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Abstract Background Badminton, a dynamic sport, demands players to display exceptional physical attributes such as agility, core stability, and reaction time. Backward walking training on a treadmill has garnered attention for its potential to enhance physical attributes and optimize performance in athletes while minimizing the risk of injuries. Objective By investigating the efficacy of this novel approach, we aim to provide valuable insights to optimize training regimens and contribute to the advancement of sports science in badminton. Methodology Sixty-four participants were randomized into a control group (n = 32) and an experimental group (n = 32). The control group received routine exercise training, while the experimental group received routine exercise training along with additional backward walking training on the treadmill. Pre- and post-intervention measurements were taken for core stability using the Plank test, balance using the Star Excursion Balance test, reaction time using the 6-point footwork test, and agility using the Illinois Agility test. Results The results showed that the experimental group demonstrated significant improvements in core stability (p

Background: balance and risk of falls are common problems among People with Parkinson's disease (PD) which compromise their functional independence and quality of life. Various rehabilitation protocols are being used for these patients. Objective: To determine the effectiveness of backward walking training (BWT) and standing balance training (SBT) on balance, and risk of falls among Parkinson's patients. Methodology: A randomized controlled trial was conducted at General Hospital Lahore from June 2020 to March 2021. The Parkinson's Patients of stage 3 or 4 of lower extremity on Brunnstrom motor recovery and the ability to walk 14 m with or without a walking aid or orthosis were included in the study. The Berg Balance Scale was used to evaluate the balance and fall risk. Group A (n=15) received backward walking training and Group B (n=15), standing balance training. The participants were assessed at the baseline, after the 6th week, and after 12 weeks of intervention. Results: The mean age of participants was 50.03+8.36 years. A total of n=17 participants were male while 13 were female. The result showed that group A received backward walking training (BWT) had a significantly large mean difference (22.13+-2.35 vs. 18.20.3.58, 95%CI (1.64,6.22) in BSS score as compared to group B received standing balance training (SBT). Conclusion: The study concluded that standing balance training and backward walking training both are effective, but backward walking training is more effective in improving balance and the risk of falls in Parkinson's patients.

Background: Badminton, a dynamic sport, demands players to display exceptional physical attributes such as agility, core stability, and reaction time. Backward walking training on a treadmill has garnered attention for its potential to enhance physical attributes and optimize performance in athletes while minimizing the risk of injuries. Objective: By investigating the efficacy of this novel approach, we aim to provide valuable insights to optimize training regimens and contribute to the advancement of sports science in badminton. Methodology: Sixty-four participants were randomized into a control group (n = 32) and an experimental group (n = 32). The control group received routine exercise training, while the experimental group received routine exercise training along with additional backward walking training on the treadmill. Pre- and post-intervention measurements were taken for core stability using the Plank test, balance using the Star Excursion Balance test, reaction time using the 6-point footwork test, and agility using the Illinois Agility test. Results: The results showed that the experimental group demonstrated significant improvements in core stability (p < 0.001), balance (p < 0.001), reaction time (p < 0.05), and agility (p < 0.001) compared to the control group. The backward walking training proved to be effective in enhancing these physical attributes in badminton players. Conclusion: Incorporating backward walking exercises into the training regimen of badminton players may contribute to their overall performance. [ABSTRACT FROM AUTHOR]

Aims/Background Backward walking is gaining traction in rehabilitation therapy, showing promise as an intervention for stroke patients with walking difficulties. However, the brain activity patterns (neurophysiological mechanisms) underlying backward walking in these patients remain unclear. This study investigated the neurophysiological mechanism in stroke patients within 1 year of their stroke. Methods Twenty-four subjects walked forward and backward for 5 min on an 8-m track while their electroencephalographic signals were collected. The power values of each frequency band were compared during forward and backward walking, and the delta to alpha power ratio (DAR) was calculated. Results The results showed a significant increase in α-band activity within the frontal cortex during backward walking (p < 0.05). This increase correlated positively with scores on the Fugl-Meyer lower extremity motor function assessment scale. Similarly, α-band activity showed significant enhancement within the right parietal cortex during backward walking (p < 0.05). There were no significant differences between forward and backward walking states in δ, θ, and β wavebands across the entire brain region (p > 0.05). Additionally, the DAR was significantly lower during backward walking than during forward walking (p < 0.05). Conclusion This study suggests that backward walking may more effectively activate neural activity in the prefrontal and right posterior parietal cortices. This finding supports the potential of backward walking to enhance motor execution and walking function in stroke patients, thereby supporting its application as a rehabilitation method. [ABSTRACT FROM AUTHOR]

Objective: To examine the effects of navigation controls and field-of-view modes on cybersickness severity and gait dynamics after cessation of exposure to a virtual environment (VE). Background: The applications of virtual reality are increasing in various fields; however, whether changes in interaction techniques and visual contents could mitigate the potential gait disturbance following VE exposure remains unclear. Method: Thirty healthy adults wore a head-mounted display to complete six sessions of 12-min run-and-gun tasks using different navigation controls (gamepad, head, natural) and field-of-view modes (full, restricted). Forward and backward walking tasks were performed before and after VE exposure. The degrees of cybersickness and presence were evaluated using questionnaires, along with the in-session task performance. Spatiotemporal gait measures and their variabilities were calculated for each walking task. Results: The participants experienced less cybersickness with the head and natural controls than with the gamepad. Natural control, based on matching body movements, was associated with the highest degree of presence and best performance. VE navigation using the gamepad showed reduced cadences and increased stride times during postexposure forward-walking tasks. When the VE was presented via the restricted field-of-view mode, increased gait variabilities were observed from backward-walking tasks after VE exposure. Conclusion: Body movement-based navigation controls may alleviate cybersickness. We observed gait adaptation during both ambulation tasks, which was influenced by the navigation control method and field-of-view mode. Application: This study provides the first evidence for gait adaptation during balance-demanding tasks after VE exposure, which is valuable for designing guidelines for virtual reality interactions. [ABSTRACT FROM AUTHOR]

INTRODUCTION. Osteoarthritis of the knee joint or gonarthrosis (GA) is one of the most common joint pathologies. The medical and social significance of GA is associated with its high prevalence and a significant percentage of premature disability and a significant deterioration in the quality of life due to persistent pain syndrome. Modern treatment of patients with GA includes a combination of pharmacological and non-pharmacological methods; physical therapy is the leading method of non-drug therapy. By now, a number of studies have been conducted to research the effectiveness of backward walking (BW) in people with GA. AIM. Analysis of scientific data on the possibilities of using BW in the rehabilitation of patients with GA. MATERIALS AND METHODS. A systematic search of literary sources by keywords was carried out: “backward walking”, “gonarthrosis”, “knee osteoarthritis”, “knee joint”, “rehabilitation”, “physical therapy”. DISCUSSION. Recently, backward locomotion is increasingly used in medicine. Kinetic and kinematic analysis during BW showed a number of advantages over the usual method of movement, which can be successfully used for rehabilitation of patients with GA. BW is associated with less overload on knee joints. It is also one of the few natural ways of strengthening the quadriceps. It prevents excessive stretching of the anterior cruciate ligament and improves the stability of the knee joint. BW leads to a more cardiovascular and respiratory load and a more significant aerobic and anaerobic capacity of the organism compared with forward walking at similar parameters of physical activity. CONCLUSION. There is evidence that adding BW to conventional physiotherapy treatment may further reduce pain, functional disability and improve the strength of the quadriceps muscles.

