Of all the articles and videos I have done over the last 18 years the most popular ones seem to be about knee pain or hip pain. One question I have been regularly asked recently about knee pain is, how good is walking backwards for strengthening your knees? In recent years this type of exercise has grown in popularity on the internet and also among many therapists as an exercise to prescribe their patients with for strengthening of the knees. I can see how it appeals to so many people with knee pain as it requires no equipment, minimal skill, and can be done almost anywhere. The big question is how effective is it really when it comes to strengthening the knees to get rid of pain? While there are some positive benefits to using this, there are several problems I believe are overlooked that would be better resolved with other exercises. In this article, I explore this exercise in more detail and challenge my bias to see if it is something that I may be underestimating.

Backwards walking, or reverse walking is exactly as the name suggests and is not a new idea as it is something that has been around for a very long time. The concept of backward walking originated in Asia thousands of years ago and passed down from generation to generation as a part of Chinese medicine and has been taught in many Tai Chi classes. I first learned backward walking way back in 2009 in a Tai Chi class and found it very difficult to master.

Chinese wisdom says: “A hundred steps backward are worth a thousand steps forward.”

In terms of movement and biomechanical characteristics it differs from forward walking in several key ways that make it quite unique in how your muscles of the foot, knee, and hip interact with each other.

When you walk normally in a forward direction your leg swings through the air, and your heel lands on the ground first. Then your straight knee bends slightly as you roll from your heel to your toes. As this occurs, your opposite leg rolls from your toes and up into the air. This heel-to-toe motion repeats and normal walking occurs.

To control these motions, the quadriceps and hip flexors contract concentrically (shortening) to lift the hip and leg followed by the glutes and hamstrings having to contract eccentrically (lengthening) to control the landing.

Most people have very stiff hips due to sitting too much and lack of movement and this stiffness often leads to weakness in the glutes making it very difficult to control these motions. Combined with poor foot stability, and immobility of the hamstrings these factors eventually lead to instability of the knee causing pain and inflammation.

Reverse walking involves an opposite gait process. Your leg swings through the air and reaches backward with a bent knee. Your toes contact the ground, and your bent knee straightens as you roll from your toes to your heel. Then your heel leaves the ground with your knee straight, and the process is repeated.

By changing the movement sequence and direction you completely change the muscle activation demands. When you walk backwards you are landing on your toe first and then rolling off your heel making it harder to have longer strides. This requires a lot more knee extension to occur during the stance phase and more knee flexion when you reach back to take steps but due to the concentric and eccentric actions being reverse it is easier to control the forces around the knee.

This gives a mechanical advantage to the quadriceps and hip flexors as they lengthen, while simultaneously giving the same advantage to the glutes as they shorten. This can put less stress and compressive force on the knees.

When trying this for myself recently I could see how this does create some quadriceps activity and could give someone that feel of improving the strength of the knee. I tried this on a treadmill and also on a basketball court so I could do it at speed. It was much easier than I expected on my sore knee which was a pleasant surprise. Maybe it has something great I to it that I am missing out on?

So this all sounds great so far, what does the research say?

What Does The Research Say About Backward Walking?

Like most research articles you have to look carefully at how they have completed the study before adopting their conclusions at the end. One of the best studies I found was completed by Gondhalekar GA, Deo MV.

They compared the effects of backward walking versus conventional physical therapy treatment for people with acute exacerbation of chronic knee osteoarthritis.

They used 30 chronic knee osteoarthritis patients who were randomly assigned into 2 groups. Group ‘A’ (7 men, 8 women) received conventional treatment. Group ‘B’ (8 men, 7 women) received conventional treatment and Retro-walking.

The used pain scale assessments and also assessed the knee range of motion (ROM), hip abductor and extensor strength after 1 week and after 3 weeks of intervention to determine if backward walking was better.

