0:00
Good morning guys, Tony Maritato here, licensed physical therapist and in
0:04
today's video I want to talk about the difference between a recumbent bike and
0:08
an upright bike, specifically related to the hip, knee, and ankle when we're working
0:12
on range of motion through the knee. Now whether you've had an ACL reconstruction
0:17
a total knee replacement, arthroscopic debridement, meniscus repair, there's lots of procedures that are gonna typically use one of these two bikes to
0:27
help you regain range of motion, improve circulation, get the fluid out of the
0:33
lower extremity back into the system, but the range of motion is what we're
0:37
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
0:45
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
0:53
racing when i'm setting up on a bike like this the normal setup position would be my knees a little
1:01
bit wider than my ankle my ball of my foot is on the pedal and as i'm going through a revolution
1:08
i want the seat to be as far back as i can while comfortably still reaching the far end of the
1:15
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
1:33
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
1:45
Now I can obviously play around with this a little bit. I can try and move the seat back a couple inches
1:51
It now becomes harder for me to reach the far end of the pedal as my range of motion improves
1:56
I can move the seat forward more. It's going to give me more knee flexion. So to give you some perspective
2:02
We went from 110 Here we're looking at about a hundred and thirty two
2:07
So the recumbent bike has some advantages in that it's usually a bigger seat back support a little more comfortable
2:14
but it requires a lot of hip knee range of motion. Now on the upright bike so if I start with the
2:24
seat nice and high just like on the recumbent bike we slide the seat back initially and then
2:29
move forward on the upright bike I raise the seat so that when I'm coming in what I want to do is
2:36
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
2:48
notice at the top I have much less hip flexion going on so now the angle of
2:54
hip flexion is sitting at about 75 where over there we were closer to 110 the
3:02
knee flexion, let's see what we've got and these are rough estimate guys, the
3:10
knee flexion is only about 60 and so this is where on an upright bike I can
3:16
get a little bit more motion through the bike, not necessarily motion through the
3:21
joints. The joints are actually moving less but it's allowing me to facilitate
3:26
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
3:41
something closer to about 90 degrees at the hip relative to the body but the knee flexion can be
3:48
as much as let's see where we are that's about 115 where it is right now and I could lower the
3:58
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
4:11
versatility for the motion at the hip, ankle, and knee, I really prefer the upright bike for anybody
4:18
who's capable of doing it. Now the drawbacks, right? It's harder to get on and off. I have to be able
4:24
to kind of step over if you are doing this and you're post-surgical usually the best way to do
4:30
it is if my left knee was the knee that was replaced i'm going to use that as my support leg
4:36
while i bring the right one over because this getting on and off the bike is really the more
4:43
kind of dangerous position that we need to be aware of so you want to do it as safely as possible
4:48
now if you don't feel like you can support yourself on the surgical side you come over
4:53
on the non-surgical side the challenge is a lot of patients can't get that over the hump in the
4:59
middle that's why we prefer often the recumbent bike without the center console so bottom line
5:08
is there is no right or wrong you choose what you have what you have access to what feels the most
5:12
comfortable for you the most important thing is you just get moving so in the next video i'll talk
5:17
about some other pieces of equipment that people commonly use after a knee replacement but if you
5:22
have a favorite let me know down in the comments below and I'll catch you on the