Backward walking is an indispensable component of activities of daily living. The backward walk test has been used to assess balance, mobility, and fall risk in different populations. This systematic review aimed to identify and synthesize measurement properties of the backward walk test in people with balance and mobility deficits. Three bibliographic databases, PubMed, Embase, and Scopus, were searched on June 18th, 2023. Cross-sectional or cohort studies assessing the measurement properties (reliability, validity, responsiveness) of the backward walk test were included. The COSMIN risk of bias checklist was used for methodological quality assessment. Study selection, data extraction, and quality assessment were completed by two reviewers independently and in duplicate. A total of 786 records were identified from three databases. Fourteen studies published from 2019 to 2023 with a total of 853 participants were included. Two studies were rated inadequate in quality assessment, all other studies demonstrated adequate to very good quality. The participants population included patients with cerebral palsy, stroke, multiple sclerosis, Parkinson's disease, fibromyalgia, hip and knee arthroplasty, dementia, and community-dwelling older adults. Good interrater and intrarater reliability, and moderate to good concurrent validity of the backward walk test were demonstrated. The review demonstrates that the backward walk test appears to be a valid and reliable tool in different patient populations. The 3-meter backward walk time and 3-meter backward walk speed can be used as outcome measures in clinical practice to assess balance and mobility and track progress throughout the course of physical rehabilitation. Future studies with a prospective cohort design are required to provide information regarding the predictive validity of the backward walk test for fall risk assessment. • The backward walk test appears to be a valid and reliable tool in clinical populations. • The backward walk test can assess balance and mobility in clinical practice. • The predictive validity of the backward walk test for fall risk remains to be investigated. [ABSTRACT FROM AUTHOR]

Background and Purpose: The purpose of this study was to investigate the 3-meter backward walk test (3MBWT) in individuals with Parkinson Disease (PD) to determine the following: (1) concurrent validity with other gait velocity measures and (2) interrater and intrarater reliability of in-person and video assessment. Methods: A convenience sample of 25 people with PD participated. Forward gait velocity was measured using a computerized walkway (Zeno Walkway System), the 10-meter walk test (10MWT), and 4-meter walk test (4MWT). Backward gait velocity was measured using the 3MBWT. Concurrent validity was assessed using Pearson’s correlations. Reliability was assessed using intra-class correlation coefficients (ICC(2,1)). Results: All relationships between the 3MBWT and gait outcome measures were significant. The 3MBWT demonstrated strong correlations with the 4MWT dual task (r = .795, p=<.001) and moderate correlations with 4MWT comfortable walking speed (r = .658, p < .001), 4MWT fast walking speed (r = .601,p=.002), 10MWT comfortable walking speed (r = .512, p = .009), and 10MWT dual task (r = .535, p = .006). A low yet significant correlation was noted with the 10MWT fast walking speed (r = .398, p = .049). Association between the 3MBWT and the Zeno Walkway System revealed moderate correlations. All reliability tests were significant at p < .001. Interrater reliability ICC(2,1) values were very high for 3MBWT (ICC(2,1) = 0.93, [0.83–0.91]). Intrarater reliability was also very high (ICC(2,1) = 0.96 [0.90–0.98]). Conclusion: The 3MBWT demonstrates validity and reliability as a tool for assessing gait speed in the posterior direction in people with PD. [ABSTRACT FROM AUTHOR]

Background In recent years, the incidence of non-specific low back pain has been increasing. The duration of conventional treatment is short, and the symptoms tend to rebound, which has a great impact on the body and mind of patients. Objective To investigate the effectiveness of backward walking based on anti-gravity treadmill training system combined with conventional low back core training on patients with non-specific low back pain. Methods A total of 40 patients with non-specific low back pain admitted to the Rehabilitation Department of Zhongshan Hospital, Fudan University from July to December 2022 were divided into the experimental group (20 cases) and control group (20 cases) according to the random number table method. The control group received conventional low back core training, and the experimental group received backward walking based on anti-gravity treadmill training system on the basis of the control group. The Oswestry Disability Index (ODI), Visual Analogue Scale (VAS) and Back Pain Classification Scale (BPS) of the 2 groups were evaluated before and 4 weeks after treatment, respectively. Results There was no significant difference in ODI, VAS and BPS scores between the two groups before treatment (P>0.05) ; after 4 weeks of treatment, ODI, VAS and BPS scores of the 2 groups were decreased, and ODI, VAS and BPS scores of the experimental group were significantly lower than those of the control group (P

Backward walking training presents a great challenge to the physical and neural systems, which may result in an improvement in gait performance. Transcranial direct current electrical stimulation (tDCS), which can non-invasively enhance cortical activity, has been reported to strengthen corticomotor plasticity. We investigated whether excitatory tDCS over the primary motor cortex (M1) or the dorsolateral prefrontal cortex (DLPFC) enhances the effects of backward walking training in healthy participants. Thirty-six healthy participants (16 men and 20 women, mean age 21.3 ± 1.4 years) participated in this study. The participants were randomly assigned to one of the three tDCS groups (M1, DLPFC, and sham). They performed 5 min of backward walking training during 15 min of tDCS. We evaluated dual-task forward and backward walking performance before and after training. Both tDCS groups increased walking speed in the backward condition, but the DLPFC group increased the dual-task backward walking speed more than the M1 group. The M1 group showed decreased gait variability in dual-task backward walking, whereas the DLPFC group showed increased gait variability. Backward walking training combined with M1 stimulation may increase the backward walking speed by reducing gait variability. Backward walking training combined with DLPFC stimulation may prioritize walking speed over gait stability. Our results indicate that backward walking training combined with tDCS may be extended to other rehabilitation methods to improve gait performance. [ABSTRACT FROM AUTHOR]

To compare the effects of backward (BW) and forward (FW) walking training on back geometry and mobility function in children with hemiparetic cerebral palsy (CP). Fifty-five children with hemiparetic CP participated in this study. They were randomly assigned into two groups. For 12 weeks, both groups got a conventional physical therapy program three days/week. Groups A and B got a specifically developed FW walking training (25 minutes/session) and a specially designed BW walking training (25 minutes/session), respectively. The trunk imbalance, lateral deviation, pelvic tilting, pelvic torsion, surface motion, and dynamic gait index of group B improved significantly more than group A (p <.05). Both groups showed significant improvements in all measured variables (p <.05). BW walking training might be considered as an effective therapy modality for improving back geometry and mobility function in hemiparetic CP children compared with FW walking training combined with a typical program. [ABSTRACT FROM AUTHOR]

