Cycling is a great form of exercise for anyone… cardio and strength workouts rolled into one. It’s a wonderful way to discover new places at your own pace. For amputees, it’s an ideal way to condition lower limbs, even residual ones.

If you cycled prior to your amputation you already have the motor skills needed to ride post-amputation. All you need is the confidence to ride again, and possibly some minor modifications to your prosthesis (if you choose to wear it to ride) and/or your bike.

The decision to use a prosthesis for bike riding often depends on the level of amputation. Those with very short above-knee residual limbs, and those who don’t use a prosthesis for daily activity, are more inclined to ride without. One benefit of riding with it however, is the exercise that the residual limb gets which aids circulation and muscle development even though your sound side may do all the work.

To say “balance” is the key to bike riding may be stating the obvious, but for amputees balance takes on a whole new meaning. Balancing on a bike is different after limb loss. Make sure the frame size is correct for your height. You may feel more comfortable on a frame slightly smaller than what is recommended for your height. Stand flat footed over the frame. The clearance from the crotch to the frame should be about one to two inches for a road bike and two to four inches for mountain bikes. The distance from seat to handlebars should feel comfortable as well.

For seat height, a general rule for below-knee amps with good strength in the residual limb says to adjust the seat height so that you can reach the ground with the toes of your good foot. If you don’t use your prosthetic side for stationary balance, then adjust the seat so that the majority of your foot is on the ground when sitting on the seat.

A comfortable seat is crucial. A narrow seat is recommended for leg amputees, allowing accommodation of the socket and to eliminate interference of the socket to seat, (causing chaffing and discomfort). One helpful tip is to turn the seat slightly away from the prosthetic socket.

Keeping prosthetic limbs secure on the pedals is one of the most difficult aspects of riding with a prosthesis, especially for above-knee amputees. Conventional toe clips, straps or riding shoes are all possibilities for more serious riders. But before you strap down your prosthetic foot consider that most prosthetic feet are set for walking, which means most are set slightly toe-out. Bike pedals are designed for feet to be set straight ahead with toes on the pedal. Of course, there’s the problem of getting the foot free if you fall to that side as well.

Using pedals with serrated edges, combined with a decent running shoe, gives considerable traction for a prosthetic foot. Bumps and potholes will still cause problems, but the rider needs to be vigilant in regularly eye-balling the foot for position on the pedal.

Before trying to ride with a clip in pedal system spend some time just sitting on a bike and leaning against a wall. Practice clipping in, and more importantly, clipping out. When you can push yourself away from the wall with your elbow and manage to unclip your foot before hitting the floor then you’re ready to ride.

These days SPD pedals and shoes are the ideal solution. Once you’re clipped into the pedal you can pull the pedal up and round ready for the next downstroke (see the BeBop pedal at www.bebop.com). These have the most “float” (free side to side rotation of the foot in the pedal)..
A more rudimentary, yet effective, solution consists of tying a weight to the right pedal so that it always brings the left pedal back to the top. Putting a small weight under the left pedal keeps it the right way up.

Safety has to be priority one at all times. Helmets are a must. A good pair of fingerless gloves with some heavy duty padding on the heel of the hand is a good idea. When re-learning to ride, start on an area of short grass, preferably with a slight slope. Be careful not to over-steer or lose your balance. Practice stopping, learning the sensitivities of the front and back brakes. Remember, bikes are not equipped with anti-lock brakes yet.

Starting on hills can a problem It is possible to clip into the pedal the first time but it’s not easy. When stopping in traffic on a hill, find a railing or signpost for stability. If you have to stop and can’t get started again, set off downhill and turn around.

Every cyclist with a disability has their own ‘work-around’ and tricks to ensure a comfortable and relatively care-free tour. From changing gears and pulling on brake levers without fingers (integrating both front and rear brakes is one fix) to incorporating “granny gear” (low-ratio gears) to compensate for an artificial knee’s inability to stand up in the pedals, it’s all a balancing act.