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Walking Backward to Alleviate Back Pain

Can walking backward on a treadmill aid in treating conditions and injuries, improving strength, gait, and mobility in the lower extremities and knee, hip, and ankle range of motion (ROM)?

Walking Backward On A Treadmill

Walking backward is often used in physical therapy to treat multiple conditions and injuries and help improve strength, gait, balance, and mobility in the lower extremities. It is also used to improve knee, hip, and ankle range of motion and lower back pain and burn calories.

The Difference Backward vs. Forward

The difference from forward walking is that certain motions are normal gait characteristics.

  • First, the leg swings through the air, and the heel lands on the ground.
  • Then, the straight knee bends slightly as you roll from heel to toe.
  • As this occurs, the opposite leg rolls from the toes and up into the air.
  • This heel-to-toe motion repeats, and normal walking takes place.

Reverse walking creates the opposite gait process.

  • The leg swings through the air and reaches backward with a bent knee.
  • The toes contact the ground, and the bent knee straightens as you roll from toe to heel.
  • Then, the heel leaves the ground with the knee straight, repeating the process.
  • The toe-to-heel gait can provide various benefits. (Cha H. G., Kim T. H., & Kim M. K. 2016)

Benefits

Walking backward on a treadmill benefits include:

  • Improved range of motion in the knee
  • Hamstring flexibility and mobility
  • Quadriceps strengthening

Walking backward also helps burn calories, improve heart function, and improve balance and stability. (Cha H. G., Kim T. H., & Kim M. K. 2016)

Knee Range of Motion

  • Reverse walking can help increase knee extension range of motion. (Zhang M. et al., 2022)
  • Individuals with knee injuries, surgeries, or arthritis may lose their knee extension or the knee’s ability to straighten.
  • The bent knee straightens fully when walking backward, moving from the toes onto the heel.
  • This helps to improve the range of motion into knee extension.

Quadriceps Function

  • Reverse walking can improve the function of the quadriceps muscles in the upper thighs. (Alghadir A. H. et al., 2019)
  • The quads are active when straightening the knee.
  • Exercises like quad sets, short arc quads, and straight leg raises increase quad strength.

Hamstring Flexibility

  • The hamstrings are located in the back of the upper thighs and work to bend the knees and extend the hips.
  • For individuals with tight hamstrings, a therapist may have you walk backward on the treadmill to improve the flexibility of the muscle group. (BBC, 2023)
  • When walking backward, the hamstring contracts to bend the knee as it swings through the air.
  • Then, the hamstring is stretched from the toe to heel movement, and the knee straightens.

Balance, Gait, and Mobility

  • Reverse walking can improve gait characteristics after an injury, surgery, or illness. (Balasukumaran T., Olivier B., & Ntsiea M. V. 2019)
  • Walking backward can help reset one’s gait and improve one’s ability to walk forward.
  • A study on stroke patients found that backward walking training was superior to standing balance training for improving balance and walking speed. (Rose, D. K. et al., 2018)

Burns Calories

  • Backward walking has been found to burn more calories than forward walking.
  • Walking backward uses up about 40% more calories per minute than forward walking at the same speed. (Cha H. G., Kim T. H., & Kim M. K. 2016)

Heart and Lung Function

  • Walking backward on a treadmill can also benefit heart and lung health.
  • Backward walking is more challenging and forces the individual to work harder.
  • Research shows it requires more oxygen and places more demands on the cardiovascular system. (Thomas K. S., Hammond M., & Magal M. 2018)
  • As a result, it improves heart and lung health better.

Conditions That Benefit

Individuals with a lower extremity impairment that results in loss of normal walking mobility may benefit from reverse walking. Common conditions that may help include: (BBC, 2023) (DelMastro H. M. et al., 2023)

  • Hamstring strain
  • Sciatica with tightness in hamstrings
  • Hip, knee or ankle surgery
  • Lower extremity fracture
  • Cerebral palsy
  • Multiple sclerosis
  • Parkinson’s disease
  • Stroke

A physical therapist will decide if an individual’s condition warrants reverse walking as part of a rehabilitation program.

