Kumar & Ashraf.

: Backward walking treadmill training and kinematics Serb J Sports Sci 3(3): 121-127

Serbian Journal of Sports Sciences Original article

2009, 3(3): 121-127, www.sjss-sportsacademy.edu.rs Received: 23 Jan 2009
UDC 796.012.412.4:611.9 ISSN 1820-6301 Accepted: 24 Jun 2009
ID 169146636

THE EFFECT OF BACKWARD WALKING TREADMILL TRAINING ON

KINEMATICS OF THE TRUNK AND LOWER LIMBS
T. R. Nanda Kumar & Muddasir Ashraf
Dolphin (PG) Institute of Biomedical & Natural Sciences, Dehradun, Uttarakhand, INDIA.

Abstract The purpose of the study was to determine the changes in the kinematics of the trunk and
lower extremities after backward walking treadmill training. Thirty male subjects participated in this
study. Each subject underwent backward walking treadmill training for 5 sessions a week for 2
weeks. In each session, 15 minutes of backward walking treadmill training (BWTT) was
administered. Video recording was done for each subject before and after training. The trunk, hip,
knee and ankle angles were calculated using Corel Draw software. Paired t-test was used for
statistical analysis. The hip joint angle decreased significantly at initial contact (p=0.0001), heel-off
(p=0.002), and midstance (p=0.002); the knee joint angle decreased significantly at initial contact
(p=0.0001), midswing (p=0.0001) and heel-off (p=0.0001) after backward walking treadmill training
(ABWTT), whereas the ankle joint angle increased significantly at initial contact (p=0.004),
midstance (p=0.033) and midswing (0.022) ABWTT. The trunk angle showed no significant
difference ABWTT. The present study has shown a decrease in the hip and knee angles and an
increase in the ankle angle after 2 weeks of backward walking treadmill training.
.
Key words: Backward walking, treadmill, kinematics

INTRODUCTION
Changing the direction of locomotion from normal forward progression to backward is done rather
readily by all people. In order to change the direction from forward locomotion to backward, the pattern
of muscle activation has to be changed to produce a reversal of leg movement and propulsion in
backward direction. Walking backward means reversing leg movement trajectories. When walking
backward, the leg not only reverses its direction of movement but it travels in the opposite direction
along virtually the same path as in walking forward [21].
Walking backward is nearly a mirror image or time-reversed copy of walking forward [5,10].
Winter, Plauck and Yang [28], in an investigation of similarities and differences in forward and
backward walking, found that backward walking was 95% reversal of forward walking. In contrast, both
Vilensky et al [23] and Kramer [14] concluded that backward walking was different from forward
walking. They reported that walking backward was associated with increased cadence and decreased
stride length when compared with forward walking. The authors also observed that joint kinematics
involved in backward walking was substantially different from that of forward walking. In backward
walking, the stance begins with toe contact and ends when the heel is lifted off the ground [10].
Walking and running in the backward direction are relatively novel tasks for most people but
there are several situations in which these movements are performed regularly. Various sports such
as soccer, football and basketball require the use of backward locomotion in a variety of situations.
Backward locomotion is also commonly used in rehabilitation treatment as a modality for injuries such
as patellofemoral pain syndrome [7, 8, 9, 12, 13] or ligament injuries [12], and as a means of
maintaining cardiopulmonary fitness [3, 12] while limiting the amount of stress placed on injured
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structures. Walking backward has also been used for injury prevention, to increase muscle strength [1,
4, 6, 16, 21] and to facilitate neuromuscular function. Several studies have investigated backward
walking and its effects while walking on the treadmill [3, 4, 5, 12, 19, 25]. The treadmill is frequently
used in biomechanical studies for locomotion and training [22], as variables such as speed or slope
can be controlled and as multiple gait cycles can be assessed easily [27]. The treadmill allows for a
controlled environment and provides a standardized and reliable performance task, a convenient
means of taking measurements from a walking subject without the necessity of having to physically
follow the subject with the recording equipment; it is therefore often used for locomotion research [18,
25, 26]. Furthermore, treadmill training in forward walking has been administered for treating a number
of conditions and benefits have been gained [11, 17, 18].
Li-Yuan Chen et al [4] analyzed the kinematics and EMG of backward walking on the treadmill
and found that backward walking on an inclined treadmill was the most stable pattern. Cipriani et al [5]
analyzed the EMG and kinematics of backward walking at three levels of treadmill inclination and
found that backward walking at an inclination showed significant changes in the joint positions of the
knee and the ankle during each sub-phase of gait.
Previous studies analyzed the EMG and kinematics of backward walking based on a single
session, but no study has yet investigated long term training effects on the kinematics of walking
backward. The purpose of this study was to determine the changes in the kinematics of the trunk and
lower extremities after backward walking treadmill training.