Backward walking (BW) is an important gait adaptation and BW speed may be an important indicator of walking function and fall risk. However, the measurement characteristics of a standardized assessment of BW post-stroke have not been fully established. To determine intra- and interrater reliability, concurrent validity and minimal detectable change (MDC) scores for the 3-Meter Backward Walk Test (3MBWT) post-stroke. Thirty-four individuals with subacute and 29 individuals with chronic stroke participated. Two trials of comfortable BW was measured over a total distance of 5-meters, while speed was calculated during the middle 3-meters of the walking distance. Intra and interrater reliability were determined by comparing the two trials from one rater and simultaneous assessment of two raters, respectively. Two additional trials were performed and BW speed was calculated using 3MBWT and an instrumented walkway to determine concurrent validity. Intraclass correlation coefficients (ICC) estimated reliability and validity. The MDC was calculated from the standard error of measurement. Excellent ICC values were obtained for the 3MBWT in the subacute (interrater: ICC2,1 = 0.99; intrarater: ICC2,1 = 0.96; validity: ICC2,1 = 0.96) and chronic (interrater: ICC2,1 = 0.99; intrarater: ICC2,1 = 0.94; validity: ICC2,1 = 0.97) groups. The MDC was 0.07 m/s (subacute) and 0.11 m/s (chronic). Establishment of the 3MBWT as a reliable and valid measure in assessing BW speed is an important addition to the assessment toolbox for rehabilitation post-stroke. [ABSTRACT FROM AUTHOR]

Although extensive literature exists on forward and backward walking, a comprehensive assessment of gait parameters on a wide and homogenous population is missing. Thus, the purpose of this study is to analyse the differences between the two gait typologies on a relatively large sample. Twenty-four healthy young adults participated in this study. By means of a marker-based optoelectronic system and force platforms, differences between forward and backward walking were outlined in terms of kinematics and kinetics. Statistically, significant differences were observed in most of the spatial–temporal parameters, evidencing some adaptation mechanisms in backward walking. Differently from the ankle joint, the hip and knee range of motion was significantly reduced when switching from forward to backward walking. In terms of kinetics, hip and ankle moment patterns for forward and backward walking were approximately mirrored images of each other. Moreover, joint powers appeared drastically reduced during reversed gait. Specifically, valuable differences in terms of produced and absorbed joint powers between forward and backward walking were pointed out. The outcomes of this study could represent a useful reference data for future investigation evaluating the efficacy of backward walking as a rehabilitation tool for pathological subjects. [ABSTRACT FROM AUTHOR]

Backward walking and running on positive grades (retrograde training) represents a closed kinetic chain exercise used by rehabilitation specialists for patellofemoral-related injuries. To date, no longitudinal studies exist to support it use. This investigation examined the effects of retrograde training on lower body strength and power in recreational athletes aged 18–50 years over 6 weeks. Thirty-seven subjects were divided into two groups. Group 1 performed retrograde training 3 days∙wk−1 using treadmill speeds, grades and bout durations ranging from 1.6–4.9 m∙sec−1 , 2.5–27.5% and 10–30 seconds, respectively (RG, n=19). Group 2 was a control group who continued their normal training (CON, n=18). Pre- and posttests assessed a variety of unilateral and bilateral measures including vertical and linear jumps, one repetition maximum leg press strength, and positive and negative power during weighted squat jumping on a horizontal leg press with a force plate. RG improved significantly in all tests (P<0.05). Mean effect size (ES) of the relative improvement in a majority of tests revealed a moderate to very large ES of RG training (ES range: 0.77–2.71). We conclude retrograde training effective for improving lower body strength and power in recreational athletes. [ABSTRACT FROM AUTHOR]

Forward walking (FW) is a common balance assessment tool. However, its sensitivity is limited by the ceiling effect. Reverse gait, such as backward walking (BW), has been reported to have more advantages than FW for balance assessment. Three factors related to postural instability (i.e., increased speeds, restricted arm swing, and reduced visual feedback) during BW were investigated to determine BW conditions that have the potential to predict falls. Three-dimensional analyses were used to analyze seven walking conditions. FW and BW at self-selected and fast speeds were analyzed to identify the effects of speed. Walking with normal arm swings, crossed arms, and abducted arms during BW was tested to determine the effects of arm position. BW with closed and open eyes was compared to investigate the effects of visual feedback. BW had a significantly shorter step length than FW at high speeds. When the arms were abducted, the stance phase (%) was significantly lower compared to when arms were crossed during BW. Moreover, BW with closed eyes revealed significantly higher mediolateral center of mass (COM) displacements than with open eyes. We observed that BW with fast speeds, a crossed arm position, and closed eyes has the potential to help assess fall risk because it requires higher balance ability through spatiotemporal and COM adjustment. [ABSTRACT FROM AUTHOR]

Introduction: Balance tests are helpful in assessing a population with variety of conditions. Computerised dynamic posturography, and other tools for balance assessment are expensive, difficult to handle/use and also not readily available. Thus, basic screening exams like 3-Meter Backward Walk Test (3MBWT) are developed. The 3MBWT is used to assess backward walking mobility, balance, and risk of fall.3-meter backward walk test (3MBWT) is a quick, easy, and clinically standardised way to evaluate backward walking and is therefore a tool for balance assessment. Aim: The study aims to review the validity and reliability of 3MBWT in individuals with balance impairments. Materials and Methods: The study commenced by exploring the databases including PubMed/Medline, Google Scholar, and Scopus to uncover full text publications authored in English. A total of 34 articles were retrieved after extensive data search, which were evaluated and only 13 articles met the inclusion criteria and were reviewed. Young adults, older adults and older populations with neurological and musculoskeletal impairments were included. Results: 3MBWT shows excellent intrarater, interrater and test-retest reliability (ICC>0.80) and moderate to strong co-relations with already established tools for balance assessment therefore is having good concurrent validity. Conclusion: 3MBWT is a reliable, valid and user-friendly tool for assessment of balance and fall risk and should therefore be included in the series of tests while assessing patients with neurological or musculoskeletal conditions. Implications: The findings may be administered in assessment of balance and risk of fall. [ABSTRACT FROM AUTHOR]

Balance impairment and accidental falls are a pervasive challenge faced by persons with multiple sclerosis (PwMS), significantly impacting their quality of life. While exercise has proven to be an effective intervention for improving mobility and functioning in PwMS, current exercise approaches predominantly emphasize forward walking (FW) and balance training, with variable improvements in balance and fall rates. Backward walking (BW) has emerged as a promising intervention modality for enhancing mobility and strength outcomes; however, significant gaps remain. Specifically, there is limited knowledge about the efficacy of BW interventions on outcomes such as static, anticipatory, and reactive balance, balance confidence, falls, and cognition. This randomized controlled trial aims to determine the feasibility, acceptability, and impact of 8-weeks of backward walking training (TRAIN-BW) as compared to forward walking training (TRAIN-FW). Ninety individuals with MS with self-reported walking dysfunction or ≥ 2 falls in the past 6 months will be randomized in blocks, stratified by sex and disease severity to either the TRAIN-BW or TRAIN-FW intervention groups. Adherence and retention rates will be used to determine feasibility and the Client Satisfaction Questionnaire will be used to assess acceptability. The primary outcomes will be static, anticipatory, and reactive balance. Secondary outcomes include walking velocity, balance confidence, concern about falling, cognition, physical activity, and fall rates measured prospectively for 6 months after post-testing. Additionally, the extent to which cognitive functioning influences response to intervention will be examined. Backward walking training may be an innovative intervention to address balance impairments and falls in persons with MS. [ABSTRACT FROM AUTHOR]

