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Cycling After a Knee Injury

Disclaimer

No medical professionals contributed to this article. If this article provokes questions about your injury or treatment, ask your doctor.

I had a car accident about three months ago. I broke several ribs, fractured some vertebrae, and shattered my kneecap. One of the first things I did after getting home from the hospital 2 days later was to Google for "cycling after a knee injury". I found some useful information, but it wasn't as specific as I'd hoped.

So I started taking detailed notes during my recovery, and am writing them up here to give other poor folks who end up in the same situation a better idea of what to expect.

My Cycling Background and General Level of Fitness Prior to the Crash
I am a 36 year old middling Cat IV cyclist. I raced about 40 times during each of the past two seasons, and logged about 4000 miles. At the peak of the season, I do about 15 hours a week. During the winter months, I get about 5 to 8 hours of cardio cross country skiing or riding my cross bike in the snow.

The longest training rides I do during the season are about 85 miles. A typical training ride is 30 to 40 miles.

I've been using a power meter to track my fitness over the past couple of seasons and was kind of obsessed with measuring my aerobic threshold, so I have some good data for early season numbers, and an estimate for my fitness at the end of last season.

In 2006, my threshold power was about 320 Watts. At the end of last season it was about 380 Watts. That might sound good, but I weigh in at 100 kg, so it's never enough!

Injury Details
I didn't lose consciousness and didn't suffer any head or neck injuries. The left side of my rib cage whacked against the door and I cracked several ribs, and punctured my lung. My pelvis stretched the lap belt and slipped under the steering wheel and airbag and my back muscles fractured the transverse processes of my vertebrae in my lower back. Something bashed my kneecap and broke it into three pieces and opened the skin up.

On the x-ray, the knee break was "clean". It looked like someone chopped it with a hatchet. So the surgeon was able to reconstruct it neatly with three screws.

When I left the hospital, my bad leg was in an immobilizer. I could walk on crutches, but could not bend the leg at all.

Month One: Recovery from Trauma
After the accident, recovering from the trauma was my number one concern. The ribs and back were painful. The knee didn't hurt. The punctured lung was no biggie. I did the breathing exercises I was ordered to do and after a week it was fine. During the first week, I basically slept 20 hours a day and tried to avoid moving.

On the third day, I started to explore my limits. I could walk with crutches fairly easily. I could do toe raises. I could shower and take care of my most basic needs without assistance. I could barely bend or twist my torso.

Even though I was jacked up, I made a feeble attempt to get some exercise. I tried to walk around for ten or twenty minutes at a time, and I could at least do toe raises to keep my calves in shape. I did two sessions per day.

A word of caution, if you suffered trauma and blood loss like me, be careful. If you start sweating uncontrollably and get super thirsty, you are about to faint. Sit down or get horizontal. You don't want to faint while standing, or seated on a precarious perch, like a doctor's exam table!

By the end of the first month, my ribs and back were healed. One morning I was able to sit up in bed without pain. I also started physical therapy that week.

Month Two: Regaining Range of Motion and Muscle Tone
The surgeon removed the immobilizer and bandages from my knee five weeks after the accident and the surgery.

My quad was GONE. It was reduced to a blob of jelly. It was smaller than my knee. My knee was swollen and angry looking. I got a new brace that was slightly less bulky than the immobilizer, but my leg would still be locked in extension for another month.

I started PT the same day. The doctor limited my exercises to calf work, and isometric muscle flexing. I was not allowed to put a load on my knee, but I could work on range of motion while sitting.

I was thrilled. Finally, I was working my way back toward riding. In spite of my enthusiasm, I couldn't even contract my muscle during the first session until the therapist zapped it with electrical current. Once it "woke up" I was able to start contracting it harder and harder. I could only bend the knee 60 degrees (out of 120). Swelling and fluid in the joint limited the motion.

