Choosing Your First FES Cycling System: A Practical Guide
Deciding to invest in an FES Cycling system is a significant step. The equipment costs thousands of pounds, the options can seem bewildering, and the fear of making an expensive mistake is entirely reasonable. I've spoken with many people who delayed for months or even years, paralysed not by their injury but by uncertainty about which system to choose.
FES cycling is a well-established, research-backed method of getting lower-limb exercise even when leg muscles are paralysed or weak. It's an approach that's relevant to many neurological conditions, including stroke, MS, and Parkinson's disease. Most of our clients who have adopted an FES cycling system have experienced a spinal cord injury amd this will be the focus of this particular article. Having said that, everything in this article would be relevant to any of these groups.
This guide aims to cut through that uncertainty. I'll walk through the key questions you should be asking, explain the main differences between systems, and describe what the assessment and selection process actually involves. My goal is to help you make a confident, informed decision—or to recognise that FES Cycling isn't right for you, which is equally valuable to know.
First Question: Am I a Suitable Candidate?
Before comparing systems, you need to establish whether FES Cycling is appropriate for your situation. Not everyone with a spinal cord injury will benefit, and it's better to discover this before you've invested time, hope, and money.
The basic requirements are:
Intact lower motor neurons. FES works by stimulating the nerves that control your leg muscles. If those nerves are damaged (a "lower motor neuron" injury, typically occurring at T12 or below), standard FES Cycling protocols won't produce useful contractions. There are specialised approaches for denervated muscle, such as the RISE Stimulator or KT-Motion, but they're different from FES Cycling.
Muscles that respond to stimulation. Even with intact nerves, muscle that has severely atrophied may initially struggle to produce meaningful contractions. This doesn't necessarily disqualify you, but it affects how we approach the setup.
No absolute contraindications. These include cardiac pacemakers or defibrillators (in many cases), uncontrolled epilepsy, active deep vein thrombosis, pregnancy, unhealed fractures in the legs and certain other conditions. Some contraindications are relative rather than absolute—meaning FES might still be possible with additional precautions.
Sufficient range of motion. Your hips, knees, and ankles need enough flexibility to allow a cycling motion. Severe contractures can mean that, for example, legs cant bend and extend to get a good cycling action. This may need to be addressed before FES Cycling becomes practical and may rule cycling out totally.
Realistic expectations. FES Cycling delivers genuine health benefits—cardiovascular fitness, muscle conditioning, improved circulation, and potential bone density preservation. What it generally won't do is restore walking ability. If that's your primary goal, we need an honest conversation about what's achievable.
A proper assessment will evaluate all of these factors. If you're unsure about any of them, that's precisely what the assessment is for.
Understanding Your Options
FES Cycling systems broadly fall into two categories, and understanding the difference will help you navigate the market.
Integrated Systems
These combine a specific bike with a matched stimulator, sold as a complete package. The stimulator is designed to work with a direct connection between the bike and the stimulator. This is necessary for communication between the two devices, such as the transmission of pedal position and power generated. This information is used to ensure that synchronising muscle stimulation with pedal position is automatic.
An integrated system has both advantages and disadvantages.
Advantages:
- Everything works together out of the box
- Sensor integration is seamless
- Designed for this particular application
Disadvantages:
- You're locked into one bike manufacturer
- If you already own a suitable bike, you can't use it
- Replacement or upgrade options are limited
- Typically higher total cost
For many years, this was the standard approach. The systems worked well, but the lack of flexibility frustrated some users. Until the middle of last year, we worked with the RehaMove System, which was sort of a hybrid between the Integrated System type and the Universal Stimulator type, which we'll describe below. It was a hybrid approach because the stimulator could support applications beyond cycling. Many of our clients still use this to good effect, creating sequences of stimulation to support a wide variety of training applications
Universal Stimulator Systems
The newer approach—exemplified by the Stim2Go—separates the stimulator from the bike entirely. Instead of relying on sensors in the bike, the stimulator uses motion sensors embedded in the Stim2Go unit. this means that the Stim2Go unit is very flexible in application. To support FES cycling, the Stim2Go unit is worn on the body (typically strapped to the thigh) to detect pedal position. This means stimulation timing is based on your leg's actual movement, not on the bike's mechanics.
