5 Tips on Bike Riding with Knee Arthritis

What do we know about the benefits of cycling for knee osteoarthritis?

Before explaining how to practice cycling effectively with knee osteoarthritis, let’s ensure that it is indeed beneficial!

Ideally, we would compare cycling to any other activity (or inactivity) that could be done instead: walking, sitting and watching TV, doing household chores, practicing yoga, etc.

Of course, it’s challenging to compare cycling to all imaginable activities. That’s why I’ll focus here on what we know about cycling compared to ‘doing nothing’: staying at home, sitting or lying down, or doing minimal tasks requiring little physical effort.

Theoretical benefits of cycling for osteoarthritis

In theory, cycling can have a positive effect on knee pain, discomfort, and osteoarthritis. Here are the main explanatory mechanisms:

1. Muscle Strengthening: Cycling strengthens the muscles around the knee joint, which can reduce pain and limit stress on the joint (thus slowing down the progression of wear and tear).
2. Improved Joint Mobility: The cyclical and repetitive movement of cycling can contribute to gentle ‘wearing in’ of joint surfaces, promoting better lubrication and improved joint mobility.
3. Increased Blood Circulation: Cycling enhances blood circulation, delivering nutrients and other molecules necessary for repairing damaged tissues in the body. This is particularly beneficial in cases of knee inflammation, common in osteoarthritis.
4. Weight Stabilization or Reduction: Cycling helps stabilize or reduce weight (compared to being physically inactive). Overweight can exacerbate pain and wear and tear.
5. Unload Activity: When cycling, a significant portion of body weight is supported by the saddle, reducing the load on the knee joints. This allows low-impact physical activity, minimizing compression forces on joint surfaces affected by osteoarthritis.

There are several coherent mechanisms suggesting that cycling is beneficial against knee osteoarthritis.

Advantages observed in people with knee arthritis

I’m betting that at least three things interest you:

1. Relieve your knee pain.
2. Be able to do more things without being limited by your knee osteoarthritis.
3. Attempt to limit the worsening of your cartilage wear.

I will detail what we know about the effects of physical activity and cycling on these three points. Not just in theory, but what happens in people with arthritis who practice cycling compared to those who do not or do so much less.

Cycling to relieve knee pain

People with osteoarthritis who engage in physical activity in general (cycling being part of it, but not only) report, on average, less pain than those who do not engage in it or do so significantly less.

A decrease of about ten points on average out of 100.

Source: Fransen 2015

Cycling to be able to do more despite knee osteoarthritis

People who cycle the most despite knee osteoarthritis are those most likely to continue being able to do daily activities.

Source: Fransen 2015

Cycling to limit knee cartilage wear?

There is less data on cycling and cartilage wear in the case of osteoarthritis than on pain or function.

It still seems reasonable to think that at worst, cycling does not damage the cartilage more than doing nothing. And at best, it brings positive structural changes to the joint.

Source: French 2022

Are there any negative effects associated with cycling in the case of knee arthritis and pain?

As always (even if it’s sometimes counterintuitive), even something natural like cycling can have negative effects, side effects, or undesirable outcomes.

Thus, cycling can:

1. Increase pain in the knee while pedaling or in the hours or days that follow.
2. Potentially damage the cartilage and other components of the joint.

The challenge lies in evaluating whether, in your particular case, the potential benefits outweigh the potential risks. You are, in my opinion, the only person who can assess this personal benefit-risk balance. I provide guidance further in the article.

At the population level, the benefit-risk ratio of physical activity in general (not specifically cycling) appears to be positive for knee osteoarthritis (Petrigna 2022).

Often, it’s mainly a question of dosage, quantity, and intensity of cycling performed.

How to practice cycling properly with arthritic knees?

Are you convinced of the benefits of cycling in your case? Do you want to know more precisely how to practice it to maximize the chances that it will be beneficial against your pain and other symptoms?

Here are some suggestions! Drawn from recommendations in scientific publications and my experience with patients seeking help to manage their osteoarthritis.

1. Ideally, pedal at a fairly brisk pace that causes slight breathlessness.
2. The ideal session time is at least 1 hour, which equals 25 km if you pedal at 25 km/hour (which is already a very good pace).
3. If these distances are much too significant compared to what you can currently do, try to increase the distance (or duration) by just a few hundred meters or minutes with each outing.
4. If cycling is truly impossible, consider other physical activities such as floor or standing gym exercises, walking, swimming, water walking (known as “longe cote”), or exercises in the gym.

If your knee pops and clicks while cycling, it’s not a problem!

You know that cycling would be beneficial for you, but you find it challenging to stick with it over time?

