Backward walking added to knee-osteoarthritis rehabilitation may improve pain and function. This is not proof of a stand-alone cure or healthy-knee injury prevention.
If your knee pain is new, worsening, swollen or unexplained, get a diagnosis before using a movement experiment to treat it.
Which knee question has actually been studied?
| Question | What the evidence says | Practical implication |
|---|---|---|
| Diagnosed knee osteoarthritis with a rehabilitation plan | Combined rehabilitation favored pain and disability outcomes. | Ask a physical therapist whether it fits your plan and how to practice safely. |
| Other causes of knee pain | The review does not establish effects for ligament injuries, patellofemoral pain or a newly swollen knee. | Identify the cause before treating it like osteoarthritis. |
| Healthy knees or injury prevention | Healthy-knee injury prevention was not tested. | Do not treat anecdotes or a gait measurement as prevention proof. |
| Weighted backward sled pulls | Walking trials do not establish loaded-sled effects. | Do not transfer the treatment effect to a different exercise. |
Lin and colleagues pooled 13 randomized trials of backward walking plus conventional rehabilitation. Pain and disability favored combined programs; stand-alone use, longer-term outcomes and evidence certainty need further research.
What did an individual trial ask people to do?
The 2021 pilot enrolled 48 people and randomized 32 eligible participants. Comfortable walking began at 10 minutes, three days weekly for four weeks, initially supervised in hospital; home sessions could progress toward 30 minutes if symptom criteria allowed.
Both groups received exercise, medication and a needle-knife procedure. The comparison tested added walking, not walking alone or a universal schedule.
Participants were 50 to 75 and met standing-balance criteria, limiting applicability to substantial fall risk. Several pain and function comparisons favored added walking, but the pain-rating group-by-time interaction was not significant and proprioception showed no extra benefit.
Why might walking direction change knee mechanics?
Forefoot-first contact and different muscle timing make backward walking mechanically distinct. Those mechanisms alone cannot establish pain relief.
A 2025 gait study measured 32 people with medial knee osteoarthritis during forward walking, backward walking and slower forward walking matched to backward speed. Backward walking lowered the first peak of the external knee adduction moment and the knee adduction angular impulse, but it did not lower the second peak of the moment.
The knee adduction moment is a surrogate gait-mechanics measure related to medial knee loading. This laboratory result does not directly measure cartilage stress, show the joint is protected from wear, or establish that every backward step is lower impact.
What about balance, calories and other claims?
Kim and Lee reviewed five trials involving 208 older adults; three contributed Berg Balance Scale results. The pooled improvement had very high variation between studies, so it does not establish fewer real-world falls from a home routine.
A pain score, gait measurement or balance test cannot establish a calorie advantage, long-term weight loss or heart-disease prevention. Those are different outcomes requiring their own evidence.
Walking backward also does not replace ordinary walking or strength work. Our walking guide explains how to choose a practical forward-walking goal without converting everyone to one mileage target.
A safer way to discuss a first attempt
If you have diagnosed knee osteoarthritis, ask your physical therapist whether backward walking belongs in your rehabilitation program and where you should practice it. A therapist can set the speed, support and duration around your balance and symptoms rather than copying a trial schedule.
If you have no knee symptoms and simply want to explore the movement, use a clear, level space with a stable handhold and begin with a few slow steps. Look over the path before moving, keep children and pets away, and stop if you feel unsteady or pain increases.
Do not start on stairs, uneven ground or a moving treadmill. People with poor vision, neuropathy, a recent fall, new dizziness or recent lower-limb surgery need individualized guidance before trying it.
Why this article started with a radio story
Radio 702’s original segment drew attention to reverse walking, also called retro walking. It is now private on YouTube; the knee question can still be explored through the linked research.
Original segment availability
Radio 702 segment on YouTube (currently private).
Sources
- Lin et al. (2026), 13-trial knee-osteoarthritis rehabilitation review.
- Chen et al. (2021), pilot trial: 48 enrolled, 32 randomized.
- Zhang et al. (2025), gait-mechanics study in 32 people with medial knee osteoarthritis.
- Kim and Lee (2025), older-adult balance and mobility review.
This article is general exercise information, not a diagnosis or a personal knee-rehabilitation plan. Ask a clinician or physical therapist about persistent pain, balance problems or a recent injury before changing treatment.