MATERIALS AND METHODS

SAMPLES
Thirty male subjects from Sheri Kashmir University of Agricultural Sciences, Srinagar and Wadooro
College of Agricultural Sciences, Baramulla, India, with the mean age of 23.13±2.06 years participated in
the study. The subjects with musculoskeletal disorders of the trunk or lower extremities, respiratory and
cardiac problems, neurological diseases, limb length discrepancy or any lower limb surgery were excluded.

PROCEDURE
Written consent, approved by the Institutional Review Board of Dolphin (PG) Institute of Biomedical &
Natural sciences, was obtained from each subject prior to data collection.
The subjects were barefoot and in shorts at the start of the trial. Lightweight spherical reflective
markers were attached to the subjects' left side at anatomical positions (the acromion, the greater
trochanter, the lateral epicondyle of the femur lateral malleolus, and the head of the 5th metatarsal) to
facilitate the lateral view digitization [15]. A motorized treadmill (Jogger 2.75HP /Fit line/ KMT-006)
was used in the study. The treadmill was initially set at the horizontal level. The subjects who were
unfamiliar with backward treadmill locomotion were habituated prior to the first testing session by
walking backward on the treadmill for a period of 15 min [13]. During the training session, subjects
walked backward on the treadmill at a constant speed of 1.33 m/sec, a comfortable speed for adults.
Instructions were given to the subjects to hold on to the rails while walking if they felt uncomfortable or
losing balance. Backward locomotion was recorded by a video camera, positioned lateral to the
subject, perpendicular to the movement plane, at the distance of 5m [15]. Video recording of backward
walking on the treadmill was done for one minute. VLC media player software was used to isolate one
complete gait cycle from the material recorded for one minute and then to reduce it into four frames at
initial contact (IC), midstance (MST), heel-off (HO) and midswing (MSW). The trunk, hip, knee and
ankle angles (TA, HA, KA, AA) of each frame were calculated using Corel Draw software.
The hip joint angle was determined by a line drawn from the acromion passing down through
the greater throchanter and by another line joining the greater trochanter and the lateral condyle of the
femur. The angle formed at the intersection of these two lines at the greater trochanter formed the hip
angle. The knee angle was determined by a line drawn from the greater trochanter passing down
through the lateral condyle of the femur and by another line joining the lateral condyle and the lateral
malleolus. The angle formed at the intersection of these two lines at the lateral condyle formed the
knee angle. The ankle angle was determined by the intersection of the line joining the lateral condyle
of the femur to the lateral malleolus with the line joining the lateral malleolus to the head of the 5th
metatarsal. The trunk angle was determined by the line joining the acromion to the greater trochanter
intersecting with the line drawn from the greater trochanter with respect to the horizontal axis in the
anterior direction.
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In order to do the backward treadmill training, initially the subjects performed a warm-up session for 5
minutes by walking on the treadmill at a self-selected speed and then they were given a 1-minute rest
before the training session started [20]. In the training session, the subjects walked backward on the
treadmill at the speed of 1.33 m/sec for 5 sessions/week for 2 weeks. Every working day, a net
walking time of 20 min of backward walking treadmill training (BWTT) was done. After 2 weeks'
training, another video recording was made and a single gait cycle was analyzed in the same way as
before the training session (Figure 1 and 2).