Injury Medical Chiropractic and Functional Medicine Clinic

Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution. We focus on what works for you to relieve pain, restore function, and prevent injury. Regarding musculoskeletal pain, specialists like chiropractors, acupuncturists, and massage therapists can help mitigate the pain through spinal adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal issues.


Control Foot Motion and Posture


References

Cha, H. G., Kim, T. H., & Kim, M. K. (2016). Therapeutic efficacy of walking backward and forward on a slope in normal adults. Journal of Physical Therapy Science, 28(6), 1901–1903. https://doi.org/10.1589/jpts.28.1901

Zhang, M., Pang, J., Lu, J., Kang, M., Chen, B., Jones, R. K., Zhan, H., & Liu, A. (2022). The Immediate Effect of Backward Walking on External Knee Adduction Moment in Healthy Individuals. Journal of Healthcare Engineering, 2022, 4232990. https://doi.org/10.1155/2022/4232990

Alghadir, A. H., Anwer, S., Sarkar, B., Paul, A. K., & Anwar, D. (2019). Effect of 6-week retro or forward walking program on pain, functional disability, quadriceps muscle strength, and performance in individuals with knee osteoarthritis: a randomized controlled trial (retro-walking trial). BMC musculoskeletal disorders, 20(1), 159. https://doi.org/10.1186/s12891-019-2537-9

BBC. (2023). Why walking backwards can be good for your health and brain. https://www.bbc.com/future/article/20231110-why-walking-backwards-can-be-good-for-your-health-and-brain

Balasukumaran, T., Olivier, B., & Ntsiea, M. V. (2019). The effectiveness of backward walking as a treatment for people with gait impairments: a systematic review and meta-analysis. Clinical Rehabilitation, 33(2), 171–182. https://doi.org/10.1177/0269215518801430

Rose, D. K., DeMark, L., Fox, E. J., Clark, D. J., & Wludyka, P. (2018). A Backward Walking Training Program to Improve Balance and Mobility in Acute Stroke: A Pilot Randomized Controlled Trial. Journal of Neurologic Physical Therapy: JNPT, 42(1), 12–21. https://doi.org/10.1097/NPT.0000000000000210

Thomas, K. S., Hammond, M., & Magal, M. (2018). Graded forward and backward walking at a matched intensity on cardiorespiratory responses and postural control. Gait & posture, 65, 20–25. https://doi.org/10.1016/j.gaitpost.2018.06.168

DelMastro, H. M., Ruiz, J. A., Simaitis, L. B., Gromisch, E. S., Neto, L. O., Cohen, E. T., Wong, E., Krug, R. J., & Lo, A. C. (2023). Effect of Backward and Forward Walking on Lower Limb Strength, Balance, and Gait in Multiple Sclerosis: A Randomized Feasibility Trial. International journal of MS care, 25(2), 45–50. https://doi.org/10.7224/1537-2073.2022-010

Lower Your Blood Pressure with Walking: Simple and Affordable

For individuals who are looking to lower blood pressure, can walking help?

Walking To Lower Blood Pressure

A walking regimen is an accessible workout that can be done almost anywhere at no cost, effectively lowering blood pressure and improving overall health. Studies show that individuals who use walking as a workout for three months have improved systolic blood pressure, which is the top number that measures the pressure in the arteries as the heart beats. (McMullan S., Nguyen C., & Smith D. K. 2022)

How It Works

Walking is an excellent way to get active. It can be done almost anywhere, including on a treadmill, outdoors, or around the house. Exercising lowers blood pressure by strengthening the heart, leading to the heart pumping blood more effectively when it is stronger. This causes less resistance to the blood vessels, which lowers overall blood pressure. (Hegde S. M., & Solomon S. D. 2015) The benefits of walking include: (American Heart Association, 2024)

  • Weight loss and management
  • Lowers stress
  • Improves mental health by reducing anxiety.
  • Improves sleep quality
  • Improves cognition
  • Strengthens the heart
  • Promotes bone health and reduces the risk of osteoporosis.

Knowing When to Take A Blood Pressure Reading

Various factors can affect blood pressure readings and can include:

  • Nervousness
  • Eating a meal
  • Drinking caffeine
  • Exercise can affect blood pressure readings.