Stim2go can turn any passive-active bike into a FES cycling system.
Advantages:
- Works with virtually any passive-active bike
- If you already have a suitable bike, you only need the stimulator
- Future bike upgrades don't require a new stimulator
- The same stimulator can be used for other applications (upper limb training, tSCS, general muscle conditioning, FES rowing)
- App-based control allows remote updates and parameter adjustments
Disadvantages:
- Requires learning to position the motion sensor correctly
- Some initial adjustment to find optimal settings for your specific bike
We like the Stim2Go approach for its flexibility. However, the "best" system is always the one that suits your individual circumstances.
## What About the Bike?
If you're going the universal stimulator route, you'll need a compatible bike.
The requirements are:
Passive-active capability. The bike must allow the pedals to be moved by external force (in this case, your electrically stimulated muscles) while also providing adjustable resistance. Pure passive bikes, which only move your legs without resistance, won't provide the training effect you need.
Appropriate resistance range. You need to start at very low resistance and gradually increase as your muscles strengthen. A bike that can't go low enough initially, or can't go high enough eventually, will limit your progression.
The Stim2go can provide much more functionality than just cycling.
Stability and safety. The bike must be stable enough to prevent tipping, with secure foot fixation (straps or foot plates) to keep your feet on the pedals throughout the cycling motion.
Practical considerations. Can it fit through your doors? Is it suitable for your living space? Can you transfer onto it safely?
We typically recommend bikes from the THERA-Trainer range, which we supply as part of complete systems. However, if you already own a suitable bike—or have access to one through a gym or rehabilitation centre—the Stim2Go can work with it.
The Cost Question
Let's address this directly, because it's often the elephant in the room.
A complete FES Cycling system—stimulator plus bike—typically costs more than £14,000. The stimulator alone (if you're using an existing bike) is in the region of £7,000 - £8000. These are significant sums, and I won't pretend otherwise.
What's included in that cost?
- The hardware itself (stimulator, electrodes, cables, bike if applicable)
- Professional assessment of your suitability
- System configuration tailored to your body and goals
- Comprehensive training until you're confident with independent use
- Ongoing technical support
- Access to remote programme updates
What's not included?
- Consumables over time (electrode pads need periodic replacement)
- Any home modifications needed to accommodate the equipment
- Ongoing therapy or supervision beyond initial training (though we remain available for periodic reviews)
Funding Pathways
The NHS rarely funds FES Cycling systems for home use, which leaves several alternatives:
Medical-legal settlements. If your injury resulted from an accident where someone else was at fault, rehabilitation equipment is often included in compensation. Case managers and solicitors increasingly recognise the long-term value of FES Cycling. There is an extensive research knowledge base available showing the benefits of FES cycling for spinal cord injury and pretty much every other neurological condition.
Charitable grants. Organisations such as specialist charities sometimes provide funding or can direct you to appropriate sources.
Self-funding. Some people choose to invest their own money, viewing it as a long-term health investment. Given that FES Cycling can help prevent secondary complications that themselves carry costs—both financial and personal—this calculation makes sense for some.
Insurance. Depending on your policy, private health or injury insurance may contribute.
The Assessment Process
So what actually happens when you contact us about FES Cycling?
Initial conversation. We start with a phone call or consultation to understand your situation, answer initial questions, and determine whether a full assessment makes sense. There's no charge for this, and no pressure. If it's clear that FES Cycling isn't appropriate for you, we'll say so. If you're interested in pursuing the matter, we would probably ask you to fill in a secure web form that just checks for some contraindications.
