Written By: Paul Frizelle, PT, DPT, MS, OCS, MTC, CSCS, PES, CES



I’m going to be honest with everyone…. gait retraining is one of my least favorite parts of lower body rehab. Young athletes seem to present an even bigger challenge for me because they are often mentally two steps ahead of where they are physically. Teaching the intricacies of coordinated and efficient movement seems to take a back seat to “get me back to playing”. In the Unusual Cases in Rehab Series: Young Athlete Shoulder, Foot and Wrist course I have an example of an ankle injury who was able to pass through many benchmarks prior to returning to play. Her case was not without a little challenge, but she was a good example of teaching the nuances of gait training successfully.

One of the tools that I like using the most is treadmill retropulsion to teach symmetrical stride length. It is a great example of a slightly higher movement coordination intervention that does not significantly increase loading or speed of movement. In fact, when compared to forward walking it is actually 30-50% slower. It is also an evidence-based intervention (Balasukumaran, Olivier & Ntsiea, 2019) that has been shown to be an effective tool for helping people with gait impairments. I have found one of the best ways to use it with young athletes is to use video recording during walking backwards on a treadmill. You can use the patient’s phone if there are any HIPPA concerns or if your clinic does not have recording equipment. This allows the rehab professional to use a low-speed intervention that is easily recorded (and HIPPA complaint) to quickly reveal stride length differences. My personal experience has been that once a young athlete sees the video, it becomes apparent the need to focus more on gait retraining. Also using the treadmill backwards keeps them engaged and moderately challenged, all at lower and safer speeds than walking forwards. In the initial phases of rehab, it may be used as gait training but as you get further into the rehab process it is a great tool to use as a therapeutic exercise for a dynamic warm-up prior to engaging in the full rehab program.


Above is a short video of a patient with whom I used this to help him understand why we needed to work on stride length before running. He was walking at about 1-1.4 mph in this video which really highlights how well the treadmill can accomplish early goals for improving stride length awareness and symmetry in the rehab process.

If you want to learn more, be sure to register for my September 10th webinar, Unusual Cases in Rehab Series: Knee, Cervical Spine, and Vestibular Dysfunction. Thanks for taking the time to read this blog and hope you get a chance to use this tool with your patients!


Explore online continuing education courses from Paul below:

Evaluation & Treatment of the Adolescent Athlete Elbow & Wrist

Evaluation & Treatment of the Knee in the Adolescent Athlete

Evaluation and Treatment of Hip and Pelvis Dysfunction

Evaluation and Treatment of the Hip in the Adolescent Athlete

Evaluation and Treatment of the Spine in the Adolescent Athlete

Examination of the Evidence Behind Rehabilitation Myths in Orthopedic Rehab of the Lower Body

Foot & Ankle in the Adolescent Athlete

Peripheral Nerve Entrapments

Strength Training in Geriatric Rehabilitation

Treating the Shoulder in the Adolescent Athlete

Unusual Cases in Rehab Series: Knee, Cervical Spine, and Vestibular Dysfunction

Unusual Cases in Rehab Series: Young Athlete Shoulder, Foot and Wrist


Visit summit-education.com for more information.



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. Clinical Rehabilitation. 2019;33(2):171-182. https://search.ebscohost.com/login.aspx?direct=true&AuthType=shib&db=s3h&AN=134456132&site=eds-live