Cycling After a Knee Injury

From CRCycling

By Kevin

I had a car accident in January, 2008. The other driver swerved into the front of my car across two lanes. I only had a fraction of a second to react, and barely managed to turn the steering wheel before the airbag went off and my car was knocked backward into a pile of snow at the side of the road. The collision broke 5 of my ribs, punctured my lung, fractured 4 of my vertebrae, and broke my right patella into 3 pieces. One of my first thoughts after the accident was, "this is really going to screw up my cycling season." And it did!

A little disclaimer: My only medical training comes from watching episodes of House, so if you are reading this article for information about your own knee injury, rely on the information that's provided to you by your doctor. During the course of my recovery, I made sure to strictly follow all the advice I was given from the medical professionals that were involved in my care; I believe that helped speed me to a full recovery as quickly as possible. This article is intended to give you a little insight about what to expect when you get back on the bike.

Time in the Hospital

I expect that the healing process might vary quite a bit from person to person based on the nature of the injuries and the course of treatment one receives. So here is some detail.

I was in the hospital within an hour after my crash. I went into surgery right away to repair my broken patella. The three pieces were rejoined with titanium screws and my leg was wrapped in an immobilizer. The break was "clean", that is, there was minimal injury to the soft tissue on the back of the patella, or around the rest of the knee joint.

I was in the hospital for two nights. Literally, as soon as I could walk on crutches they sent me home. I am using the word "walk" loosely. I hobbled on crutches while sweat sprayed out of every pore in my body and I tried not to faint from the pain and effort.

Recovery from Trauma

The general trauma from the crash, including the lung puncture, broken ribs, and fractured vertebrae, and blood loss initially caused me the most grief. The broken ribs and vertebrae were very painful and made it difficult to sleep or even to sit comfortably. For about a week, I didn't do much except sit in a chair or hobble back and forth to the bathroom.

However, after about a week, I started to make an effort to get a little physical activity every day, for example, I'd walk up and down stairs and do leg lifts with my immobilized leg, and do squats with my good leg, and I did toe raises on both legs.

The pain from the back and rib injuries diminished day after day. After about 5 weeks, the pain had completely subsided. However, I was still severely underpowered from blood loss. I came close to fainting once while going to visit my family Doctor, and about a week after that, I actually did faint while sitting on the exam room table during a follow up visit to the hospital. If you start sweating uncontrollably, get super thirsty, and start to feel slightly dazed, you're going to faint. Get into a chair, or on the ground while you're able to plan how to do it!

Physical Therapy

I started PT about 1 month after my accident. Since my leg had been immobilized for several weeks, the quads on my injured leg shrank to nothing. I wasn't even able to contract the muscle initially. I needed assistance from an electronic muscle stimulation device to get it going. I was limited to a small set of exercises, like flexing my quads, and doing leg lifts, all while wearing the brace. I had PT sessions three times a week, and did my exercises as often as I could stand it--typically three or four times a day.

I was lucky to do my therapy at Outpatient Rehabilitation & Aquatic Center at the Geauga YMCA. The therapists were kind, professional, and got my leg working again as quickly as possible.

A couple of weeks after I started PT, I began doing some range of motion exercises. My range of motion was initially 60 degrees (out of 120). I regained about 3 degrees of motion per day, and eventually recovered full ROM. My knee always felt gummy and tight even as the range of motion increased. When I achieved 90 degrees, for example, about 60 degrees felt "normal", 60-90 degrees felt tight.

I never really pushed too hard to regain range of motion. That is, once I encountered resistance and pain in the joint, I'd relax the knee, and do another rep after a few seconds. Also, I did the exercises as often as I could stand to, and iced the knee as much as possible.

My knee didn't feel completely free and normal until I got back on the bike. The spinning motion seemed to tear up whatever scar tissue was still left.

Back on the Bike

About 3 months after the accident, I was cleared to ride. I first rode a stationary bike. I did 100 Watts for 30 minutes. That session loosened up my knee, and it finally felt "normal".

It was painfully obvious I lost much fitness and that the 2008 season was going to be all about recovery, not winning. Producing 120 Watts (wimpy) pushed my heart rate up to 85% of max! Also, the quads on my bad leg were essentially gone, and the skin flopped around as I spun. I couldn't stand and pedal, so sprinting wasn't going to be possible for a while.

Cleared to Lift Weights

Four and a half months after the accident, I was cleared to lift weights with my bad leg. With my good leg, I was able to easily do sets of 10 single leg extensions with 90 pounds. With my injured right leg, I was struggling with 12 pounds!

Cycling Performance

I did my first road ride after a few sessions on the trainer. Riding was actually easier than walking or running. I was able to return to "normal" training after about 1 month of easier rides. I was actually able to hang on in the field of the Westlake training race. Though I was able to race, I was still much weaker than I'd been in the previous season. For example, my critical power was reduced significantly (280 Watts instead of 380 Watts or so), and I could not get out of the saddle to sprint or climb.

I continued to do weight lifting sessions, but I was focusing more on riding than lifting. I think, in retrospect, that balance was incorrect. I was a little fooled by my ability to hang on at Westlake. I thought riding would rebuild the muscle, but it definitely didn't. The problem with riding, from the point-of-view of rebuilding an atrophied muscle, is that the healthy leg takes over for the weaker leg, and the injured leg remains weak. I've tried to concentrate on pedaling with the bad leg with more force, but it's too easy to slip back into autopilot mode where the strong leg takes over.

My leg weakness has been a big limiter during this season. Even though my cardio fitness has returned almost to normal, I've been dropped regularly while racing at Westlake, which was an easy race for me last year. Even now, 8 months after the accident, and 21 weeks after starting to ride again, my fitness is significantly worse than last season. In an 8 mile TT, for example, I'm only averaging 22 mph. Last season I was doing 5 mile training TTs at 25 mph on a regular bike.

I've switched to doing more weight work and running in recent weeks. I'm now (August, 2008) doing leg extensions with 36 pounds and it seems like I am making progress more quickly. Still, it is painful to do the leg extensions. I don't know whether it's the muscle or the joint that hurts, but it's excruciating. It seems to hurt less if I warm up prior to doing leg extensions.

I've given up on achieving any results this season. I'll have to ride the 'cross season this year, and cross country ski through the winter, and I should be back in shape in 2009.

I guess if I knew back in March what I know now, I'd spend significantly more time in the gym and not worry so much about my cardio fitness, and definitely not entertain any thoughts of winning or placing in a race.