The purpose of this article is to overview the modality of backward walking as a component of the rehabilitation program for many lower extremity injuries and/or for injury prevention. In so doing, we will identify the salient features of backward walking from a rehabilitation perspective, and also suggest an exercise routine to incorporate which may be of benefit for many active individuals.
The kinematics, or patterns, of walking forward are somewhat different than those of walking backward. Some of the differences can be observed visually, while others (activation patterns of muscles; specific joint angle differences) have been quantified scientifically. We will synthesize the information that we have learned in the laboratory in order to make it more practical for general understanding.
We can summarize the differences between forward and backward walking as follows:
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A simple exercise routine developed by the authors that has benefitted many older adults is as follows. Two individuals work together as a team. They stand facing each other and hold each other's hands. As one person walks backward, the other walks forward. The coupling of the two individuals by holding hands assists with balance and the person walking forward serves as the "eyes" for both individuals. Both of these aspects provide an added degree of comfort/confidence especially during the initial exercise periods. The walk can be of any reasonable length, but short to moderate distances enhance the exercise by requiring more changes of direction for the pair.
A more complex variation of this exercise concept combines static balance in addition to the forward and backward walking pattern. It consists of both forward and backward walking to gain the proprioceptive advantages, but also utilizes additional balance practice to assist in overall rehabilitation advantages. The exercise is simple in description and action complex in potential benefits. The exercise regime is as follows:
1) Walk forward five steps
2) Balance briefly on the support leg as the swing leg is reversed
3) Walk backward four steps
4) Balance briefly on the support leg as the swing leg is reversed
Note: The balance phase during each body reversal should be 3 to 5 seconds in length
This exercise incorporates the advantages of forward walking, backward walking and balance/proprioception. During this "5-4" walking pattern combined with a balance phase, the neuromuscular system can be exercised to its perceived fullest by incorporating dynamic gait (forward and backward) as well as static postural control on alternating legs. This exercise can be done initially with the use of hand rails and eventually without the support of rails in a demonstration of full system (body) control. One of the many potential benefits of this "5-4" routine as the nervous system is "exercised" and balance improves is the potential prevention of falls.
"5-4" is a newly introduced exercise intervention, however, feedback on its use has been extremely positive, as well as diverse in nature. Reported anecdotal benefits include enhanced whole-body (global) balance and control, including spinal column alignment. Lower extremity articular musculature, especially that of the ankle joint, is perceived to be strengthened. Stimulation of the circulatory system as a result of general movement (exercise) has also been noted. All of these reported benefits could address the problems associated with osteoporosis and falls, as previously identified.