They found that there was significant improvement in function in both the groups however, the improvement in backward walking was greater than that of conventional therapy. Some of their findings suggested that the advantages of backward-walking include improvement in muscle activation pattern, reduction in adductor moment at knee during stance phase of gait and augmented stretch of hamstring muscle groups during the stride. This may have helped in reducing instability of the knee and aided improvement of function.

Backwards walking also has effect on improving strength of hip extensors leading to reduced hip flexion moment during stance phase and thus preventing abnormal loading at knee joint and, in turn, the disability. As a result of exercises and backward walking there was improvement in the strength of muscles at knee and hip which may have reduced functional disability.

They also noted the possibility that proprioceptive and balance training may have improved during backward walking adding to its benefits of biomechanical function.

Reference:

Retro-walking as an adjunct to conventional treatment versus conventional treatment alone on pain and disability in patients with acute exacerbation of chronic knee osteoarthritis: a randomized clinical trial. N Am J Med Sci. 2013 Feb;5(2):108-12. doi: 10.4103/1947-2714.107527. PMID: 23641371; PMCID: PMC3624710.

While it is quick to assume this study confirms the use of backward walking is guaranteed to strengthen your knee there are a few problems with this assumption.

Firstly, the study noted that medications of patients, activities of daily living and recreational activities of patients were not taken into account. The compliance of patients with the home exercise program was also not monitored which could alter the results of the study significantly.

Secondly, and also my biggest concern with this assumption was what where the type of exercises used in the conventional program. If they focused solely on trying to improve the knee and used predominately isolated exercises to strengthen muscles or improve flexibility they were never really going to make any lasting changes. This is something I have spoken about numerous times in articles and videos about knee pain, and in great detail in the article – Why the knee is not the problem when it comes to knee pain

Knees are exposed to tremendous pain and problems whenever they are forced into a twisting or bend sideways, (eg ACL tear) known as valgus or varus, and lastly if they hyper-extend. This joint is more or less a hinge, it cannot twist and rotate itself, and it cannot bend the other way either.

Many injuries can begin at the bottom and work their way up, or at the top and work their way down the kinetic chain and it is very common to see knee, hip, and lower back injuries caused by the feet. Once the feet lose their ability to provide stability it can set off a chain reaction to other joints.

This is what is known as the "Joint by Joint" approach which was invented by Gray Cook and Mike Boyle. This gives great insight into how many movement problems are often created somewhere else and to correct the problem using this approach can help identify the right course of action.

What you will see is that every second joint needs flexibility and mobility, and the other joints need the exact opposite being stability and strength.

Here is how it works.

• Feet - The feet have a tendency to being lazy, and easily losing strength and motor control. From poor footwear, to sitting too much, and even the lack of barefoot walking, the feet need exercises to make them stronger and more stable. The big toe is very important here and it needs incredible mobility as much as stability.
• Ankle - The ankle tends to develop stiffness very easily and needs more focus on mobility and flexibility. Again another risk factor with ACL injuries.
• Knee - The knee like the feet becomes weak and sloppy easily, (VMO for instance completely shuts down with as little as 10ml of fluid present). This in turn creates severe knee injuries and if left untreated eventually chronic stiffness in an attempt to stabilize it. Stability and strength work is needed for this joint.
• Hip - This joint is often the cause of many knee and lower back problems. The hips have a tendency towards stiffness and as a result benefit from flexibility and mobility work.
• Lumbar Spine - The lumbar spine is similar to the knee joint and mainly requires stability to pre-vent unwanted flexion or extension.
• Thoracic Spine - Needs significant amount of mobility to provide extension and rotation of the ribcage. Loss of mobility here exposes the shoulder to instability and injury.
• Scapula & Glenohumeral Joints—Needs stability with some degree of controlled mobility.

The knee needs to have some mobility which many people lose through tight quadriceps and hip muscles, but it needs a great deal stability to prevent the dangers of twisting and rotating that will ruin the knee.

The rotation of the leg must come from the two joints above and below the knee, being the HIPS and the ANKLES. The feet must control stability of the foot to correctly align the lower limbs. If there are problems at any of these joints the knee will inevitably be forced into a poor alignment causing instability and eventually pain.

