Therapeutic Applications of Retrograde Walking and Running
Backward walking and running are valuable therapeutic interventions for rehabilitation of neurological conditions, musculoskeletal injuries, and athletic performance enhancement due to their unique biomechanical and physiological properties.
Applications in Stroke Rehabilitation
Backward walking shows significant benefits for stroke patients with mobility limitations:
Motor control training: Adding backward walking on an inclined treadmill as part of a motor control program results in significant improvement in knee joint proprioception during early and intermediate phases of rehabilitation, with moderate effects persisting up to 2 years after ACL reconstruction 1
Gait rehabilitation: The American Heart Association/American Stroke Association guidelines recommend backward walking as a rhythmic auditory stimulation (RAS) technique for improving gait parameters, including velocity, cadence, stride length, and gait symmetry 1
Balance improvement: Backward walking challenges balance differently than forward walking, making it particularly useful for patients with balance deficits following stroke 1
Applications in Musculoskeletal Rehabilitation
Backward locomotion offers unique benefits for musculoskeletal conditions:
Anterior cruciate ligament (ACL) rehabilitation: Backward walking on an inclined treadmill improves knee joint proprioception and is recommended as part of motor control training programs 1
Knee osteoarthritis management: Backward walking has shown helpful effects on improving lower limb proprioception, gait synergy, and limb balance in patients with knee osteoarthritis 2
Quadriceps strengthening: Backward running increases quadriceps strength while decreasing joint compressive forces about the knee, making it valuable for knee rehabilitation 3
Physiological Benefits
The unique physiological demands of backward locomotion provide several advantages:
Higher metabolic demand: For a given speed, backward walking and running elicit significantly higher oxygen consumption (VO₂), heart rate, and blood lactate levels compared to forward locomotion 3
Cardiovascular conditioning: During backward walking, individuals exercise at approximately 60% of their forward VO₂peak, while backward running reaches about 84% of forward VO₂peak, allowing injured athletes to maintain cardiovascular fitness during rehabilitation 3
Muscle activation patterns: Backward running is characterized by increased muscle activity and greater reliance on isometric and concentric muscle actions compared to forward running 4
Athletic Performance Enhancement
Backward running offers several benefits for athletic performance:
Strength and power development: Research has shown improved lower body strength and power following backward running training 4
Injury reduction: Backward running training has been associated with decreased injury prevalence 4
Change of direction performance: Improvements in change of direction performance have been documented following backward running training 4
Biomechanical advantages: Backward running has a smaller ratio of braking to propulsive forces, increased step frequency, and decreased step length compared to forward running 4
Safety Considerations and Implementation
While beneficial, backward locomotion requires careful implementation:
Fall risk: There have been documented cases where walking backwards during physical therapy resulted in falls and significant morbidity 5
Supervision requirements: Backward walking should be performed with adequate supervision, especially in patients with balance deficits 5
Progression: Begin with slower speeds and shorter durations, gradually increasing as confidence and ability improve
Environment: Ensure a clear, obstacle-free path for backward walking exercises
Neural Mechanisms
The neural control of backward locomotion differs from forward locomotion:
Shared neural circuitry: Evidence suggests that backward and forward locomotion may be generated by the same neural rhythm circuitry 6
Specialized control: Backward walking additionally requires specialized control circuits beyond those used for forward walking 6
Transfer effects: Due to these neural differences, training effects from backward walking/running may not transfer directly to forward walking/running 6
Practical Implementation Guidelines
For optimal results when implementing backward walking/running:
- Frequency: At least 3 times weekly for stroke rehabilitation 1
- Duration: Begin with shorter sessions (5-10 minutes) and progress to 20+ minutes as tolerated 1
- Intensity: For cardiovascular benefits, aim for 77-95% of maximal heart rate 7
- Progression: Gradually increase speed and duration as ability improves
- Safety: Always ensure proper supervision and a safe environment, especially for patients with balance deficits
By understanding and appropriately implementing backward walking and running in therapeutic settings, clinicians can harness their unique benefits for rehabilitation and performance enhancement.