sounds bad, but it's something she wanted. It's something she used and she crushed me in the ride outside that year. All right? So, please don't send me nasty messages about getting my wife a piece of exercise equipment. Please.
But that bike which was sitting in one of the rooms in our house, I rode it for several months and then once the weather was warmer, I felt more comfortable getting outside for some gentle rides. So my surgery, my first surgery was in October. I took a few months to recover and I started to get on that bike in the late winter, early spring on that stationary bike and then once the weather warmed up outside, I was able to get outside.
But like my experience, your outdoor biking is probably going to come a little bit later once your strength, stability, coordination, and confidence are further along. Maybe two weeks after surgery isn't the best time to go for an outdoor bike ride. Okay.
Fourth major thing to consider is the bike setup. I mean, what kind of bike are we even talking about? The bike setup matters more than people think. All bikes are not created equal.
The height of the seat is very important. If the seat is too low, you're going to end up bending the hip more than you probably should early on, and it's going to cause you more pain. It's going to make that motion, if your seat's too low, it's going to make that motion as you pedal more uncomfortable than it needs to be because it's compressing that hip more and all the muscles around your hip are going to need to be more flexible.
So, in general, starting with a slightly higher seat and very low resistance, maybe don't ride uphill. Or if you have gears on your bike, try a lower gear. That'll make things a lot easier on the hip joint.
This is when you start back on a bike or when you're starting to ride after a hip replacement surgery. This is the time to think about making smooth motions with your legs and your hips, very controlled and as comfortable as possible. Basically, learning how to ride a bike correctly. A lot of times people get on a bike and their interpretation of bike riding is just pounding the pedals down. Push, push, push, push, push down. And a better way to think about it is to try to spin your legs in a circular motion as best you can because that'll keep it smoother and less impact on your legs and your joints, especially your hip.
Again, in the beginning, it's better to just try to get used to the circular motion with very little effort, very little resistance before you increase to a lot of resistance or a lot of time on the bike.
Number five, what kind of seat or saddle is on that bike? And saddle is a fancy term that the bike community uses as the name of the seat. Okay, it's a saddle. I found that out the hard way in a bike shop basically being laughed at by the staff in the store regarding a seat that I had selected.
All right. Now, is the seat on your bike, is it a small, thin one, or is it wide and padded? And a small thin one will definitely impact your hipbones and your pelvis much more than a wider padded one.
The reason there are small thin seats on some bikes, some higher-end bikes, is because it's more efficient and it's lighter and it rubs legs and I guess butts or hipbones less than a bigger seat. All right? So, that's why small seats are common on higher-end bikes. But use a seat that's comfortable for you. If you're not racing, trying to win the Tour de France or some other major cycling event, get comfortable. Use a comfortable seat.
Number six, pain and swelling. We have to pay attention to pain and swelling and how your body responds to that. A little bit of soreness from the activity may not be unusual, especially when you just start, but sharp pain, increasing swelling in the hips or legs, pinching, maybe some instability, some unnerving sensations that you don't feel stable, or pain that lingers or gets worse are signs that maybe something's not right. And that's the time to go see the doctor.
But the way to avoid the doctor in the first place, the way to avoid the need of seeing a doctor is to number one, wait to get on a bike until you already have some range of motion, that the incision is sealed and that the bone has healed. So, you don't want to get on a bike and exert yourself when your bone is still trying to heal. Maybe not the best. Maybe a little bit to improve circulation, but I wouldn't push it.
Your body will probably tell you through pain when the activity is too much and too soon or if it's just not the right fit yet. But the problem is that your body might not tell you for a few days and then it's too late.
Number seven, what about strength? Consider strength and balance when getting on the bike. You might have enough mobility to pedal. That might be fine, but not enough control to get on and off the bike safely. All right? So, if you're standing there and you can walk, that might be great, but lifting one leg over the bike may make you unstable. All right, then it's not time to get on a moving bike yet.