I got into a good routine with therapy three times a week, and I did my exercises three times a day. I also iced and elevated the leg if I wasn't my PT drills.

I gained 3 to 5 degrees of "motion" per day. But after several days, I realized there were really two ranges of motion. The "Extreme" range and the "comfortable" range. The extreme range of motion expands from day to day, but the joint still feels tight over much of that range. Then a few days later, some fraction of the extreme range of motion feels "comfortable". For me, I got to 90 degrees pretty quickly, but the comfortable range lagged by about 30 degrees.

The limiters of the motion shifted around from day to day. One day, the lower part of my knee hurt. One day, the muscles just above the knee hurt. I generally pushed the leg to bend just past the point of pain and held it for a few seconds.

I was also going to the gym three times a week to lift weights and do some awkward cardio. I continued my normal cycling weight routine as much as possible with just my left leg. I was able to use the elliptical trainer with my brace on.

By the end of the second month, I was feeling almost normal. I had full range of motion, though the comfortable range was considerably smaller and I could at least see my quad muscle, though it was a fraction of its former size.

Month Three (now): Back on the Bike! Learning to Walk.
At the start of the third month, I went back for my second follow up exam and xrays. My knee looks "normal". No swelling. The range of motion was only a couple of degrees shy of full, though it was still tight at the extreme end. The xray showed that the bone wasn't 100% fused, but good enough to ditch the brace, to drive a car, to walk, and to ride! But not good enough to lift weights, yet.

The first week I was not 100% confident in the knee, so I was very cautious about everything. I had a pronounced limp. I could not go up or down stairs with weight on the bad leg.

I was able to ride the trainer, though. It felt great! The remaining stiffness in my knee vanished. My "spin" was ruined, and there was some pain in the joint for the first couple of sessions. I was not able to ride out of the saddle at all. I took the first week to explore how hard I could push it.

The second week, my gait was returing to "normal". I had settled into a routine with my newer physical therapy exercises, and was ready to try riding on the road.

First Rides on the Road
I planned to play it safe on the first ride. Any sign of trouble and I'd go back home.

I rolled out the driveway and started for the open road. There's a short steep climb out of my neighborhood onto the main road. I usually fly up that out of the saddle to get the blood pumping. I muscled up the hill with my good leg and just used the bad leg to push through the dead spot in my stroke. It was easy! Easier than walking! I was thrilled and put in a rolling 8 mile test ride. No problema! A day later, I did a 20 miler. This coming weekend, I'll do a 40 mile ride.

Cycling is great for rebuilding the muscle, because I can perfectly modulate my efforts so the muscle and knee are working at 100% of what I can stand, no more, no less, for several hours.

Conclusion: Fitness Loss and Plans for the season
On the 20 mile ride, I hit a long gradual climb as hard as I could. 250 Watts. Ugh. That's weak. I would not be able to race right now. I am guessing it will be another 8 weeks before I can hang out at the back of the field in a flat race. It will probably be several months before I can compete at the level I was at last season.

In the early season, I'm just going to do the easy races on the local schedule and hang out in the field. I'm planning to work my ass off to try to compete in the July and August races, and put more effort into cyclocross season than I normally do.

Epilogue: Could've Died-itis
I was lucky in many respects. I have good health insurance. My employer backed me 100%. I doubt I will have any lingering physical effects from these injuries.

I was really positive and upbeat while I was recovering--I had a goal and I was pursuing it with all my energy. When the brace came off, I was euphoric for a couple of days, but crashed into a black mood for about a week.

I've named these mood swings "could've died-itis". An event like this crash is a slap in the face from the universe. A few more miles per hour, or a different angle here or there and I'd be dead. While I was recovering, I had the distinct sense that my life would change drastically once I recovered.

Of course, when I got back into my pre-crash routine, except for a new car and a slight limp, nothing changed! But after a life changing event like this, normal just isn't possible, and every day brings an armload of questions stemming from this existential crisis.

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