Knowing how and when to take a blood pressure reading after walking can help prevent false elevated numbers. According to the CDC, individuals should wait at least 30 minutes after exercise before taking a reading (Centers for Disease Control and Prevention, 2024). Exercise and walking have been shown to cause an immediate reduction in systolic blood pressure. This is known as post-exercise hypotension and is normal. The reduction lasts around 24 hours after exercising and is more noticeable in those with high blood pressure. Consistent exercise and walking will cause a longer, more sustained blood pressure reduction. (Hegde S. M., & Solomon S. D. 2015)

Taking Blood Pressure at Home

Correctly taking blood pressure can help improve accuracy and reduce inaccurate readings. To do: (Centers for Disease Control and Prevention, 2024)

  • It is recommended not to talk while the blood pressure is being taken.
  • Apply the blood pressure cuff snugly around the arm.
  • Place your arm on a table, level with your heart.
  • Sit in a chair, keep your feet flat on the floor, and do not cross your legs or lean back on the chair.
  • It is recommended not to eat or drink 30 minutes before and to have an empty bladder.

Pace and Intensity

A study found that walking three to five times weekly for 20 to 40 minutes at a moderate pace for three months can lower systolic blood pressure. However, various groups determined BP rates differently by measuring heart rate, VO2 max/the maximum volume of oxygen you can use simultaneously, and walking speed. (McMullan S., Nguyen C., & Smith D. K. 2022)

Increasing Workout Intensity

Individuals with hypertension who walk may want to increase workout intensity to challenge themselves for added fitness. This can include:

  • Walk faster
  • Use intervals – walk as fast as you can for a minute or two at a time.
  • Add inclines
  • Use ankle or wrist weights or a weighted vest.
  • Walking with someone to challenge each other to push a little harder.
  • Try other places to walk.

Always talk to a healthcare provider if you are starting a walking workout for the first time, want to increase walking intensity, and take medications prescribed by a healthcare provider.

Hypertensive Crisis

A hypertensive crisis is when a person’s blood pressure is extremely high, can cause life-threatening conditions like stroke, and is a medical emergency. It is a blood pressure of 180/120 mm Hg or higher. (American Heart Association, 2024) If you get a blood pressure reading of 180/120 mm Hg or higher at home, wait five minutes and take another reading. If the blood pressure is still high, immediately contact a healthcare provider. (American Heart Association, 2024) If the individual is experiencing the below symptoms, call 911 (American Heart Association, 2024)

  • Chest pain
  • Shortness of breath
  • Vision changes
  • Difficulty speaking
  • Weakness
  • Numbness
  • Back pain

Injury Medical Chiropractic and Functional Medicine Clinic

Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to build optimal health and wellness solutions. We focus on what works for you to relieve pain, restore function, prevent injury, and help mitigate issues through adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal problems.


Hypertension Explained


References

McMullan, S., Nguyen, C., & Smith, D. K. (2022). Can Walking Lower Blood Pressure in Patients With Hypertension?. American family physician, 105(1), 22–23.

Hegde, S. M., & Solomon, S. D. (2015). Influence of Physical Activity on Hypertension and Cardiac Structure and Function. Current hypertension reports, 17(10), 77. https://doi.org/10.1007/s11906-015-0588-3

American Heart Association. (2024). Getting active to control high blood pressure. https://www.heart.org/en/health-topics/high-blood-pressure/changes-you-can-make-to-manage-high-blood-pressure/getting-active-to-control-high-blood-pressure

Centers for Disease Control and Prevention. (2024). Measure your blood pressure. Retrieved from https://www.cdc.gov/high-blood-pressure/measure/

American Heart Association. (2024). Understanding blood pressure readings. https://www.heart.org/en/health-topics/high-blood-pressure/understanding-blood-pressure-readings

American Heart Association. Association, A. H. (2024). When to call 911 about high blood pressure. https://www.heart.org/en/health-topics/high-blood-pressure/understanding-blood-pressure-readings/hypertensive-crisis-when-you-should-call-911-for-high-blood-pressure