Or you may be able to ride for a little bit, maybe 10 minutes, but not be steady enough if you have to stop suddenly. So, if you're outside on a bike, there's all kinds of hazards. Maybe it's a dog, maybe a cat jumps out of the bushes, maybe a car, maybe somebody else, maybe another rider. All of these things may cause us to start or stop or turn suddenly, which could be a problem.
And you might feel fine riding in a straight line, but not feel secure turning or starting or stopping or navigating bumps and uneven surfaces on the road.
So, biking outside adds other demands as compared to riding inside on a stationary bike. Your balance, your reaction time, emergency response, starting, stopping, turning. These are all part of the equation of riding outside. I'm not saying don't do it. I'm saying go slow when you start and don't start until you're further along, at least outside. And when I say further along, probably a couple months.
Number eight, what kind of ride are we even talking about? You know, not only are there different types of bikes, but there's also different types of rides, different types of biking. Are we talking about a comfortable ride on a stationary bike or a casual spin on a flat, smooth surface? Are you on smooth pavement or rocky gravel with bumps that could jolt your body?
When I was doing one of my IRONMANs in Arizona, the road that we were on was so bumpy that for almost the entire ride on this section, about a 40 mile section three different times, 30 mile section three different times, the bike was vibrating so much that my hands and arms were numb from holding on to the bike. The bike was vibrating because the road was so bumpy.
That was okay for me. I mean, I did not enjoy it, don't get me wrong, but that was years, five, six, seven years after my hip replacement surgeries. I would not even attempt that early on because I would have been in severe pain from the vibrations.
Another thing to consider is how are you attached to the bike if at all? And when I say attached, you have a couple connection points. You have your hands obviously, you have your butt on the seat and then you have your feet on the pedals. And when I say attached, I mean, are your feet attached to that bike with cages that your feet go into or with some type of clip?
And if you're watching on YouTube, I have I'm holding up one of my cycling shoes. And the way these shoes work is that there are clips on the bottom of these shoes and they attach to special pedals that I have on my bike on both the indoor stationary bike that we have and my outdoor bikes.
And the reason people use these is for efficiency. So, not only do you produce power when you push down on the pedals, but you produce power as you pull the pedal back and up and around. And because this is attached to the bike, the bike shoe is attached to the bike, I'm able to produce power no matter where my foot is in this cycle of turning the pedals.
Okay. If you're using shoes that clip in to the bike or that go into cages, it's like a cage that you put the front of your foot in. It's going to be harder to pull your foot out. Your reaction time is going to be a little bit slower than if you didn't have anything attaching your feet to the pedal at all. Because if there's nothing attaching your foot to the pedal, you can easily put your foot down to stop yourself. Not so with a clip shoe or a cage. So, be careful if you're using these. Go extra slow and just be diligent on your surroundings.
All right. I didn't use clips on my bike for several years after my hip replacement surgery. I took them off and I used regular shoes for all my rides, even rides over 100 miles. Not the most efficient, but I traded safety and security and confidence for the efficiency of the pedals. It worked out great for me. It was the right decision for me at the time.
So, after the pedals, what else about the bike ride would be important? Are we talking steep hills, mountain biking, gravel rides, maybe rough terrain, rocks or crowded trails. All of these things are important to consider. The farther you get away from surgery, the safer those rides should be for you. If you're closer to surgery, your surgery date, do something very plain vanilla, as flat as you can, as smooth as you can, as conservative as you can.
What about group rides? That's a completely different animal. I did a lot of fast group rides before and after surgery, but I didn't go anywhere near group rides for many months after surgery. And when I went back, and when I say group rides, I mean I participated in big charity rides, 10,000 people. But after surgery, I tried to keep as much distance between me and other riders as possible. And I did that for several years. I didn't want to go near anybody because it's very bad if somebody bumps you when you're on your bike. It's very bad if somebody stops in front of you and you run into them from behind because you will likely fall. And like we said, the last thing you want is a fall on a bike.
So if you want to participate in group rides, keep your distance and wait as long as you can after surgery before you jump back into those.
What about the distance of a ride? What are we talking about? Are we talking 20-minute ride or a couple miles or are we talking 50 miles or three hours? These are much different experiences. I've done a lot of 100 plus mile rides, but none of them were anywhere near the first few months of surgery.