Introduction Recently backward/retro walking has been increasingly used in medicine. Kinetic and kinematic analysis during backward walking showed advantages over traditional ambulation making it ideal for those who struggle with knee pain. Retro walking is well known for reducing the strain on the knees and it is one of the few natural ways to strengthen the quadriceps of the thigh. Walking backwards leads to a more significant load on the cardiovascular and respiratory systems. This load builds a more substantial increase in both the aerobic and anaerobic capabilities than just walking forward with similar parameters of physical activity. Material and methods A systematic search of studies published during the period up to February 2020 was conducted using bibliographic databases in English, including Medline, PubMed, Scopus, Web of Science and in Russian, including eLIBRARY, CyberLeninka to summarize the available information on the possibilities of retro walking in treatment and rehabilitation of patients with knee pathology. Search terms included 'backward/retro walking/running', 'knee joint'. Results and discussion Several studies have been performed to explore the effectiveness of backward walking for knee osteoarthritis. There is a strong evidence that backward walking can be a useful adjunct to conventional physiotherapy to improve pain, knee function and strength of the quadriceps muscles. There is a limited number of papers describing effects of backward walking for patellofemoral pain syndrome and anterior cruciate ligament injury. Conclusions Although there is little data overall reporting effects of backward walking, and more studies are needed to further explore this topic this version of walking has been shown to provide great beneficial effects in knee joint rehabilitation.

Background: Backward walking exercise may offer some unique and potentially beneficial differences compared with forward walking exercise. There is still a lack of research on backward walking exercises and forward head posture. Objects: The purpose of this study was to determine the effect of backward walking exercise on college students forward head posture in their 20s. Methods: Twenty-one subjects participated in the experiment. The subjects were those with a craniovertebral angle (CVA) of 55 degrees or less who understood the purpose and method of this study and voluntarily agreed. A camera capable of taking pictures of the lateral plane was installed at a distance of 1.5 meters before exercising. Pictures were taken before walking backward, and after walking for 15 minutes on the treadmill, the images were taken in the same way. The composition of the backward walking exercise was walking at a rate of 1.0 for 5 minutes, and the remaining 10 minutes were walking at a rate of 1.5. Wilcoxon signed rank test was used to compare CVA and craniorotational angle (CRA) before and after exercise. Results: As a result of this study, there was a significant difference in CVA before and after exercise (p < 0.05). There was a significant difference in CRA before and after exercise (p < 0.05). Conclusion: The backward walking exercise and verbal command seems to have positively influenced the changes in CVA and CRA among college students in their 20s. It seems that studies to confirm balance or muscle activity as well as changes in forward head posture through the long-term intervention of the backward walking exercise should be conducted.

In recent years backward walking is increasingly used in sports and medicine. During sports training backward walking can be used as one of the methods of fitness. Backward walking increases the cardiovascular and respiratory loads and aerobic and anaerobic capacities of the organism. Backward walking is associated with less overload of knee joints. It is also one of the few natural ways of strengthening the quadriceps. Backward walking training has found its application in rehabilitation programs for different categories of neurological patients with the aim of restoring sustainable body position and gait. Backward walking is used to elaborate the correct pattern of gait in children with cerebral palsy, in persons with hemiplegia after stroke, in patients suffering from Parkinson’s disease and multiple sclerosis, in spinal cord injured patients. There is an information about the application of backward walking exercises in diabetic foot syndrome in order to reduce a plantar pressure and in physical rehabilitation of postoperative patients. Tests with backward walking are used for diagnostic purposes - to assess the severity of impaired coordination and motor skills in post-stroke patients and in Parkinson's disease, to identify the minimal walking impairment in persons with multiple sclerosis and for probability of falling prediction in elderly individuals and patients with dizziness.

Although there is growing literature supporting the implementation of backward walking as a potential rehabilitation tool, moving backwards may precipitate falls for persons with Parkinson's disease. We sought to better understand interlimb coordination during backward walking in comparison to forward walking in persons with Parkinson's disease and healthy controls. We assessed coordination using point estimate of relative phase at each participant's preferred walking speed. Persons with Parkinson's disease demonstrated impaired interlimb coordination between the more affected arm and each leg compared to controls, which worsened during backward walking. For those with Parkinson's disease, inability to output smooth coordinated movement of the more affected shoulder may impair coordination during forward and, especially, backward walking. Our findings provide new information about backward walking that can allow clinicians to make safer, more effective therapeutic recommendations for persons with Parkinson's disease. • Point estimate of relative phase was used to assess coordination in those with PD. • Those with PD had significantly impaired limb coordination while walking backward. • More affected shoulder was involved in impaired coordination in backward walking. [ABSTRACT FROM AUTHOR]

Objective: The present study aimed to assess proprioception of the knee to evaluate the effectiveness of backward walking for rehabilitation after anterior cruciate ligament (ACL) reconstruction. Methods: Patients (n = 52) who underwent ACL reconstruction in a single knee divided randomly into four experimental groups (A-D) and a control group, who all practiced a systematic rehabilitation exercise program. The patients in the experimental groups underwent backward walking using different treadmill angles: group A (0°), B (5°), C (10°) and D (15°). The whole training period comprised 4 weeks. Outcomes for the joint were assessed using the Angle Reproduction Test (ART) and Passive Motion Perception Test (PMPT). Results: Compared with the pre-training recorded parameters, significant differences were found in the ART and PMPT scores among all training groups and between the control group and the training groups. When the four training groups were compared with each other, there was no difference in the ART results between groups A and B, but significant differences were found between group A and groups C and D. Conclusion: Backward walking as a rehabilitation technique improved knee proprioception after ACL reconstruction. Increasing the angle of the treadmill during exercise improved the efficacy of rehabilitation. [ABSTRACT FROM AUTHOR]

Equine physiotherapy commonly includes basic exercises such as walking backward (BW) and voluntary lifting of single limbs (SLL), but trunk movements during these have not been studied. In order to compare the trunk kinematics during BW and SLL with forward walking (FW), nine horses were measured in FW, BW and during SLL triggered by tactile cue. Kinematics were obtained from skin markers captured by ten high-speed video cameras. Trunk angles were calculated in sagittal and horizontal planes from withers, dorsal to spinous processes of the 16th thoracic vertebra (T16), 2nd and 4th sacral vertebrae (S2, S4), WT16S2 and T16S2S4 respectively. From the hooves, maximum hoof height during swing phase and horizontal distance between hoof and median body plane during swing and stance phases were determined. Dorsoventral range of motion (ROM) and maximum flexion of WT16S2 was significantly larger in BW than in FW, while laterolateral ROM was significantly smaller during hindlimb swing phase in BW and SLL than in FW. In contrast, dorsoventral ROM of T16S2S4 was significantly smaller during stance and swing phases of hindlimbs in BW compared to FW, and throughout the movement. During forelimb swing phase, T16S2S4 ROM was significantly larger in BW than SLL. Hindhoof height in SLL was significantly higher than in FW. Distance between median body plane and hooves was significantly larger in BW than in FW, and significantly larger in BW than in SLL for hindlimb swing phase. In BW, increased lumbosacral stabilisation and the larger area of support created by fore- and hindlimbs may represent a strategy to enhance body stabilisation, as BW entails some insecurity. • Sagittal back movement increased walking backwards (BW) compared to forwards (FW). • Lumbosacral flexion was greater during BW than during FW. • Fore- and hindlimbs created a larger area of support in BW compared to FW. • Range of trunk movement decreased during single limb lifts compared to locomotion. [ABSTRACT FROM AUTHOR]

