Riding evenly after a knee operation


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I had a knee reconstruction about 1 year ago which they call a TTT. Its pretty major surgery (for a knee) where they break your leg to change the angle of kneecap and put a few screws in there, tighten things up etc. It took me a long time to even walk properly again and now I have well and built my fitness back to well beyond what it was and whilst I don’t do squats I believe my quads are shaping up not too badly tone either. However, I can’t help but feel as if I’m favouring one leg whilst riding. I ride clipped in and consciously try to keep an even pedal stroke and pull with my operated on leg but my non-operated leg seems to fatigue before the other, indicating that im using it more.

Has anyone experienced this and have suggestions for how to fix it? I’ve had a smaller less intense version of the operation previously and you always tend to favour the other leg. It’s most likely a mental thing more than anything but to progress and get better I think I need to try to overcome this and even the power out!

Also I ride mountain bike, All mountain and enduro XC.



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I have had 2 knee surgeries and have had advice from various people that clipping in is not the best thing for dodgy knees, I haven't ridden clipped in for ages anyway but it'd be worth playing around with some flats to allow your feet and therefore knees to work at the most comfortable angle.

You could also try doing some strength exercises and get the knee/ leg back up to pace, my physio had me doing rehab exercises that were pretty non-specific, for more specific ones try out this site, http://www.bikejames.com/ and despite the temptation keep your exercises even across both sides of your body, you may find it takes a while but the sides will even out.


I however am very normal. Trust me.
I'm actually doing a PhD into this very topic, investigating a a few potential ways of overcoming this very issue.

While agree completely that you'll have 'subconscious' changes in motor patterns in which you rely tend to rely on the 'good' leg, it is not as simple as this.

Following any major joint injury and surgery, you central nervous system turns of activation to the affected muscle groups (the premise is this is a protective mechanism to prevent further harm to the joint), this is termed arthrogenic muscle inhibition (AMI). Your central nervous system is no longer able to voluntarily recruit a % of you muscle mass - so it you contract you quads as hard as possible - such as in a leg press movement - a significant portion of your muscle is still relaxed. This functionally means you are a lot weaker than you should be, and the muscle fibres that are active are under a lot more loading than they should be at a submaximal intensity, so they fatigue fast.

The unfortunate thing is your central nervous system also inhibits the contralateral limb - so you no longer have a good leg either. So a one sided (unilateral injury) results in a strength deficit to both sides (bilateral). One long term issue people have is they rely on the 'good' leg, which is not so good, so much that it wears at an accelerated rate = osteoarthritis and joint replacement.

AMI is present in both limbs up to and well past 4 years and once you are past the acute stage of rehab the only thing that may help is more time (how long is a piece of string?) and resistance training. The best thing you can do now is get involved in some heavy resistance training, particularly leg press / leg extension, train each leg individually, not at the same time. Also important to train hamstrings, gluts and gastroc as they are all effected to a lesser degree.

You definitely need some to do some more rehab/resistance training for both legs.


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I've had 2 major knee reconstructions on my right knee and a couple of related corrective surgeries. The first time I also shattered my knee cap which complicated things a little. The good news is that after both injuries I was eventually able to return to cycling and racing at an elite state and national level (The one thing I have given up is ironman triathlons due to the running/knee issues).

As MWI stated you need to start doing some training on each leg individually. I done and still do this not only in the gym but also on the bike using a stationary trainer doing single leg drills to ensure correct technique and efficiency. I never stopped using clip in pedals but did switch to crank brother pedals which have more float and found them a lot more comfortable on long enduro races (this may or may not have anything to do with my knee injury). The key as with most things if you want to improve/recover is consistency, perserveance, hard work and rest when you need to.
Good luck