But consider this. When you're talking about distance or time on a bike, when you go out to ride, you may feel great while you're doing it, but then feel terrible for days afterwards. So, be careful. Think ahead. Think about what your body's going to feel like over the next few days. And don't just go further and faster because you feel good right now as you start riding the bike. Go gentle, go short.
Number 10. What about other people being around you? Are you moving fast or slow? The faster you move, the more risk you have. And what's the experience of the other riders? Are they good at this? Do they normally ride in a group? Have you ridden with them before?
And be careful with kids. Kids are about as unpredictable on bikes as possible. So, be extra careful around kids if you're on your bike. Even to this day, when I take my daughters out for bike rides, I keep a distance away from them because they have the best intentions, but they're not really paying attention most of the time. They're looking around, they're not riding in a straight line. So, they may move a few feet left or right and create a problem.
So, I try to keep I don't know 5, 10 feet between us and them, between me and my kids as much as possible. So, be careful. Be careful with other people around.
And when I started back up again, I started riding inside on a stationary bike. But then when I went outside, I was by myself, just in my neighborhood. And then when I eventually went back to these charity rides, like I said, these big 5,000 10,000 group rides, these five or 10,000 people in these group rides, I kept my distance. Falling would have been the worst case scenario. And it's easy to fall if you bump into someone else.
Number 11. What about special kinds of bikes? And I've seen some articles and some social media posts about child seats. So that's where you put a seat on your bike to carry a child or to take your child for a bike ride. And I would recommend waiting until you've ridden a couple times after your hip replacement surgery by yourself because you're just adding more risk and you're putting someone else in danger or you're having to make you're going to you may have to put yourself in a situation decide whether or not to fall or make a sudden move. Do you risk a hip injury or do you risk hurting the child?
So, maybe best to wait for several months or as long as you can before you have somebody else strapped to your bike. I'm not saying it can't be done. I'm saying be careful and wait as long as you can before you bring someone else on your bike.
What about tandem bikes? And if you don't know what a tandem bike is, a tandem bike is a two-person bike. That's where somebody rides in front and somebody rides in the back. And this could be a little bit unpredictable. I've seen a lot of these things. And what typically is is it's two spouses on a bike and they're riding. And frankly, that's a lot of love and trust. But what's important on these bikes is that communication is key because one person can cause both people to fall down on the bike.
So, just make sure you're communicating, you're turning the same way, you're leaning the same way on a bike, you know when the front person is stopping. So, if you're going to get on a tandem bike, communication is key. But certainly, two people on a bike who are both riding and pedaling can ride much faster than one person pedaling.
So, what's the smart approach to bike riding after a hip replacement? Number one, start with clearance from your surgeon or physical therapist. Then, if you're cleared, start small, start controlled, start easy, start short. Try to use a stationary bike first. Make sure the seat is positioned high, use low resistance, and don't stay on that bike long. And pay attention to how you feel during the ride and later that day and the next day to make sure you don't overdo it.
And if things go well, then just gradually build. There's no need to overdo it all in day one and then set yourself back a few weeks or a few months. Move gradually through a progression of longer or more challenging rides because the goal is not to prove something. The goal is to recover well, not to win a race yet.
So, can hip replacement patients ride a bike after surgery? Yes, of course, many can. And for a lot of people, biking can be an excellent activity, maybe one of the best after a hip replacement surgery. Again, the real question is not just can you do it with that new hip. The real question is can you do it safely, confidently, and in a way that helps you recover instead of hurting yourself, safety and progression, getting better and stronger and more mobile. That's the standard. That's the goal and that's how you keep moving forward.
Thanks for listening to The Hip Replacement Podcast. And if you found this episode helpful, if you find this podcast helpful, share it with somebody who may be preparing for surgery, recovering now, or wondering if they can get back to the activities that they love. Maybe leave a post on social media, tell your surgeon, tell your physical therapist. Because by letting someone know about the podcast, you may be helping somebody when they need it the most.
Until next time, I wish you the best recovery possible. Take care.