Introduction: Retro walking or backward walking is an exercise mode which incurs an increased metabolic cost and results in a greater cardiopulmonary demand when compared to forward walking, while placing a lower stress on the joints of the lower limb. Abdominal adiposity, a part of metabolic syndrome, is an early risk-factor for morbidity and mortality in adulthood. Aim: The study aims to compare the effect of retro walking treadmill training and that of forward walking treadmill training, as potential modifiers of general obesity and abdominal obesity in untrained young adults. Materials and Methods: In this quasi experimental study, 111 untrained young men/young males aged 18-25 who were students of a medical university in Kingdom of Saudi Arabia were recruited and allocated randomly into two groups. One group underwent retro walking treadmill training five times a week for six weeks, and the other group underwent forward walking treadmill training for the same period. Waist-Hip Ratio (WHR), Waist- Height Ratio (WHtR) and Body Mass Index (BMI) were measured before and after the six-week intervention and subjected to statistical analysis. Results: There was a significant reduction in WHR and WHtR in the participants of the retro walking program when compared to participants of forward walking program. The decrease in BMI was not statistically significant. Conclusion: A retro walking training program is more effective in reducing BMI, WHR and WHtR in untrained young adults as compared to a forward walking program.

Introduction: Retro walking or backward walking is an exercise mode which incurs an increased metabolic cost and results in a greater cardiopulmonary demand when compared to forward walking, while placing a lower stress on the joints of the lower limb. Abdominal adiposity, a part of metabolic syndrome, is an early risk-factor for morbidity and mortality in adulthood. Aim: The study aims to compare the effect of retro walking treadmill training and that of forward walking treadmill training, as potential modifiers of general obesity and abdominal obesity in untrained young adults. Materials and Methods: In this quasi experimental study, 111 untrained young men/young males aged 18-25 who were students of a medical university in Kingdom of Saudi Arabia were recruited and allocated randomly into two groups. One group underwent retro walking treadmill training five times a week for six weeks, and the other group underwent forward walking treadmill training for the same period. Waist-Hip Ratio (WHR), Waist-Height Ratio (WHtR) and Body Mass Index (BMI) were measured before and after the six-week intervention and subjected to statistical analysis. Results: There was a significant reduction in WHR and WHtR in the participants of the retro walking program when compared to participants of forward walking program. The decrease in BMI was not statistically significant. Conclusion: A retro walking training program is more effective in reducing BMI, WHR and WHtR in untrained young adults as compared to a forward walking program. [ABSTRACT FROM AUTHOR]

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BACKGROUND: Backward walking is mainly considered to improve the symptoms of patients with knee osteoarthritis, which is used for rehabilitation and adjuvant treatment of knee osteoarthritis, but there is no evidence for evidence-based medicine. OBJECTIVE: To systematically review and quantify the evidence for the effect of backward walking on knee osteoarthritis in order to clarify the effect of backward walking on knee osteoarthritis. METHODS: PubMed, CINAHL, EMBASE, CNKI, CBM, WanFang and VIP were searched for relevant literature. After randomized controlled trials were screened, a meta-analysis was used to evaluate the effectiveness of backward walking on knee osteoarthritis. A total of 7 articles involving 231 patients were included in the result analysis. RESULTS AND CONCLUSION: Meta-analysis found that: compared with conventional treatment alone, the combination of conventional treatment with backward walking was better in pain relief [mean difference (MD)=-1.05, 95% confidence interval (CI) (-1.46, -0.63), P= 0.000 1], improving knee joint function [standardized mean difference (SMD)=-0.98, 95% CI (-1.33, -0.64), P < 0.000 01], enhancing quadriceps strength [SMD=1.07, 95% CI (0.52, 1.63), P=0.000 2] and improving timed up to go performance [MD=-0.41, 95% CI (-0.67, 0.16), P=0.001]. However, there was no significant difference in the WOMAC score after backward and forward walking [SMD=-0.43, 95% CI (-0.94, -0.08), P=0.10]. Meta-analysis results indicate that the combination of backward walking with conventional treatment has better clinical efficacy than conventional treatment alone for knee osteoarthritis patients. However, on the basis of conventional treatment, backward walking has comparable effects on WOMAC scores as compared with forward walking, which needs further large-sample high-quality randomized controlled trials to be verified. [ABSTRACT FROM AUTHOR]

Backward walking (BW) has been extensively used in athletic training and orthopedic rehabilitation as it may have value for enhancing balance. This study identified the differences in foot intersegment kinematics (forward walking (FW) vs. time-reversed BW) and plantar pressure parameters of 16 healthy habitually shod individuals walking FW and BW using flexible shoes (SH) and under barefoot conditions (BF). BW was found to have shorter stride length (SL) and higher stride frequency (SF) under BF conditions compared with SH, which indicates a better BW gait stability under BF conditions. Decreased HX/FF dorsiflexion at HO in BW induces less plantar aponeurosis tension which may inhibit the windlass mechanism compared to FW walking. Increased forefoot relative to hindfoot (FF/HF) pronation and sequentially hindfoot relative to tibia (HF/TB) eversion combined with medially distributed plantar pressure and a higher plantar contact area in the medial side in BW-BF maybe beneficial in maintaining balance. These results indicate that BW training may be more reliable under BF conditions compared to the SH conditions based on greater sensory information feedback from the plantar area resulting in better biomechanical behavior. [ABSTRACT FROM AUTHOR]

BACKGROUND: Multiple sclerosis (MS) is identifiable by the destruction of myelin in the central nervous system leading to gait and balance dysfunction. Our laboratory has shown that backward-walking (BW) velocity in addition to MRI measures may improve fall prediction for people with MS (PwMS). OBJECTIVES: This case series examines the impact of an 8-week BW training program on the superior cerebellar peduncle (SCP) and body of the corpus callosum (CCbody), utilizing myelin water imaging (MWI) and associated changes in gait, postural control, and falls. METHODS: Eight individuals with relapsing-remitting MS and self-reported walking dysfunction on the 12-item Multiple Sclerosis Walking Scale (age range, 51-65 years; Patient Determined Disease Steps score range, 1-5; 2 men, 6 women) participated in this pilot study. Participants completed functional tests (backward- and forward-walking velocity; sway during an eyes-closed, feet-together (ECFT) balance task; postural latency of stepping in reactive balance) and 3T MRI before and after the 8-week intervention, consisting of treadmill and overground BW once per week and home exercises twice per week. Falls were monitored for 6 months after the intervention. The MWI metric of geometric mean of the intra-/extracellular water T2 (geomT2IEW), reflecting axon size/packing density, was estimated from the SCP and CCbody. RESULTS: Of the 8 participants, 7 demonstrated increased geomT2IEW in both the SCP and CCbody, and the change in structure was associated with an improvement in forward-walking (4 of 8 participants) and BW velocity (6 of 8 participants). All participants improved sway metrics during the challenging ECFT task after training. Reactive stepping responses on the push-and-release task improved in 7 participants; 2 participants could not generate reactive steps in the backward direction before training but were able to elicit responses after training. Participants were divided into quartiles by BW speed. Before training, 7 participants fell into the lowest 2 quartiles with velocities of < 0.91 m/s. After training, 4 participants improved their walking enough to move quartiles and reduce their fall risk. CONCLUSIONS: Our results suggest that BW training appears to have both structural (SCP and CCbody) and functional (gait, balance, and reactive stepping) effects over 8 weeks. Future studies should examine structural and functional changes in a larger sample size undergoing more intensive training. Incorporating MWI to assess brain regions potentially associated with BW performance could result in more targeted therapies that enhance clinical outcomes for PwMS. [ABSTRACT FROM AUTHOR]