A classic example is excessive pronation at the feet causing the knees to collapse inwards as seen in the image below.

This means that to fully prevent this from happening and guarantee the knee is strong enough to resist rotational forces you need exercises that encourage and develop movements that use this exact sequence.

This is where the limitations of backward walking are found out for it does not require any of these forces. This does not mean it is not useful, but it does mean it will not do all that much for resolving the source of the knee problem in the long term.

Before we discuss how I think this information is best used let’s take a look at some of the other useful things backward walking may help you do.

Increase Knee Range of Motion

This first benefit in my opinion is arguably its best attribute.

One of the most common problems with knee pain, and in particular chronic knee pain is a loss of mobility and reduced range of motion. Most of your efforts for improving this should be based around improving hip, quadriceps, and hamstring flexibility, however, relying on this alone may not be enough as explained in the article – Why tight quadriceps exacerbate knee pain and the solution is not with stretching

In many cases the tightness is more to do with weakness and poor alignment than over use and the quads being too strong. The tightness is merely a protective mechanism from the body to protect the knee joint from more harm as the underlying problem is the poor alignment of the patella caused by dysfunctional repetitive movement. Stretching is unlikely to change this faulty alignment of movement and in some cases can stress the patella even further complicating the stiffness at the knee.

This is where mobility exercises that require some degree of stability are more effective than just stretching.

In simple terms flexibility is the capacity of a single joint or muscle to move through its full range of motion. Stretching is specific to a particular movement or joints and is often held for long periods of time or used as a PNF contract relax method.

Whereas mobility is freedom of movement. It is not limited to a single joint but a combination of joints and is more movement based as opposed to holding one particular muscle with increased length for a period of time.

This is where reverse walking comes into play and may help increase knee extension range of motion. People how have just knee surgery, or severe knee arthritis often have a loss of knee extension, which is your knee’s ability to straighten.

While walking backward, your bent knee straightens fully while you are moving from your toes onto your heel. This helps to improve the range of motion into knee extension. While you could use stretching to straighten the knee it may do very little to change things when you stand up for the loss of stability is not used in combination with the stretch.

Also you must not fall into the trap of thinking it is only about knee flexibility. Often the stiffness in the hips is a much greater problem that begins to inhibit the glutes from firing, and if you remember from earlier the glutes are important for maintaining optimal alignment of the lower limbs. Having stretches and mobility exercises that target this area is one of the best things you can do for knee pain. You will find some good ideas of how to do this in the videos below.

I would also suggest to read the article - 10 ways to improve your hip mobility to get more ideas of how to improve mobility at this joint.

Walking backwards on the other hand still requires some degree of muscle activation, in particular with the quadriceps, and therefor it may be more effective in trying to straighten the knee for people struggling to improve stability.

This brings me to the next point.

Improves Quadriceps Function

One of the most difficult areas to strengthen with knee pain is the quadriceps. Many of the best exercises for improving strength into this muscle group are also very problematic and can easily trigger inflammation and pain. Having several exercises in your toolkit, especially in the early stages of rehabilitation can be useful in getting to these big exercises with less risk.

As we just discussed with mobilizing the knee the quads are highly active when while your knee is straightening as you move from toe to heel. This is handy to know when coming back from injury as you can gradually introduce walking backwards with little risk and begin the long process of strengthening the quads. This is very similar to the benefits of using a stationary bike in the early stages of rehabilitation or post-surgery, for the load is very low and easily adjusted, and the stability requirements are not excessive.

Where I have a problem with this being discussed as a strengthening exercise is it is not going to have much effect. It may improve the function of your quadriceps muscles on a basic level but it is not going to make much of a difference long term for it lacks the intensity and also the interaction between other muscles in more functional tasks. The other thing to factor in is that most people will need to apply a strong mental focus on contracting their quadriceps as they do this exercise to ensure they achieve maximal contraction.