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Wow, thanks for the great responses, I didn’t quite expect such good detailed suggestions.
I am not particularly keen on stopping using clips, I have pretty good shoes now which are suppose to ease pressure on your knees by having a slight offcamber angle to them. I never usually find I get pain in my knees as such either whilst riding unless my technique (foot angles are off, seat height not correct). I would’ve been inclined to think clips would’ve helped to some extent, as its forcing you in a fixed position, whereas with flats in the past I have had my legs at all sorts of funny angles.
Interesting you’re doing a phD on this field MWI, pretty interesting topic and I think that a lot of people (myself included) once they get fitness back up and they can return to normal activities the targeted physio specific to strengthing the affected area stops or at least slows right down. As you kinda feel like your 80% healed so you lose some motivation for doing it. Very interesting what you say about the CNS and what it does post op, I didn’t realise that was the case and explains a bit about why the leg never feels the same again, probably aren’t pushing it hard enough to fully get it back to how it should be.
I unfortunately have never been too keen to do leg exercises at the gym as I often found they felt like they put a fair bit of stress on my knees. However since bike riding I have been much more considerate of my legs and trying to get them working as well. My leg workout so far is a woosy no weight squats, riding and the cross trainer (which I think actually feels like its helped a little but probably only with muscle tone and some endurance rather then strength). Now I feel pretty comfortable the joint is relatively strong, I will try some exercises you suggested and see how I go, might start pretty light for the first couple of weeks and work from there to try and build the resistance up.

Hearing you about triathlons, I find that running feels funny since my first op, and it isn’t good on tar or asphalt. I can do it on grass fields ok though.

MWI, would you reccomend using a protein powder to help build strength. I am 80kg, 6ft, atm very fit, toned but not overly musclely and have a relatively immaculate diet, although I dont like eggs. But I eat a lot of meat and fish. If so do you have a brand you reccomend? I see torq in mtb magazines, it looks hell expensive though!
Thanks for the great replies, they are a great help. I will try and give an update in 3 months or so to see how its tracking 


I however am very normal. Trust me.
In regards to protein, to maintain muscle mass you need .81-1g/per kg/daily or up to around 1.62/per kg/daily if you want to put on muscle mass - but if you have a pretty good diet you'll be close to these requirements anyways. Perhaps it more important to make sure you time some protein intake around cycling or other exercise strenuous exercise, then your body can 'uptake' it more effectively. about 45 mins prior to and 1-2 hours post exercise has been shown to be an effective time of intake. Personally I eat dinner or a meal shortly after a hard exercise session and only take a protein supplement if I skip a meal or have little protein otherwise. No idea what brand I'm taking, guy at gym gives it to me for free for some programming help :)

Yeah running will feel funny, the damage around the knee affects the sensation and the knee will be a little more unstable than it should be. Just don't do any crazy DH sprints! Otherwise running, as long as it's not causing post joint swelling or pain will be good for it.

It'll take time for it to get better, no matter if you push it hard or not, having nice active lifestyle is probably the most important element. We have measure inhibition around the knee (both sides) from a unilateral injury 5 years following the surgery. If you do go to or have access to a gym, don't use heaps of weight to start with - say less than half body weight on a leg press movement and just focus on a nice smooth / controlled movement - particularly as you let the weight back down. As the knee feels better just progress the weight by 5-10kg increments.

If you use a tape measure to measure the circumference of your quads (around 5cm above the knee cap) are you legs the same size?


Wheel size expert
Ok, this is all really interesting. I'm going to hijack a little...

I had a number of injuries and surgeries on my left knee* culminating about 10 years ago, what I find now is that if I'm tired, experiencing the effects of my osteoarthritis, experiencing adrenalin/shock etc I really need to 'think' about how I walk (especially), pedal etc. Its to the point where if I'm tired or sore my gait becomes near comical and I have very little control at all, particularly in terms of forward/backward flexion at the kneejoint on footfall and general quadriceps function.
To be honest I tapered off heavy recovery work not long after the last injury (and was pretty heavily developed which I guess has slowly tapered off with age and laziness), and am now noticing after a quite sedentary year that I am losing strength and control rapidly.

Is there a muscle memory thing at work here on top of raw strength? Is strength training likely to help me regain that automatic control?

(torn medial l., torn acl, couple of heavy patellar impacts, vastus lateralis release performed, most meniscus removed, permanent sutures in medial l. etc)


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I just measured my legs. Both are pretty close in size, there is probably 5mm circumference difference (favouring the non-op one). But my legs are only about 450mm circumference measured at about 5cm above the knee, which obviously isnt big. My right leg defiantely feels stronger though and tends to fatigue less when I isolate them.

As for the weight, I would probabyl be struggling to do 1/2 my body wieght lol. I have a gym membership and went yesterday and did 15kg pushes and 15kg leg extensions with 10 reps on each but I only did it using 1 leg (ie 15kg per leg) then swapping to the other leg to try and make sure they evenly did the weight. The right one felt a bit stronger but the left could keep up but it started to shake a little once it started to get fatigued.

Good to hear about the protein I might give the shakes a miss for the minute and focus on getting the excerises sweet.

Sweet :)