Purpose: Forward Walking (FW) and Backward Walking (BW) on different gradients of the treadmill is a common exercise for lower extremity rehabilitation. However, limited studies are found about the three-dimensional analysis of lower extremity and status of the knee joint during FW and BW on different gradients. Therefore, this study aimed to investigate the lower extremity joints kinematics during FW and BW on incline and decline surfaces. Methods: The current research has a quasi-experimental design. Sixteen healthy males with the mean (SD) age of 22.4(2.5) years, volunteered to participate in this study. The subjects’ FW and BW with their preferred speed on a treadmill at four gradients (-7.5%, 0%, +5% and +10%), were analyzed by using motion capture system. All data were analyzed using paired sample t test (P

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Background: Population based studies showed that a lifetime prevalence of neck pain was 70% and a point prevalence was between 12-34%. Most common causes of neck pain include:- myogenic positional faults, septic arthritis, osteomyelitis, ankylosing spondylitis, fractures, torticollis, paget's disease, neurogenic causes as well as soft tissue injuries, vertebral tumor. Backward walking has shown potential benefits in lengthening of posterior muscular chain and stretching the posterior myofascial. There is greater amount of hip extension and knee flexion in backward walking as compared to forward walking. As there is greater amount of hip extension, there occurs greater amount of extension of lumbar spine which loads up the facet joint opening up the disc space. The unloading of the discs occurred may lead to reduction in the pain. Objectives: To study the effect of backward walking in subjects with mechanical neck pain Method: Ethical clearance was obtained from the Institutional Ethical Committee. 38 subjects were selected between the age group 20 to 40 years suffering from mechanical neck pain from 1 month. Male and female subjects were selected according to inclusion and exclusion criteria. Pre values of numeric pain rating scale and cervical lordotic index were taken. Study was carried out for 5 days for 1 week. Post data analysis was note and data analysis was done. Result: A statistical analysis using paired t test within the group comparison was done and conclusions was estimated. Result found from analysis was significant. Conclusion: There was a reduction in pain status and cervical curve between the values of pre study and post study. Hence, this study concludes that there is effectiveness in backward walking in subjects with mechanical neck pain [ABSTRACT FROM AUTHOR]

BACKGROUND: Clinical conservative treatment can easily lead to the recurrence of lumbar disc herniation. Backward walking is a popular rehabilitation exercise method for the treatment of lumbar disc herniation. After clinical guidance treatment, patients walk backwards and follow up statistics, confirming that walking backwards is an effective rehabilitation exercise therapy. OBJECTIVE: Based on biomechanics, the significance of backward walking for lumbar rehabilitation was explored by finite element analysis. METHODS: The three-dimensional model of lumbar spine was established based on CT images, and then the mechanical conditions of lumbar spine were simulated. The finite element method was used to examine the role of backward walking in the treatment of lumbar disc herniation from the mechanical point of view. RESULTS AND CONCLUSION: (1) The displacement of L1-L2 intervertebral disc was only 1/2 of that of the gait, and the stress of the intervertebral disc was greatly reduced when walking backwards. (2) The stress of L1-L2 intervertebral disc during gait progression was 2.35 times as much as that during walking backwards. (3) Therefore, the changes of stress and displacement of lumbar spine and intervertebral disc are smaller than that of normal gait, which reduces the pressure on nucleus pulposus and helps the recovery of patients with lumbar disc herniation. [ABSTRACT FROM AUTHOR]

Background: Forward and backward walking are both impaired in Parkinson disease (PD). In this study, an exploratory factor analysis was performed to investigate the relationship between forward and backward walking in PD.Research Question: Given the difference in levodopa response between forward and backward walking, what is the additive value of testing backwards walking in a clinical setting.Methods: Sixty-two patients with PD (65.29 ± 7.17 yrs, UPDRS OFF = 29.68 ± 9.88, UPDRS ON = 16.40 ± 8.21) and eleven healthy age-matched controls (63.09 ± 8.09 yrs) were recruited. PD participants completed forward (F) and backward (B) walking tasks on a 6.1 m instrumented walkway (OFF and ON levodopa). Factor analysis was used to derive models for both walking tasks/medication states.Results: In both OFF and ON, four factors were identified: Variability (OFF: F = 30.0%, B = 17.8%, ON: F = 21.6%, B = 25.0%), Rhythm (OFF: F = 14.5%, B = 17.0%, ON: F = 17.4%, B = 19.0%), Asymmetry (OFF: F = 13.7%, B = 14.3%, ON: F = 16.1%, B = 15.2%), and Pace (OFF: F = 12.2%, B = 17.0%, ON: F = 13.9%, B = 8.7%). In the ON state, a fifth factor was identified: Posture (ON: F = 3.8%, B = 7.7%).Significance: This study demonstrates the similarity in gait domain factors in both forward and backward walking. While domains of gait are similar in both walking tasks, levodopa response is reduced in backward walking. This could be a result of the increased complexity of backward walking. This study provides a normative dataset that can be used when assessing forward and backward walking in individuals with PD. [ABSTRACT FROM AUTHOR]

Background: With limited inpatient rehabilitation (IR) length of stays for patients post-stroke, it is critical to maximize the effectiveness of interventions to address their balance and gait speed deficits. Backward walking (BW) is an emerging training approach; however, its application to patient populations consistent with those in IR is limited. Objectives: To describe the effects of an additional BW training program to standard IR care on balance, walking ability and fall-risk in a heterogenic caseload of adults <2 weeks post-stroke with a broad range of lesion locations and physical sequelae. Methods: Eight patients with first-time stroke (5 male; average age 66.5 ± 11.7 years; average stroke onset 7.6 ± 1.6 days; 6 right hemiparesis) participated in 10-daily sessions that included 20 min of over ground BW training for each session, in addition to standard IR. Standard outcome measures were used to assess balance, walking ability and fall-risk at admission and post-intervention. Results: All eight patients demonstrated improvements in all outcomes with a clinically meaningful increase in forward walking speed, as measured by 10MWT. Four participants exceeded fall-risk cut-off scores for all balance-related outcome measures. Conclusions: In a diverse patient population early after stroke, individuals successfully participated in an additional BW training program. Despite the patients' acuity and severe impairments in walking, significant gains in balance and walking function were noted. This program may be useful in improving outcomes with patient characteristics commonly seen in IR. [ABSTRACT FROM AUTHOR]