While this can certainly help in the early stages it is nowhere near enough to finish the job and I would be trying to progress to exercises like the decline squat shown in the video below that discusses everything you need to know about strengthening the quadriceps.

This is a unique tool that enables you to build incredible strength into the weakened areas of the quads without limitations at the ankle compromising the movement. When the knee joint angle is 45°, 60°, and 90°, squat exercises on a decline board result in more external movement than squat exercises on a flat floor, significantly increasing the muscle activity of the Rectus Femoris.

You can read more about this in the article – How the decline squat to improve quadriceps strength after a knee injury

I will provide more ideas on strengthening towards the end of the article. Let’s look at the next benefit.

Improve Hamstring Flexibility

Another area that can easily develop stiffness and lead to you over-using your knees during movement is your hamstrings. Your hamstrings are located in the back of your upper thighs and work to bend your knees and extend your hips. Not all people with knee pain will have tightness in the hamstrings but for those who do it can be a great way to combat the problem.

Tight hamstrings are usually developed in combination with tight glutes, and create what is referred to as a posterior tilt of the pelvis. This posterior tilt forces the body to either use the knees or the lumbar spine to complete the action of bending over. This movement dysfunction can be very difficult to change but it is very important that it is identified early on for the person will continue to move in daily life until a corrective program is put in place. You can read more about correcting this in the article about anterior pelvic tilt.

The effects of this posture is seen quite clearly in the info-graphic below and I discussed this in great detail in a recent article about manual handling techniques that cause back pain.

As discussed several times already in this article one of the main reason people move like this is due to poor mobility of the hips and a poor understanding of how to move. Finding ways to improve your hip function is going to prevent ongoing dysfunction and walking backwards is one way this may help resolve this dysfunction.

When walking backward, your hamstring contracts to bend your knee as it swings through the air. Then, your hamstring is stretched as you roll from your toes onto your heel and your knee straightens.

Both of these functions are in reverse of how it normally operates so it can provide a great way to reverse the chronic over-activity it normally uses. However, as with the previous benefits the long term advantages are minimal at best so you will need to use many other exercises to finish the job.

Improves Balance & Coordination

This next benefit is not directly linked to knee pain but is still something of great use that is unique to backward walking and that is balance.

Walking is more complicated than many of us realize. Remaining upright requires coordination between our visual, vestibular (sensations linked to movements such as twisting, spinning or moving fast) and proprioceptive (awareness of where our bodies are in space) systems.

When we walk backwards, it takes longer for our brains to process the extra demands of coordinating these systems. However, this increased level of challenge brings with it increased health benefits and could be something that helps an older adult or someone with extreme walking impairment that may be vulnerable to a fall.

An interesting thing to make note of with regards to falls and the relation to mobility is observing the difference between a young person and an older person when they fall. Young people tend to lower the centre of gravity by bending their knees and make big, fast movements to counteract the momentum of the fall.

Older people tend to do the exact opposite and apply a rigid and stiffening strategy of locking the knees and straightening their legs and stiffening all their muscles to brace for the fall. This second strategy makes falling inevitable and the consequences of one much more severe. Loss of flexibility will encourage an automatic response to "lock out" as the joints have lost their ability to bend in the way needed for a reflex lowering to the ground.

This is where the addition of backward walking may help the older adult develop the skills of reflex stability to prevent the damage from a fall. There is obviously a lot of other things associated with this problem and I encourage you to read our full article below for more detail.

Using agility training and reflex stability to prevent falls with older adults

How to Safely Walk Backwards on a Treadmill

You can incorporate backwards walking into your workouts as a warmup, cooldown, or even a standalone activity. However, this might feel very awkward at first so you have to take your time getting used to it. You can do this outdoors but you have to have an area that you are confident you will not trip over anything and enough room to deviate a bit as you cannot see where you are going. If you walk looking behind you it throws your gait off so it defeats the purpose of using it. I have found it is much easier to use a treadmill as you can hold onto the handrails for support and easily manipulate the resistance you need to be challenged but at the same time keeping it safe.