Detailed assessment. If we proceed, we conduct a thorough evaluation. This examines your injury level, muscle response to stimulation and any barriers to exercise. We can also discuss your goals, living situation, and support network. This assessment may happen in person or via a combination of remote consultation and information from your medical team. Clients often have the support of a physiotherapist, and if that's the case, we encourage them to attend a demonstration.
Trial where possible. Ideally, we arrange for you to try FES Cycling before committing. This might happen at our premises, at a partner rehabilitation centre, or during a home visit. Experiencing the sensation and seeing your legs move can resolve uncertainties that no amount of explanation can address.
Recommendation. Based on the assessment, we provide a clear recommendation: whether FES Cycling is suitable, which system configuration we suggest, and what outcomes you might reasonably expect. If we don't think FES Cycling will benefit you, we'll tell you—and where possible, suggest alternatives.
Decision. With all this information, you're in a position to make an informed choice. There's no hard sell. Some people decide immediately; others take weeks or months to consider. Both approaches are fine.
Questions to Ask Any Supplier
Whether you're talking to us or exploring other options, these questions will help you evaluate what's on offer:
1. What's included in the price? Hardware, training, support, consumables—get specifics.
2. What training is provided? How many sessions? In person or remote? What happens if you need additional training later?
3. What ongoing support is available? Who do you call if something goes wrong? Is there a cost for support after the initial period?
4. Can I try before I buy? If not, why not?
5. What happens if it doesn't work for me? Is there any return policy or trial period?
6. How are parameters adjusted over time? As your muscles strengthen, settings need to change. How is this managed?
7. What's the evidence base? Can they point you to research supporting the benefits they're claiming?
8. Can I speak to existing users? Hearing from people who've been through the process is invaluable.
Be wary of any supplier who can't answer these questions clearly, or who pressures you toward a quick decision.
Red Flags to Watch For
Over the years, I've seen people make purchases they regretted. Here are warning signs:
-Promises of miraculous outcomes. FES Cycling has genuine benefits, but anyone guaranteeing you'll walk again is not being honest.
- Pressure tactics. "This price is only available today" or "We only have one unit left" are sales techniques, not genuine constraints.
- No assessment offered. If someone is willing to sell you equipment without evaluating whether it's appropriate, they're prioritising the sale over your welfare.
- Vague answers about support. Post-purchase support is essential. If it's unclear what you'll receive, assume the worst.
- Unwillingness to let you try the equipment. There are sometimes logistical reasons why a full trial isn't possible, but complete unwillingness to demonstrate the product should raise questions.
Making Your Decision
Ultimately, the right FES Cycling system is one that Is appropriate for your injury and physical status. It should fit in with your living situation and lifestyle, come with adequate training and support and be financially accessible through whatever pathway applies to you. There's no single "best" system that suits everyone. The best system for you depends on your individual circumstances, which is why proper assessment matters more than brand comparisons. Always think about your outcomes and expectations
If you're feeling overwhelmed by the decision, that's understandable. This is exactly why we emphasise consultation over salesmanship. Our role is to help you understand your options, evaluate what's realistic, and make a choice you'll be confident about—even if that choice is to wait, or to pursue a different approach entirely.
Next Steps
If you're considering FES Cycling and want to explore whether it might suit your situation:
1. Get in touch for an initial conversation. Call us or use the contact us form to arrange a no-obligation discussion.
2. Gather relevant information. If you have details of your injury level, any previous muscle testing, and your current rehabilitation activities, these will help us assess suitability.
3. Think about your goals. What do you most want to achieve? Cardiovascular fitness? Muscle bulk? Reduced spasticity? Managing these expectations helps us advise appropriately.
4. Consider funding early. If you'll need financial support, starting those conversations sooner gives more options.
We've been supplying FES Cycling systems in the UK for around twenty years. In that time, we've learned that the best outcomes come from careful matching of technology to individual needs—not from pushing equipment onto people who won't benefit. That's the approach we'll take with you.