Background: While over half of stroke survivors recover the ability to walk without assistance, deficits persist in the performance of walking adaptations necessary for safe home and community mobility. One such adaptation is the ability to walk or step backward. Post-stroke rehabilitation rarely includes backward walking (BW) assessment and BW deficits have not been quantified in post-stroke community ambulators. Objective: To quantify spatiotemporal and kinematic BW characteristics in post-stroke community ambulators and compare their performance to controls. Methods: Individuals post-stroke (n = 15, 60.1 ± 12.9 years, forward speed: 1.13 ± 0.23 m/s) and healthy adults (n = 12, 61.2 ± 16.2 years, forward speed: 1.40 ± 0.13 m/s) performed forward walking (FW) and BW during a single session. Step characteristics and peak lower extremity joint angles were extracted using 3D motion analysis and analyzed with mixed-method ANOVAs (group, walking condition). Results: The stroke group demonstrated greater reductions in speed, step length and cadence and a greater increase in double-support time during BW compared to FW (p <.01). Compared to FW, the post-stroke group demonstrated greater reductions in hip extension and knee flexion during BW (p <.05). The control group demonstrated decreased plantarflexion and increased dorsiflexion during BW, but these increases were attenuated in the post-stroke group (p <.05). Conclusions: Assessment of BW can unmask post-stroke walking impairments not detected during typical FW. BW impairments may contribute to the mobility difficulties reported by adults post-stroke. Therefore, BW should be assessed when determining readiness for home and community ambulation. [ABSTRACT FROM AUTHOR]

Objectives: This study aims to examine the effect of backward walking (BW) and forward walking (FW) on the myoelectric activity ratio of the vastus medialis oblique (VMO)/vastus lateralis (VL) in females with patellofemoral pain syndrome (PFPS). Patients and methods: Between September 2016 and December 2016, a total of 40 female participants (mean age 20.9±1.9 years; range, 19 to 26 years) were included in the study. The participants were divided into two groups as those with unilateral PFPS (PFPS group, n=20) and healthy controls (Control group, n=20). Surface electromyography (EMG) from VMO and VL muscles were collected during FW and BW at a speed of 3 km/h using the Myomonitor® IV EMG system. Results: There was a significant increase in the EMG activities of the VMO and VL muscles during BW compared to FW in PFPS and healthy groups (p=0.001). During BW, the VMO activity of PFPS was significantly higher than the healthy controls (p=0.013) without any significant difference in the VL activity (p=0.916). During FW, there was no significant difference in the VMO and VL activities between the groups (p=0.348 and p=0.705), respectively. The VMO/VL ratio of the PFPS group during BW was significantly higher than the FW ratio (p=0.001) without any significant difference between BW and FW of the healthy group (p=0.841). During BW, the ratio of the PFPS group was significantly higher than compared to the healthy controls (p=0.016) without any significant difference between the groups during FW (p=0.100). Conclusion: Our study results show that BW increases the VMO muscle activation and preserve the ideal VMO/VL ratio in PFPS patients. Therefore, clinicians should consider BW training when developing rehabilitation programs for females with PFPS. [ABSTRACT FROM AUTHOR]

Studies have compared the differences and similarities between backward walking and forward walking, and demonstrated the potential of backward walking for gait rehabilitation. However, current evidence supporting the benefits of backward walking over forward walking remains inconclusive. Considering the proven association between gait and the cerebral cortex, we used electroencephalograms (EEG) to differentiate the effects of backward walking and forward walking on cortical activities, by comparing the sensorimotor rhythm (8–12 Hz, also called mu rhythm) of EEG signals. A systematic signal procedure was used to eliminate the motion artifacts induced by walking to safeguard EEG signal fidelity. Statistical test results of our experimental data demonstrated that walking motions significantly suppressed mu rhythm. Moreover, backward walking exhibited significantly larger upper mu rhythm (10–12 Hz) suppression effects than forward walking did. This finding implies that backward walking induces more sensorimotor cortex activity than forward walking does, and provides a basis to support the potential benefits of backward walking over forward walking. By monitoring the upper mu rhythm throughout the rehabilitation process, medical experts can adaptively adjust the intensity and duration of each walking training session to improve the efficacy of a walking ability recovery program.

Backward walking (BW) is being increasingly used in neurologic and orthopedic rehabilitation as well as in sports to promote balance control as it provides a unique challenge to the sensorimotor control system. The identification of initial foot contact (IC) and terminal foot contact (TC) events is crucial for gait analysis. Data of optical motion capture (OMC) kinematics and inertial motion units (IMUs) are commonly used to detect gait events during forward walking (FW). However, the agreement between such methods during BW has not been investigated. In this study, the OMC kinematics and inertial data of 10 healthy young adults were recorded during BW and FW on a treadmill at different speeds. Gait events were measured using both kinematics and inertial data and then evaluated for agreement. Excellent reliability (Interclass Correlation > 0.9) was achieved for the identification of both IC and TC. The absolute differences between methods during BW were 18.5 ± 18.3 and 20.4 ± 15.2 ms for IC and TC, respectively, compared to 9.1 ± 9.6 and 10.0 ± 14.9 for IC and TC, respectively, during FW. The high levels of agreement between methods indicate that both may be used for some applications of BW gait analysis.

Background: Backward walking (BW) training is thought to impact balance performance through improving motor system proprioception and gait characteristic, but relevant evidence remains sparse and inconclusive.Objective: This study systematically reviewed and quantified the scientific evidence regarding the effectiveness of BW training on balance performance.Methods: Keyword and reference search on BW training interventions was conducted in six electronic databases (PubMed, Web of science, SPORTDiscus, CINAHL, Cochrane Library, and CNKI) for peer-reviewed articles published till November 2017. A standardized form was used to extract data from each selected article that met the pre-specified eligibility criteria. Meta-analysis was conducted to estimate the pooled effects of BW training on balance performance measures.Results: Eleven studies (nine randomized controlled trials and two pre-post studies) met the eligibility criteria and were included in the review. All studies reported some beneficial effects of BW training on balance performance. Compared to control, BW training was associated with a reduction in overall stability index score by 0.99 (95% CI = 0.37, 1.61; I2 = 0.0%; fixed-effect model), medial-lateral stability index score by 0.95 (95% CI = 0.34, 1.57; I2 = 0.0%; fixed-effect model), and anterior-posterior stability index score by 0.99 (95% CI = 0.37, 1.61; I2 = 0.0%; fixed-effect model). Meanwhile, BW training was associated with an increase in open-eyes single leg standing duration by 0.91 s (95% CI = 0.29, 1.53; I2 = 75.9%; random-effect model) in comparison to control.Conclusions: BW training could serve as a potentially useful tool to improve balance performance among those with a high risk of fall. However, current evidence remains preliminary due to the small cohort of studies and possible learning effect in pre-post studies. Future work with larger scale and randomized experimental design is warranted to evaluate the effectiveness of BW training on balance performance across diverse population and disease subgroups, and elucidate the underlying biomechanical and neurological pathways. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effectiveness of backward walking in the treatment of people with gait impairments related to neurological and musculoskeletal disorders. Design: Systematic review and meta-analysis of randomized and quasi-randomized control studies. Data sources: Searched from the date of inception to March 2018, and included PubMed, Scopus, Cochrane Library, PEDro, CINAHL, and the MEDLINE databases. Methods: Investigating the effects of backward walking on pain, functional disability, muscle strength, gait parameters, balance, stability, and plantar pressure in people with gait impairments. The PEDro scale was used to assess the quality. Similar outcomes were pooled by calculating the standardized mean difference. Results: Of the 21 studies (neurological 11 and musculoskeletal 10), 635 participants were included. The average PEDro score was 5.4/10. The meta-analysis demonstrated significant standardized mean difference values in favour of backward walking, with conventional physiotherapy treatment for two to four weeks to reduce pain (−0.87) and functional disability (−1.19) and to improve quadriceps strength (1.22) in patients suffering from knee osteoarthritis. The balance and stability in cases of juvenile rheumatoid arthritis, and gait parameters and muscle strength in anterior cruciate ligament injury improved significantly when backward walking was included as an exercise. There was no significant evidence in favour of backward walking in any of the other conditions. Conclusion: The systematic review and meta-analysis suggests that backward walking with conventional physiotherapy treatment is effective and clinically worthwhile in patients with knee osteoarthritis. Insufficient evidence was available for the remaining gait impairment conditions and no conclusions could be drawn. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effects of backward gait training on balance, gross motor function, and gait parameters in children with cerebral palsy. Data sources: PubMed, Cochrane Library, Web of Science, Science Direct, Physiotherapy Evidence Database (PEDro), and Google Scholar were searched up to May 2018. Review methods: Randomized controlled trials were included if they involved any form of backward gait training for children with cerebral palsy. Two authors independently screened articles, extracted data and assessed the methodological quality using PEDro scale, with any confliction resolved by the third author. Modified Sackett Scale was used to determine the level of evidence for each outcome. Results: Out of 1492 papers screened, 7 studies with 172 participants met the inclusion criteria. The duration of treatment ranged from 15 to 25 minutes, three times a week and for 6–12 weeks. The quality of studies ranged from good (two studies) to fair (four studies) and poor (one study), with a mean PEDro score of 4.7 out of 10. All included studies showed positive effects in the measured outcomes. The results showed level 1b evidence for balance when compared to no intervention, and for gross motor function, step length and walking speed when compared to same dose of forward gait training. The clinical heterogeneity of studies makes meta-analysis inappropriate. Conclusion: In children with cerebral palsy, there is moderate evidence that backward gait training improves balance, gross motor function, step length and walking velocity. More high-quality studies are needed. [ABSTRACT FROM AUTHOR]