Also the treadmill allows you to make small changes in incline or decline can also alter the range of motion for joints and muscles, offering pain relief for conditions such as plantar fasciitis and Achilles problems.

Start with a slower speed (2-3 km) and hold onto the handrails for balance. You can let them go once you get more comfortable.

1. Use the safety key by attaching the lanyard to your shirt at hip height. This will automatically stop the belt if you get too far from the console.
2. Begin with five to 10 minutes and gradually build up as your endurance improves.
3. Think of reaching back with your leg, landing on your toe and rolling through to your heel before picking up your other leg.
4. Focus on taking even steps, keeping your step length the same on both sides.
5. Engage your core muscles and stay as upright as possible, avoiding the tendency to lean forwards.
6. Add a slight incline as you get stronger

While this can be a great tool to assist you in the early stages it should never be used as the only thing. You should also not neglect regular walking as it is important to address the compensation in your regular gait. This should not be used as a replacement to a properly structured strengthening program.

The BEST Solution Is To Improve Functional Movement Stability & Strength

One of the first things always discussed when talking about knee pain exercises is trying to strengthen the vastus medialis oblique muscle otherwise known as the VMO. We know that this muscle plays a critical role in providing stability of the knee and prevents the onset of patella tracking problems that are so common among people of all ages. The problem with most of the exercises used to strengthen this muscle do so in isolation, ignoring the role of other anatomical factors contributing to the VMO weakness.

Factors such as tibial torsion, valgus knee collapse due to poor hip muscle control, poor foot stability creating over-pronation, and ankle stiffness inhibiting quadriceps strength need to be addressed if you truly want to strengthen the VMO and stabilize the knee.

The strength of the VMO is dependent upon the muscles and joints above and below for providing the perfect position to complete its function. It is pointless in using exercises to strengthen this if you have not addressed those factors first. 

Where do you start? What are the best exercises?

Well unfortunately, this all depends on the person. Some may need a lot of work with foot stability and hip mobility whereas others it may be more to do with improving gluteal strength and coordination of movement. The only way to find out what your body needs is to complete an assessment that looks at all the potential factors and addresses the weaknesses of each.

You will find great information about the VMO and knee pain exercises in the articles in the links below.

• Weak VMO – How to strengthen in 5 steps
• Knee pain has nothing to do with the knee itself
• How to complete a knee pain assessment

Do You Need More Help?

I suggest if you are someone with a chronic knee problem right now your best bet is to get my full KNEE PAIN program shown below. I created this program a few years ago to provide a program in a simple step by step process to effectively change all of the things we have just spoken about in this article. We have been able to successfully help hundreds of all types of knee injuries, (if not thousands over the internet) using this exact program. Click here to see a preview trailer of what is in the video.

Click here to get a copy of this program.

Summary

I must admit I did find the backwards walking to be much better than expected. It did give me a feeling of controlling the knee and being able to strengthen the quadriceps to some degree.

However, I also did notice how it did little to change the things that were hurting my knee. I was still able to make a bigger difference using the "bigger" more intensive exercises like the Hip Airplane and specific mobility exercises for the hip. In my case I know my problems are coming from the hip and if this area gets stiff for any reason I am going to have problems.

However, I must acknowledge that other people may be different so there is definitely some use to using this exercise, especially in the early stages when it may be too difficult to use the more complex and risky exercises. As long as you can understand when to use this in combination with the other "big" exercises and see it more as a stepping stone to those exercises I think backwards walking could be a useful addition to a knee pain program.

Try it out yourself and let me know what you think.

For more ideas and information on specific topics I may not have covered in detail be sure to check out our INDEX PAGE on the website that has over 300 of our best articles. These are all sorted into categories for quick reference so you can find what you are after more easily. You can also subscribe to our FREE fortnightly newsletter by clicking here.

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