Can Walking Backward Actually Help Knee Osteoarthritis?

Written by the Nuvirox Research Team

Short answer: yes, with honest caveats. Several small randomized trials, including a dedicated "retro-walking trial" published in BMC Musculoskeletal Disorders, found that six weeks of structured backward walking reduced knee osteoarthritis pain and improved quadriceps strength and function more than forward walking or usual care. It's a real, replicated finding — just built on modest sample sizes.

Why would walking backward do anything different from walking forward?

It comes down to biomechanics, not calories burned. Gait-analysis research shows that backward walking reduces the external knee adduction moment (often abbreviated EKAM) compared with forward walking at a matched speed. EKAM is a biomechanical proxy for how much load passes through the inner (medial) compartment of the knee with every step — the same compartment that degenerates in the most common form of knee osteoarthritis. Lower moment, in theory, means less repetitive stress on the joint surface that's already worn down, while backward walking also shifts more of the work onto the quadriceps in a way that appears to build strength around the joint rather than just moving through it.

What does the actual clinical trial data show?

The "retro-walking trial," a three-arm single-blinded RCT, randomized 68 people with knee OA into retro walking, forward walking, or a no-walking control group, all combined with a standard physiotherapy program, for six weeks. It measured pain (numerical rating scale), function (WOMAC index), quadriceps strength, and the timed up-and-go mobility test at baseline and six weeks.

What human studies actually show

The retro-walking trial (BMC Musculoskeletal Disorders) found that, in intention-to-treat analysis, the retro-walking group had a significantly greater reduction in pain intensity and functional disability than the forward-walking group, along with greater gains in quadriceps strength and faster timed up-and-go performance, over six weeks.

An earlier, separate randomized controlled trial on retro-walking versus forward walking in knee OA similarly reported that retro-walking improved symptoms, pain, and self-reported ability to perform daily activities more than forward walking in a smaller, 34-person single-blinded trial.

Honest counterweight: both trials are small (34–69 participants), run over just six weeks, and conducted by overlapping groups of researchers rather than being independently replicated at scale by multiple unrelated labs. None of the retro-walking trials to date have followed patients for more than a few months, so it's unclear whether the pain and function gains persist, and none specifically enrolled people with severe or end-stage OA, where the biomechanical benefits may not be enough to matter.

What retro-walking won't do

It isn't a cure for osteoarthritis, it won't regenerate lost cartilage, and it shouldn't replace an existing physical therapy plan, weight management, or medical treatment — in every trial to date, it was tested as an addition to standard physiotherapy, not a substitute for it. It also isn't well-suited to uneven outdoor terrain or busy public spaces for obvious safety reasons; the studies used a treadmill or a controlled, clear indoor space with supervision. Balance-impaired individuals or anyone with a fall history should get clearance from a physical therapist before trying it unsupervised, since walking backward inherently increases fall risk versus walking forward.

How to actually try it

The published protocols used roughly 10–15 minutes of backward walking, 3 days a week for 6 weeks, either on a treadmill at a slow, self-selected pace with handrail support available, or on a flat, obstacle-free indoor surface. If you want to try this as an add-on to your existing knee OA management: start on a treadmill at its slowest setting holding the rails, build up slowly, and combine it with the standard strengthening program your physical therapist has already given you rather than replacing it.

FAQ

Is backward walking the same as backward running?
No — the OA trials specifically used slow, controlled walking, not running. Backward running research is a separate, mostly sports-performance literature and wasn't part of the knee OA trials cited here.

How long until I'd notice a difference?
The published trials measured outcomes at six weeks with a 3-day-a-week protocol; that's the timeframe with actual data behind it, not a guarantee of results for every individual.

Can I do this if I have hip OA instead of knee OA?
The trials specifically studied knee osteoarthritis. Backward walking's biomechanical effect on the hip joint hasn't been tested the same way, so it's reasonable but unproven for hip OA specifically.

Is a treadmill required, or can I walk backward outside?
The studies used treadmills or clear, flat indoor spaces for safety and consistency. Outdoor use introduces obstacle and fall risks the trials didn't address.

Does retro-walking help every type of knee osteoarthritis equally?
The published trials specifically enrolled people with primary knee OA, generally affecting the medial (inner) compartment, since that's the pattern most directly tied to the knee adduction moment mechanism retro-walking is thought to improve. Other knee OA patterns, or OA affecting other joints entirely, haven't been tested the same way.

What does a typical 6-week retro-walking session actually look like in practice?
Published protocols generally used short daily bouts — a few minutes at a time, building toward roughly 10–15 minutes — rather than one long continuous session, combined with the participant's existing physiotherapy strengthening program on the same days.

Retro-walking is one of several movement-based approaches that show up in the knee OA literature alongside general activity; see our broader look at whether exercise helps or hurts arthritic joints for how it fits into the bigger picture, and our piece on whether kettlebell training is safe for joints if you're building a broader joint-friendly strength routine.

From Nuvirox

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The Bottom Line

Multiple small randomized trials found that structured retro-walking, added on top of standard physiotherapy, reduced knee osteoarthritis pain and improved strength and function more than forward walking alone over six weeks. The mechanism — a lower knee adduction moment — makes biomechanical sense, but the evidence base is still early, short-term, and built on modest sample sizes, so treat it as a promising add-on rather than a proven standalone treatment.

References

1. Alghadir A, Anwer S. A randomized control trial on retro-walking improves symptoms, pain, and function in primary knee osteoarthritis. PMID: 33314883.
2. Alghadir AH, Anwer S. Effect of retro and forward walking on quadriceps muscle strength, pain, function, and mobility in patients with knee osteoarthritis: a randomized controlled trial (retro-walking trial). BMC Musculoskelet Disord. PMCID: PMC6456984.
3. Effect of retro and forward walking on quadriceps muscle strength, pain, function, and mobility in patients with knee osteoarthritis: a protocol for a randomized controlled trial. BMC Musculoskelet Disord. DOI: 10.1186/s12891-016-1021-z.

*These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease. This article is for informational purposes only and is not a substitute for professional medical advice.