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The Ultimate Guide

Bicycling with a disability often requires modification, be it with the style of your riding or with the equipment you need to get out on the bike safely. That may using a recumbent trike (tricycle) for balance or cranking a handcycle to compensate for leg weakness. From both personal experience and from veteran riders, this detailed ActiveMSers guide shows you everything you need to know to get out—and stay out—on the bike trail, on one wheel, two wheels, three wheels, or four.

Dave Bexfield of ActiveMSers riding trike in New Mexico

I’ve ridden bikes and trikes and handcycles regularly for years—I’ve got the road-rash scars to prove it—and I’ve also got a mean streak of stubborn. When I was diagnosed with MS in 2006 I had to make some tweaks, and then some more tweaks as my disability progressed. Along the way I’ve learned some valuable lessons, lessons I don’t want you to repeat. These days I take my handcycle out for adventures virtually every other day and it has transformed my fitness life. Here’s how I manage to get the most out of my favorite active passion despite my myriad challenges.

IMPORTANT: Consult with your doctor and/or neurologist before starting any exercise program.

dave on leg trike.jpg


These are our top tips for riding with multiple sclerosis or a chronic illness.

  • Get the right cycle for your level of disability. Today. Don’t “wait” for your balance to improve or your leg strength to get better. I didn’t ride for several years, hoping to get back on two wheels. When I finally capitulated, I waited so long to transition to a leg-powered trike that I only rode it for one season before gifting it to my wife in exchange for an arm trike.

  • Pay attention to the ease of mounting/dismounting. A disease like MS often affects the legs. When I was riding a two-wheeler, the first issue I had while riding was not balance, but getting on and off the bike. Boy was it challenging to swing my legs over the center tube after a hot ride. Certain trikes can be especially tricky to get off of because they tend to be low to the ground.

  • Consider how you will transport your ride. If you plan to ride from your garage, this isn’t a big deal (although finding space to park your bike in there may be). But if you need to drive to your fave bike trail, transporting said bike is going to be rather important. Because of their size, trikes can be challenging to transport without a large SUV or pickup. And tandems can be harder still. Trike tandems? You best be a professional mover.

  • Clipless pedals: use them. Paresthesia and cycling don’t go great together. Like two-year-olds at Toys R Us, feet tend to wander off pedals when you can’t feel them that well. Clipless pedals prevent that, and also permit you to use both your upstroke and downstroke to provide power, conserving energy. If you ride a low-slung trike, these pedals are mandatory—you don’t want to drag a foot under your ride. Youch. Handcyclist? No worries ‘cause there are no pedals!

  • Weigh your budget. You can find used bikes on Craigslist for a song or drop five figures on a tricked out roadie. Know that you usually get what you pay for. My advice: buy what you can afford, and don’t go nutzo unless you are confident that cycling is your sport and your disability level is mostly stable. Alas, even entry level trikes tend to be expensive (over a grand usually) and used ones are hard to come by, but arm trikes pop up with frequency on resale websites. I found mine for $900 and it had only been ridden a few times (originally over $2K).

  • Ride with friends. Cycling is fun. But cycling with a pal or two is even more fun. There’s also a practical side to riding with others. “Riding with a buddy adds to the fun, is safer, provides motivation and keeps one honest,” says veteran member of ActiveMSers and longtime cyclist Larry Danahey. “If I tell my buddy I'll meet him at 0-dark thirty for a ride, I'll do it.” Best of all, if you have a mechanical or medical issue, someone is there to help (or can ride off to get help).

Best Advice
dave arm trike in tetons.jpg


When you learned to ride a bike as kid, it was probably on two wheels or perhaps four if you had training wheels. And your parents probably told you to watch out for that fire hydrant, which you then eyed so intently that you barreled smack into it (true story, poor Laura). Today, there are gobs of options to ride, so let’s get rolling.

  • Unicycle. Seriously? Good-on-ya, my friend.

  • 2-Wheel Bike. Unsurprisingly, you can find a vast range of two wheelers, from road to mountain to snow to recumbent. But what’s best when you have MS? There isn’t a best, because it all depends on the issues your disability presents. In general, the bigger the tires, the more stable the bike. In general, road bikes tend to be lighter. In general, cruisers with no top tube are easier to mount and dismount. Like I said, it all depends. Choose what works best for you and your goals. If you plan to compete in an Ironman, a cruiser is a poor choice (but great for a quick ride to your local bakery).

