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Good morning guys, Tony Maritato here, licensed physical therapist and in
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today's video I want to talk about the difference between a recumbent bike and
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an upright bike, specifically related to the hip, knee, and ankle when we're working
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on range of motion through the knee. Now whether you've had an ACL reconstruction
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a total knee replacement, arthroscopic debridement, meniscus repair, there's lots of procedures that are gonna typically use one of these two bikes to
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help you regain range of motion, improve circulation, get the fluid out of the
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lower extremity back into the system, but the range of motion is what we're
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going to focus on. I've got a little goniometer here just to give us some rough numbers but typically when I'm sitting on a recumbent bike, patients
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like the recumbent bike because they like the backrest, they like to be able to recline and sit back into it, it gives them a sense of at least abdominal trunk
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racing when i'm setting up on a bike like this the normal setup position would be my knees a little
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bit wider than my ankle my ball of my foot is on the pedal and as i'm going through a revolution
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i want the seat to be as far back as i can while comfortably still reaching the far end of the
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pedal revolution from a hip perspective and this is really the thing with a recumbent bike it does require quite a bit of hip flexion So if I open up my goniometer I line up roughly between my body and my thigh I get a quick measurement
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I'm sitting at about 110 degrees of hip flexion for the knee. Right here, I'm sitting at about 110 degrees of knee flexion
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Now I can obviously play around with this a little bit. I can try and move the seat back a couple inches
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It now becomes harder for me to reach the far end of the pedal as my range of motion improves
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I can move the seat forward more. It's going to give me more knee flexion. So to give you some perspective
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We went from 110 Here we're looking at about a hundred and thirty two
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So the recumbent bike has some advantages in that it's usually a bigger seat back support a little more comfortable
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but it requires a lot of hip knee range of motion. Now on the upright bike so if I start with the
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seat nice and high just like on the recumbent bike we slide the seat back initially and then
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move forward on the upright bike I raise the seat so that when I'm coming in what I want to do is
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I want to have the seat absolutely as high as it can so that when I point my ankle I plantar flex my ankle I can still reach the pedal at the bottom of the revolution but if you
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notice at the top I have much less hip flexion going on so now the angle of
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hip flexion is sitting at about 75 where over there we were closer to 110 the
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knee flexion, let's see what we've got and these are rough estimate guys, the
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knee flexion is only about 60 and so this is where on an upright bike I can
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get a little bit more motion through the bike, not necessarily motion through the
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joints. The joints are actually moving less but it's allowing me to facilitate
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some rhythmic stabilization and rhythmic movement through the bike and then as I improve this is where we come in and we can lower the seat we come back on now I'm looking at
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something closer to about 90 degrees at the hip relative to the body but the knee flexion can be
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as much as let's see where we are that's about 115 where it is right now and I could lower the
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seat even more and I can pedal even more and I can work on this a little more So there absolute advantages in terms of positioning and comfort relative to the trunk the low back the body on the recumbent bike But in terms of
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versatility for the motion at the hip, ankle, and knee, I really prefer the upright bike for anybody
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who's capable of doing it. Now the drawbacks, right? It's harder to get on and off. I have to be able
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to kind of step over if you are doing this and you're post-surgical usually the best way to do
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it is if my left knee was the knee that was replaced i'm going to use that as my support leg
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while i bring the right one over because this getting on and off the bike is really the more
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kind of dangerous position that we need to be aware of so you want to do it as safely as possible
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now if you don't feel like you can support yourself on the surgical side you come over
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on the non-surgical side the challenge is a lot of patients can't get that over the hump in the
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middle that's why we prefer often the recumbent bike without the center console so bottom line
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is there is no right or wrong you choose what you have what you have access to what feels the most
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comfortable for you the most important thing is you just get moving so in the next video i'll talk
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about some other pieces of equipment that people commonly use after a knee replacement but if you
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have a favorite let me know down in the comments below and I'll catch you on the
