Ask the Coach: Coming Back From Surgery, Injury or Illness

By Coach John Hughes

Rob writes, “I’ve been a RBR reader for years and have appreciated your writings during that time.

“I am now 66 and was a moderate distance rider for 15 years (2,000-2,500 miles/year). I transitioned about three years ago to swimming (Competitive Masters), which was my sport back in school. After 50 years of increasing knee problems from a mild congenital knee deformity, the associated arthritis, all accelerated by being a soccer player (20 years) and referee (15 years), I’ve had my first knee replaced. The winter before the surgery I got back on my bike to help build up the legs prior to surgery, maybe 500 miles in the three months leading up to surgery with a long ride of 30 miles. Riding felt fine, while walking more than two miles or standing for 15-30 minutes were uncomfortable.

“I’m only one-week post-op, so no where near getting back on the bike. I expect to be able to get on my trainer by week four. I am planning on the bike being fundamental to my long term PT. How would you suggest I proceed, obviously with the doctor’s approval? My goals are modest. I want to get back to being comfortable with a weekend ride of 40 miles with 2-3,000 feet of elevation gain and the occasional longer charity ride at about 15 mph average.”

Coach Hughes, Rob you’re asking a great question. Almost every cyclist at some point has to come back from surgery, injury or illness.  Although I’m describing how you should get back in shape the same principles apply to any comeback.

I’m drawing on my personal experience as well as coaching experience. In ’89 I was hit by a truck and my left knee was fractured, a while back I broke my pelvis and a few years ago I broke my ankle. Different injuries but similar rehab.

Taking care of yourself.

I applaud you for taking care of your knee before it becomes debilitating. I wrote recently about my 92-Year-Old Hero and Lessons We Can Learn. Rick put off having his hip replaced until it was too late and now he’s suffering the consequences.

Prehabilitation.

You shifted from swimming to riding and rode about 500 miles in the three months before your knee surgery. You were smart to build fitness in the leg before the surgery. I’m having surgery on my right foot this fall and am working on cardio, endurance, intensity and strength this summer (and having fun doing it!)

For your comeback you need to address all the different aspects of fitness:

Cardio.

You swim so as soon as you can get in the pool start swimming. Depending on the condition of your knee and your doctor’s recommendation it may be better to start with a pull buoy and paddles so you’re just using your upper body. When cleared to do so you can also walk or run in the water for cardio, which uses your leg muscles a little more like riding. When you can start riding (below) it will be more cardio. Even when you’re riding the trainer I suggest you also swim because it’s good cardio without stressing your legs, especially your knee.

The general point for any comeback is to start with easy cardio ASAP even if it’s not on the bike.

Range of motion.

If you aren’t already working with a physical therapist get started with one. Tell the PT what your specific goals are and the PT can tailor your exercises to your cycling. You have lost range of motion and the PT can give you specific exercises to increase your ROM. Ask the PT how soon you can get back on the bike just to work on ROM, i.e., pedaling very easily with the leg without the knee replacement doing all the work and the leg with the new knee just going along for the ride to regain full ROM.

Strength.

Muscles atrophy when they aren’t used and they unfortunately atrophy faster as we get older. Any comeback from surgery, injury or illness should include strength exercises in addition to cardio.

In your case the muscles in the leg with the new knee have all atrophied. As part of your comeback you need to strengthen all the different muscle groups that are involved in cycling. A good PT can get you started on exercises for these different muscle groups, many of which you can work on even before you can get on the bike:

• Quads
• Hamstrings
• Glutes
• Calves
• Adductors
• Abductors
• Core

Ask the PT to give you specific exercises you can do at home with minimal equipment.

Cycling on the trainer.

When you can get on the trainer you’ll progress faster if you do several smaller sessions a day. As an example assume you can only do 10″ on the trainer at first. Instead of one 10″ workout, do 5″ after breakfast, 5″ around lunch and 5″ or more around dinner. You’ll get more total time on the bike with the recovery breaks. The third ride can be longer because you can recover overnight.

This is the approach I use with any client who’s been off the bike for a significant amount of time for any reason. The rider may be able to do longer rides that you can right now but the principle is the same: multiple shorter rides and more total volume produces faster recovery.

You can probably increase your riding by not more than 5% per day. For example, if you ride 5″ + 5″ + 7″ = 17″ the first day then the next day you can add a minute to one of your rides. This may seem like you’re not increasing by much each day but by the end of the week you’ll have increased your total riding time by about 30%. Don’t keep adding time to the same ride, e.g., the evening ride. The three rides should be roughly the same length.

Listen to your body.

You should finish each ride feeling like you could have done more … and the next day you will. Feeling a little fatigue after a workout is fine but if you aren’t fully recovered by the next workout then skip it. You may be better off increasing your riding for two to four days, riding less the next day, increasing by two to four days, easier day, etc.

Technique.

Effective cycling results from good technique as well as from cardiovascular and muscle fitness. Fortunately, because of muscle memory your technique doesn’t fade as fast as your other aspects of fitness.  However, you’ll come back faster if you also work on technique. When you can do a 15-minute ride on the trainer start to incorporate drills into just one of the rides.