  • 3-Wheel Trike. When balance gets iffy, a trike makes a load of sense. Another bonus: when you tire, you can park in the shade and chill while seated. When I finish riding, I’ll relax and cool down before I climb out of my trike, giving my body extra time to recover. There are two main designs in trikes: delta and tadpole. Delta trikes have one wheel in front and two in back (one of the rear wheels typically provides the power). Tadpoles have two wheels in front and one in back, with the rear wheel typically providing the power. Generally, tadpoles are more stable and agile, but entry and egress tend to be harder. There are upright deltas that are chair height that, while not terribly sporting or quick or light, will get one from point A to point B. As a rule, trikes with larger wheels are faster, but they will never be as fast as a two-wheeler.

  • 3-Wheel Handcycle. Handcycles for the road tend to be deltas with the front wheel providing power, but tadpole arm bikes are popular for more challenging terrain. Some you sit upright, while for others the rider kneels instead of sits and are the cycle of choice for off roading on rocky mountain trails due to their superior stability and ability to generate climbing torque (alas, I have not tried one yet). The deltas can vary widely from perched high (slowest) to near prone (fastest). If you have trouble with entry/egress, lying down to cycle could prove seriously problematic. Keep in mind, though, that the higher the seating position, the slower and less stable the handcycle. Cycling using your arms requires more effort and is slower than a comparable three-wheel leg cycle and far slower than a traditional bicycle.

  • 3-Wheel Trike (Arm & Leg). It’s called the Berkel Bike (there are other types). Have I tried one? No. Does it hold promise? Yes. Will you go fast? No. Does it look awkward? Yes. Does that matter? No.

  • 4-Wheel Cycle. These are called surreys and they are mainly for rent to ride on a boardwalk with three other friends who can pedal while you pretend to pedal.

  • E-Bike and Trikes. Electric-assist bicycles and tricycles are all the rage and for good reason. They seamlessly add a boost to your pedal stroke—typically in a range, say from 1-5—so you can dial in the assist. Up it for hills, drop it for flats, or max it out if you are gassed. Worried about not getting in enough of a workout? Don’t. Research has found you still burn just as many calories and work just as hard, only you go faster and farther. This is incredibly helpful if you ride a trike or handcycle, which are far, far slower than a regular bike. With the generous help of Teton Adaptive Sports, I tested an e-trike in the Grand Tetons—the Nuke from Reactive Adaptions—and it was more fun than I anticipated. So much so that my newest handcycle has an assist. Once I break it in and get a good feel for it, I’ll have far more feedback and advice in that department.

Choosing Your Ride
Dave Bexfield ActiveMSers on upright hand cycle
Recommended Accessories


So, if you plan to be a regular cyclist, you are going to need to gear up. Already riding? You may need to add to your gear arsenal. These are our recommendations. Most are MS-specific, but we’ve added general items as well.

  • Proper Bike Attire. If you are a cyclist, you likely already own gear—shorts, top, shoes, socks. While certainly not mandatory, cycling gear helps keep you drier and cooler and more comfortable. Plus it looks rad. If you use a recumbent, know that those cool pockets in the back of your bike shirt are going to be rather useless.

  • Helmet. This is a no-duh, but MS affects cognition. And it is easy to rationalize with your MS brain that helmets are hot and that you don’t need a helmet because you are riding a trike and you can’t possibly wreck. Um, I proved that false and ended up in the ER. (Pictures of my cheese-grated elbow can be provided on request.) Thankfully, I had a helmet on at the time, which I then cracked getting into the car to drive to the ER. But at least I didn’t get a concussion! Laura uses the Lumos lighted helmet for safety while Smith Optics makes highly regarded noggin protectors.

  • Walking/Rolling Aids. Walking after cycling can be an issue with MS, especially if you are overheated. I used to strap on a pair of foldable forearm crutches to my trike. They’ve saved my bacon for restroom emergencies (and, ahem, ER visits). A foldable cane or trekking poles work well for that extra assist when you need it. Personally, I’m looking into trike attachments to even take along my wheelchair, potentially a trailer, so I can get off my bike and get around. Like, to grab a beer. Or pee.

