Walking Backwards on a Treadmill in Physical Therapy

How Reverse Walking Is Used for Rehabilitation

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Walking backward on a treadmill, also known as reverse walking or retro walking, is often used in physical therapy clinics to help people improve their gait and mobility in the lower extremities. It is frequently used to improve knee, hip, and ankle range of motion (ROM), improve strength, and improve lower extremity mechanics related to gait.

In visiting a clinic, you may see people walking on a treadmill and note one or more walking backward on the treadmill. Physical therapists (PTs) work with people to help them move better and feel better. Therapists may be helping people with bed mobility, strength and balance exercises, and improving walking ability through gait training.

This article discusses walking backward on a treadmill, how it is beneficial, and its uses in physical therapy. It also provides tips for how to walk backward on a treadmill safely.

Photo of a woman PT speaking with a patient on a treadmill.
Daryl Leniuk / Getty Images

Walking Backward vs. Forward

Reverse walking differs from forward walking in several key ways. When you walk forwards, there are certain motions that are considered normal gait characteristics. 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.

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. This toe-to-heel gait pattern may offer many different benefits.

Benefits of Walking Backwards

Walking backward on a treadmill offers several benefits. These include improved range of motion in your knee, quadriceps strength, hamstring flexibility, and mobility. In addition, walking backward offers similar benefits to regular walking, including burning more calories, better heart function, and improved balance and stability.

Increase Knee Range of Motion

Reverse walking may help increase knee extension range of motion. If you have a knee injury, knee surgery, or knee arthritis, you may 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.

Improve Quadriceps Function

Reverse walking may also help to improve the function of your quadriceps muscles on your upper thighs. The quads, as they are often referred to, are active when straightening your knee. Exercises like quad sets, short arc quads, and straight leg raises may help to improve your quad strength.

Reverse walking may also be an option that your physical therapist uses to improve quad function. As you are walking backward, your quad is active while your knee is straightening as you move from toe to heel. This may improve the function of your quadriceps muscles.

It is important to focus on contracting your quadriceps as you are walking backward. Your physical therapist can give you the right verbal cues to accomplish this.

Improve Hamstring Flexibility

If you have tight hamstrings, your therapist may have you walk backward on the treadmill to improve flexibility of this muscle group. Your hamstrings are located in the back of your upper thighs and work to bend your knees and extend your hips.

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.

Better Balance, Gait, and Mobility

Reverse walking may also be done to improve gait characteristics after an injury, surgery, or illness. By walking backward, your gait may be “reset,” and walking backward may improve your ability to walk forwards.

A small study on recent stroke patients found that backward walking training was superior to standing balance training for improving both balance and walking speed.

If you are having balance and mobility problems, your PT may have you reverse walk to improve general safe mobility.

Burns More Calories

Backward walking also burns more calories than traditional walking, according to the American College of Sports Medicine Compendium of Physical Activities. Energy expenditure (calorie burn) is measured by metabolic equivalents (METs). Walking 3.5 miles an hour is ranked as 4.3 METs, whereas backward walking at the same speed is 6.0 METs.

Improved Heart and Lung Function

Walking backwards on a treadmill can also benefit your heart and lungs. Backwards walking is more challanging than forward walking and forces you to work harder.

Research in healthy subjects shows it requires more oxygen and places more demands on the cardiovascular system. As a result, it improves heart and lung health better than forward walking. 

Conditions That Benefit From Backward Walking

In general, any person who has a lower extremity impairment that results in loss of normal walking mobility may benefit from reverse walking, either on the treadmill or over solid ground.

Common conditions that may benefit from reverse walking may include:

This list is not exhaustive; your physical therapist can work with you to decide if your specific condition warrants the use of reverse walking as part of your rehab.

How to Safely Reverse Walk

The most important thing to keep in mind while reverse walking is to remain safe. Your PT can work with you to ensure that backward walking as part of your rehab is safe for you.

Before starting reverse walking on a treadmill, you should be able to safely walk backward over flat, level surfaces. You should also visit with your physician or physical therapist before any exercise to ensure that it is safe for you to do.

To safely engage in treadmill retro walking:

  1. Stand on a treadmill facing towards the rear of the machine. Place your feet on either side of the belt.
  2. Attach the safety lanyard to your shirt or pants. This device automatically stops the belt from moving if your body gets too far from the front of the treadmill.
  3. Start the treadmill and make sure the belt is moving at the lowest speed.
  4. Hold onto the side rails of the treadmill.
  5. Start walking backward by reaching one leg backward and landing on your toes. Roll onto your heel as your knee straightens.
  6. Repeat the toe-to-heel walking pattern, and have someone slowly increase the speed of the treadmill. Most people can manage walking backward at about 2 miles per hour. Your speed may vary depending on your specific condition.
  7. When finished, have someone stop the belt from moving. Be sure to keep walking backward until the belt has come to a complete stop.

Most people walk in reverse on the treadmill for five to 10 minutes. You may do a bit more or less depending on your condition; your physical therapist should be able to prescribe the right amount of time for you.

After reverse treadmill walking, your PT will likely have you perform exercises specific to your condition. You may be prescribed quad-strengthening exercises, knee range of motion exercises, or hamstring stretches to perform to augment the benefits of reverse walking. Your PT may also work on specific gait characteristics after you walk backward.

A Word From Verywell

Reverse walking on the treadmill is occasionally used in the PT clinic to help people improve their walking ability, improve strength, range of motion, or flexibility. If you have a lower extremity injury, your PT may utilize backward walking to help you fully recover. By understanding what to expect with reverse walking, you may be able to quickly and safely return to your maximal level of mobility and function.

5 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Alghadir AH, Anwer S, Sarkar B, Paul AK, Anwar D. 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 Musculoskelet Disord. 2019;20(1):159. doi:10.1186/s12891-019-2537-9

  2. Balasukumaran T, Olivier B, Ntsiea MV. The effectiveness of backward walking as a treatment for people with gait impairments: A systematic review and meta-analysis. Clin Rehabil. 2019;33(2):171-182. doi:10.1177/0269215518801430

  3. Rose DK, DeMark L, Fox EJ, Clark DJ, Wludyka P. A backward walking training program to improve balance and mobility in acute stroke: a pilot randomized controlled trial. J Neurol Phys Ther. 2018;42(1):12-21. doi:10.1097/NPT.0000000000000210

  4. Ainsworth BE, Haskell WL, Herrmann SD, et al. 2011 Compendium of Physical Activities: a second update of codes and MET values. Med Sci Sports Exerc. 2011;43(8):1575–81. doi:10.1249/MSS.0b013e31821ece12

  5. Thomas KS, Hammond M, Magal M. Graded forward and backward walking at a matched intensity on cardiorespiratory responses and postural control. Gait Posture. 2018;65:20-25. doi:10.1016/j.gaitpost.2018.06.168

By Brett Sears, PT
Brett Sears, PT, MDT, is a physical therapist with over 20 years of experience in orthopedic and hospital-based therapy.