Background/Aims: Little is known regarding the activation of knee and hip muscles during backward walking in patellofemoral pain syndrome. This study examineD the effects of backward walking and forward walking on the activation of knee extensors, hip abductors, and adductors in patients with patellofemoral pain syndrome. Methods: A total of 20 females with patellofemoral pain syndrome and 20 age-matched typically healthy female controls participated in this study. Surface electromyography from vastus medialis obliquus, vastus lateralis, gluteus medius, and adductor longus muscles were collected during forward walking and backward walking. Findings: The patellofemoral pain syndrome group had a significantly higher normalised root mean square of the vastus medialis obliquus, vastus lateralis and gluteus medius muscles (P=0.001), without significant difference in adductor longus muscle activity during backward walking versus forward walking (P=0.098). During forward walking, the patellofemoral pain syndrome group showed significantly higher activation of adductor longus muscle (P=0.001) and significantly lower activation of the gluteus medius muscle (P=0.002) compared to the healthy group. During backward walking there was a significant increase in the vastus medialis obliquus and adductor longus muscle activity of the patellofemoral pain syndrome group compared to the control group (P=0.003, 0.001) respectively. Conclusions: Clinicians should consider backward walking training to increase the muscle strength of knee extensors and hip abductors when developing rehabilitation programmes for patients with patellofemoral pain syndrome. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study is to find the effect of proprioception exercise and backward walking training among diabetic neuropathy patients. Background of the Study: The physical activity is the key element in prevention and management of diabetes mellitus. Physiotherapy intervention, such as aerobic exercise, resisted exercise, and endurance exercise lower blood glucose level, among diabetes mellitus patients. The background of the study is to find the effectiveness of proprioception training and backward walking training among diabetic neuropathy patients for the improvement of proprioception sensation of lower limbs and improve the quality of life in diabetic neuropathy patients. Materials and Methods: Once the study is approved by the Institutional Review Board, 30 patients both male and female were selected from clinically diagnosed diabetic neuropathy. The study setting was in Chennai. The source population includes patient with a clear history of diabetes mellitus, the patient has symptoms of neuropathy such as numbness and tingling sensation of extremities, loss of sensations, and abnormal sensation (dysesthesia), for example, burning and electric pain and both male and female. The age group was within 40-55 years. The Patient who score <20 s in time up and go test. Patient who score 21-40 in berg balance scale (BBS) grading test. Clinically diagnosed diabetes mellitus. The study population excludes severe traumatic illness in lower limbs, poor vision that affects walking, severe cardiopulmonary insufficiency, presence of other forms of neuropathies such as mononeuropathy, severe pain, and muscle weakness, and psychiatric illness. The samples were fully explained about the benefits of participating in the study. They were asked to fill the consent form duly signed by the samples and therapist. Data regarding the balance were collected using the BBS and time up and go test. Result: The result of this study shows that both proprioception exercise training and backward walking training are effective in increasing proprioception sensation of lower limbs. However, proprioception exercise training was better than backward walking training in improving the proprioception sensation of lower limbs among diabetic neuropathy patients. [ABSTRACT FROM AUTHOR]

Background: Patients with spastic Cerebral Palsy are prone to equinus deformities, likely affected by short and inextensible plantarflexor muscles. Manual stretching is a popular treatment but its effectiveness concerning joint mobility, muscle-tendon morphometrics and walking function is debated. Eccentric exercise by backward-downhill treadmill training could be a therapeutic alternative for ambulatory patients improving gait and muscle function.Research Question: What are the effects of eccentric training by backward-downhill treadmill training and plantarflexor stretching concerning gait and muscle function in patients with spastic Cerebral Palsy?Methods: 10 independent ambulators with spastic Cerebral Palsy (12 [SD 4] years old, 2 uni- and 8 bilaterally affected) participated in a randomized crossover-study. One group started with manual static stretching, the other one with backward-downhill treadmill training. Each treatment period lasted 9 weeks (3 sessions per week). Pre and post treatments, 3D gait was assessed during comfortable and during fastest possible walking. Ultrasonography and dynamometry were used to test plantarflexor strength, passive joint flexibility, as well as gastrocnemius morphometrics, stiffness and strain on muscle-tendon and joint level.Results: When comparing both treatments, backward-downhill treadmill training lead to larger single stance dorsiflexion at comfortable walking speed (+2.9°, P = 0.041) and faster maximally achievable walking velocities ( + 0.10 m/s, P = 0.017). Stretching reduced knee flexion in swing, particularly at faster walking velocities (-5.4°, P = 0.003). Strength, ankle joint flexibility, as well as stiffness on muscle-tendon and joint level were not altered, despite similar increases in passive muscle and fascicle strain with both treatments (P ≤ 0.023).Significance: Backward-downhill treadmill training can be an effective gait treatment, probably improving coordination or reducing dynamic stretch sensitivity. More intense BDTT might be necessary to further alter muscle-tendon properties. Manual static plantarflexor stretching may not be optimal in Cerebral Palsy patients with high ambulatory status. [ABSTRACT FROM AUTHOR]