  • Reflective Vest. If you ride enough on the road, you’ll be really glad you have one, especially if you ride a low-slung trike. Laura made me purchase one and now I always ride with it. After trying far too many and discovering drawbacks galore—too hot, too big, unusable pockets (if you are on a recumbent)—I’ve got two favorites, but availability may be challenging. If you can find it, this one by Lixada is super light and airy, albeit the pockets are limited.  So until I can track them back down, I suggest trying one of these.

  • Bike Repair. For fixes on the trail, batting your eyes and playing the disability card help, but that’ll only you get you so far. For absolute starters, you’ll want spare tubes (be sure to specify Schrader or Presta). Other helpful gear: tire levers, a pump, and a lightweight multi-tool. Or just make sure you are riding with other bike geeks who have all that stuff!

  • Lights. A front light and a rear light are just smart purchases. You need to stay as visible as possible on the road. Our choice for front lights is Cygolite Metro Plus (any amount of lumens). For the rear light, the consumer website The Wirecutter recommends the Cygolite Hotrod 50 USB.

  • Flag for Trikes. Fly it proudly. Drivers will thank you. Plus your friends and family will be able to find you better in a sea of cyclists.

  • Other Aids. Even if you don't use them normally, you might find an AFO, knee, wrist or elbow brace or even just a little appropriately placed athletic tape can add a significant level of strength, comfort and endurance to your rides, says Larry. To help with getting off my trike, these days I wear a gait belt so Laura can use her muscle. If you need it, protection in the form of disposable and absorbing adult underwear (I’ve even tried a condom catheter for long rides). Finally, since you’ve now dropped serious cash, perhaps consider a lock.

dave cycling on halloween.jpg


Q: I wanna still ride my 2-wheeler, but my balance is meh. Right now it just sits in the garage, basically a brick made of expensive carbon fiber. Would training wheels be a good compromise?

A: No. This has been tried by many MSers and the answer is always, “well that didn’t work out as planned.” You can’t turn properly, ride at speed properly, dismount properly, or even feel confident staying upright properly. Training wheels are not a solution, sorry.

Q: My partner is a hardcore cyclist. What are your thoughts on tandems?

A: A tandem is potentially a great solution. You’ve got a backup engine when you run out of gas, an extra layer of stability, and full assurances that your partner won’t speed away from you. If eyesight or cognition is an issue, riding with someone is practically mandatory, and this is ideal. That said, there are some potential drawbacks other than being forced to listen to said partner discuss the direction of endless plot lines in a television series you are not watching over a 3-hour spin. For starters, these larger bikes are easy to ride out of the garage, but not so easy to load into a car. Also, they may be challenging to mount/dismount with a high center bar. Tandem trikes might be the Holy Grail, but they turn like a semi-truck and basically require a semi-truck to transport.

Q: Speaking of transport, I only own a small car. How about a foldable bike that fits in the trunk?

A: Hmm. Beware of “foldable” bikes and trikes, as they tend to offer lower performance and cost more. The kicker: I’ve heard from bike retailers that owners rarely bother folding them anyway because it’s a hassle, and this is particularly true with trikes. I’m not saying there aren’t good options out there, but definitely try before you buy.

Q: You mention riding with a buddy, but I don’t know anyone who cycles. Where do I find these folks? And what if they are too fast—or too slow—for me?

A: You can mine all sorts of areas for potential riding partners. You can post a meet-up on the forums at ActiveMSers. Your local MS Society or even MS clinic may have connections. There are also a number of adaptive sports organizations like Adaptive Adventures. If you have a life partner, perhaps he or she might take up cycling with you. My wife Laura has been my seeing-eye-wife on the bike trail when my eyesight got wonky, my Sherpa when it comes to carrying my gear and loading my bike, my water babe when I need a refill, my extra eyes when crossing a street, my human EZ lift when I need help getting off, and more. She is much faster than I am, so she’ll often ride ahead, and then loop back around so we can cruise together. We make a good team. In fact, I think I hear her calling. It’s time for another ride!

Last updated January 21, 2022

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