Here are some tips I give to my patients in this situation:

1. Use a cyclometer or a bike computer (an app on your smartphone, a bike computer) and note the steps you take every day.
2. Propose to a family member, neighbor, or friend to ride with you.
3. Join a group of cyclists (at your level) from a local association.
4. Set very small goals. For example, use the stationary bike for 10 minutes 3x/week in the evening (adapt as needed based on your current capabilities). It’s a start!
5. Note in your calendar the days you plan to ride and check off the task when it’s done.
6. Identify the least costly time for you to start (often in the morning or while watching a TV show for a stationary bike).

If you are concerned that cycling may exacerbate your pain, you can note your feelings after each ride. This will help objectively assess the potential impact of cycling on your pain.

And observe that perhaps your pain fluctuates whether you cycle or not!

Is an electric bike good for knee arthritis?

Yes, an electric bike is one of the activities you can engage in if you have knee arthritis.

However, I recommend trying out the model you want to buy beforehand. Why?

Depending on the weight of the bike and its motorization system, you may have to exert a lot of force at the start or up to a certain speed (often 25 km/hour). This can be difficult or even painful depending on the condition of your knee.

You need to find an electric bike that doesn’t trigger significant pain every time you start.

In this regard:

1. Road bikes (on-road or on a home trainer),
2. City bikes,
3. Mountain bikes,
4. Stationary bikes,

pose fewer problems in the case of knee osteoarthritis.

Adjust the saddle height so that it is comfortable for your knee when pedaling.

Knee arthritis, pain, and elliptical bike

As for the electric bike, again, I recommend trying an elliptical bike before buying if you have osteoarthritis. Unlike other types of bikes, you are not sitting.

Some people also like to use simple pedals that are placed on the floor, without resistance or with minimal resistance. They are used by sitting on a chair or armchair. You can also use them with your arms.

You can find them in sports stores or online.

Cycling: Is it the Best Sport for Knee Osteoarthritis and Pain?

I don’t believe there’s a one-size-fits-all answer when it comes to the best sport for individuals with knee osteoarthritis and pain.

In my opinion, the best sports for you, if you have knee osteoarthritis, are those that ideally meet these three criteria:

1. You enjoy it enough to want to do it regularly over the long term, regardless of weather conditions or your overall fitness.
2. It allows you to engage your muscles and maintain a light continuous breath (gentle continuous breath for several minutes). This rules out sports like petanque or archery.
3. It is low-impact, or without excessive strain and weight on the knee. For example, cycling or swimming meet this criterion, although recent data suggests that a bit of impact may be beneficial (Célik 2013).

Therefore, cycling theoretically belongs to the best sports for knee osteoarthritis.

However, if you really dislike this activity, it’s better to engage in a slightly less ideal sport in theory, involving weight and knee constraints (such as hiking), but that gets you moving!

I Can No Longer Cycle Due to Knee Arthritis: What Should I Do?

Have you genuinely tried to gradually increase the duration of your cycling sessions (starting with a few minutes)? And really, despite all efforts, your knee can no longer tolerate even a brief cycling session without significant pain?

This is a situation that regularly occurs with my patients undergoing rehabilitation for a partial or total knee replacement.

The decision to undergo knee replacement surgery is often considered when “nothing else works.” People truly want to resume their favorite physical activities (such as cycling or walking) for longer periods.

Some individuals prefer not to undergo surgery and explore all possible natural treatments for knee osteoarthritis. However, the most effective natural treatment is… physical activity!

When physical activity becomes genuinely impossible (even when attempting other activities like walking or swimming), it becomes challenging.

When someone seeks my opinion on the relevance of surgery and knee replacement in their case, I try to:

1. Evaluate everything they have already done to alleviate pain or improve their abilities.
2. Understand their specific expectations and hopes regarding what the operation might offer.
3. Confront them with data on the postoperative course of knee surgery:
   • Average pain progression after surgery.
   • The average improvement in activities people can perform after surgery.

It is through these pieces of information that one can form the most informed opinion on what knee replacement surgery can (or cannot) offer in cases of severely debilitating knee osteoarthritis when all else fails.

Here are some preliminary data on this topic, pending a more comprehensive article:

• In a study of 97 individuals after knee replacement surgery (average age 70 years), 12% were cycling before the operation, and 14% were cycling after. Therefore, some individuals resumed cycling after the operation (Ventura 2022).
• The operation improves the ability to be consistently active in daily activities in the three to four years following the operation (Abbasi-Bafghi 2012).
• Patients tend to have overly optimistic expectations about functional recovery after joint replacement surgery and underestimate the recovery time (Abbasi-Bafghi 2012).
• 85.5% of people who undergo total knee replacement surgery before the age of 50 are satisfied or very satisfied with the operation (Aujla, 2017).