One leg pedaling is the best. Clip in with one foot, e.g., the right one and rest the left foot on a box, stool, etc. Pedal with your right leg for 15 to 60 seconds, whatever you can do – assume 15 seconds. Clip in with your left foot and pedal with both legs for the same amount of time as your one leg pedaling – 15 seconds. Then unclip your right foot and pedal with your left leg for the same amount of time -15 seconds. Once through the sequence for the time you can handle is plenty initially. Then you can add repetitions of the sequence. When you get up to three or four reps of the same duration as initially then stay with the same number of reps and start increasing the duration of each one-leg interval.  E.g., three reps at 20 seconds and then three reps at 25 seconds, etc.

Builds are a second good drill. Do these in an easy gear. The goal is to work on your spin, not to ride hard.

• 1″ at 70 rpm
• 1″ at 80 rpm
• 1″ at 90 rpm
• 1″ at 100 rpm

Keep increasing as long as you are pedaling smoothly. When you get to your max rpms then go back down:

• 1″ at 90 rpm
• 1″ at 80 rpm
• 1″ at 70 rpm

Cycling on the road.

When you can get on the road frequency and volume are more important than the duration of your long rides. Just like on the trainer you’ll progress faster if you can ride for shorter amounts twice a day and do these shorter rides five or six days a week instead of fewer longer rides. Here are some rules of thumb:

• All of your riding should be at a conversational endurance pace. Don’t try to push yourself to 15 mph. Once you have roughly 1000 miles in your legs then you may add some intensity – but you don’t have to if you don’t want to!
• Increase your weekly mileage by 5 – 15%.
• Increase the length of your weekly long ride by 5 – 15% per week.
• You’ll progress faster with two shorter long rides than just one long weekend ride. For example, instead of one long ride of 25 miles do a 12 to 15-mile ride mid-week and a 15 to 20-mile ride on the weekend.
• If you’re doing one long endurance ride it should be no more than 50% of your total weekly miles. If you’re doing two long rides they should total no more than about 60% of your total weekly miles.
• Keep building this way until you can do your comfortable 40-mile rides.
• Increase your monthly miles by 10 – 25%.
• When you are planning to do a longer charity ride then ramp up your long rides to 65-75% of the duration of your event. For example build up to a 45 to 50 mile ride in training if you are preparing for a 100K (66 mile) ride.

Here’s a column on How to Do Endurance Training Correctly.

Intensity

Intensity training is like prescription medicine. The right dose of the right kind for you personally will help you to improve; however, the wrong dose or the wrong amount won’t help and may set you back! After you have the 1000 miles in your legs then adding a dollop of intensity will be beneficial.

Here’s a column on Six Kinds of Intensity Training: Which One is Best for You? The column explains which kind of intensity riding will increase your cruising speed — and it doesn’t have to hurt!

During your recovery be patient and when in doubt do less!

John Marsh, the previous publisher of RoadBikeRider broke his collarbone, which required surgery.  Here’s his column on Personal Comeback Reflections, Trainer Tips.  His comments about the psychology of coming back are particularly insightful.

Here are my two columns on his training:

• The Comeback part 1: No Sweat
• The Comeback part 2: Step by Step

How to Become a Better Cyclist: the Six Success Factors. I’ve been riding since 1976 and coaching professionally since 1995. I’ve ridden millions of virtual miles with clients that I’ve coached. I’ve learned that every rider – whether he’s in his 70s or she’s in her 30s, whether he’s training for a first century or she’s training for the Race Across America – improves most if we work on Six Success Factors:

1. Effective training
2. Sound nutrition
3. Proper equipment
4. Proficient skills
5. Mental techniques
6. Planning and goal-setting

My 36-page How to Become a Better Cyclist: the Six Success Factors goes into detail about how to improve in each of the six ways, not just do your favorite(s). How to Become a Better Cyclist: the Six Success Factors is just $4.99.

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• How to Become a Better Cyclist: The Six Success Factors: 36 pages.
• Your Best Season Ever, Part 1: A 32-page eArticle on how to plan and get the most out of your training.
• Intensity: Using Perceived Exertion, Heart Rate or Power to Maximize Training Effectiveness: A 41-page eArticle with the latest information on how to use perceived exertion, a heart rate monitor and a power meter to maximize training effectiveness.
• Optimal Recovery for Improved Performance: A 16-page eArticle with 10 different recovery techniques illustrated with 14 photos.
• Eat & Drink Like the Pros: A 15-page eArticle of nutritional insights from pro cycling teams. It contains a dozen recipes for you to make your own food and sports drinks.

The Best of Coach Hughes: 5 eArticles to Make You a Better Cyclist totals 140 pages and is available at the special price of $15.96 (this is a special 5-for-the-price-of-4 discount); and only $13.57 for our Premium Members.

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Coach John Hughes earned coaching certifications from USA Cycling and the National Strength and Conditioning Association. John’s cycling career includes course records in the Boston-Montreal-Boston 1200-km randonnée and the Furnace Creek 508, a Race Across AMerica (RAAM) qualifier. He has ridden solo RAAM twice and is a 5-time finisher of the 1200-km Paris-Brest-Paris. He has written over 40 eBooks and eArticles on cycling training and nutrition, available in RBR’s eBookstore at Coach John Hughes. Click to read John’s full bio.