STATISTICAL ANALYSIS
A paired t-test was used to compare the Trunk angle (TA), Hip angle (HA), Knee angle (KA) and Ankle
angle (AA) at Initial contact (IC), Midstance (MST), Heel-off (HO) and Midswing (MSW) before backward
walking treadmill training (BBWTT) and after backward walking treadmill training (ABWTT). SPSS for
Windows 11.0 was used for all statistical analyses. Significance was accepted at the 5% level.

RESULTS
The paired t-test comparing Trunk angle (TA), Hip angle (HA), Knee angle (KA) and Ankle angle (AA)
at Initial contact (IC) done before and after backward walking treadmill training showed significant
differences for HA (p=0.0001), KA (p=0.0001) and AA (p=0.004).
The paired t-test comparing TA, HA, KA and AA at midstance (MST) done before and after
backward walking treadmill training showed significant differences for HA (p=0.002) and AA (p=0.033).
The paired t-test comparing TA, HA, KA and AA at heel-off (HO) done before and after backward
walking treadmill training showed significant differences for HA (p=0.002), and KA (p=0.0001).
The paired t-test comparing TA, HA, KA and AA at midswing (MSW) done before and after
backward walking treadmill training showed significant differences for HA (p=0.0001); KA (p=0.001)
and AA (p=0.022) (Table 1).

Table 1. Comparison of Mean and Standard Deviation of TA, HA, KA, AA, at IC, MST, HO, MSW before
and after backward walking treadmill training

BBWTT ABWTT
Variables t-value p-value
(Mean ± SD) (Mean ± SD)
ICTA 87.85 ± 5.24 88.78 ± 3.0 -1.25 0.22
ICHA 11.1 ± 8.86 4.62 ± 2.85 4.84 0.0001
ICKA 29.79 ± 8.07 21.36 ± 5.76 5.15 0.0001
ICAA 121.75 ± 10.53 26.3 ± 7.01 3.09 0.0004
MSTTA 88.55 ± 3.58 88.26 ± 3.16 0.617 0.542
MSTHA 9.67 ± 4.60 7.41 ± 3.28 3.44 0.002
MSTKA 11.11 ± 4.98 9.24 ± 3.59 1.95 0.060
MSTAA 120.20 ± 10.98 124.20 ± 8.41 2.23 0.033
HOTA 88.53 ± 4.37 89.21 ± 3.22 1.09 0.282
HOHA 18.80 ± 4.82 15.53 ± 4.71 3.33 0.002
HOKA 29.32 ± 6.84 19.95 ± 6.03 6.04 0.0001
HOAA 123.07 ± 7.02 123.5 ± 9.19 0.34 0.736
MSWTA 88.80 ± 5.03 88.57 ± 4.06 0.283 0.779
MSWHA 14.45 ± 8.13 7.02 ± 2.96 5.29 0.0001
MSWKA 37.58 ± 8.87 28.39 ± 8.71 4.20 0.0001
MSWAA 119.55 ± 11.64 124.73 ± 10.55 2.42 0.022
ICTA --- Initial contact trunk angle HOTA – Heel-off trunk angle
ICHA --- Initial contact hip angle HOHA -- Heel-off knee angle
ICKA --- Initial contact knee angle HOKA -- Heel-off ankle angle
ICAA --- Initial contact ankle angle HOAA -- Heel-off ankle angle
MSTTA--- Midstance trunk angle MSWTA – Midswing trunk angle
MSTHA -- Midstance hip angle MSWHA – Midswing hip angle
MSTKA – Midstance knee angle MSWKA – Midswing knee angle
MSTAA – Midstance ankle angle MSWAA – Midswing ankle angle

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Figure 1. Analysis of Trunk angle, Hip angle, Knee angle, Ankle angle at IC, MST, HO, MSW before
backward walking treadmill training

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Figure 1. Analysis of Trunk angle, Hip angle, Knee angle, Ankle angle at IC, MST, HO, MSW after
backward walking treadmill training

DISCUSSION
Walking and running in backward directions are relatively novel tasks for most people, whereas there
are several situations in which these movements are performed regularly, such as in soccer, football
and basketball [13].
The present study analyzed the effect of backward walking treadmill training on kinematics of
the trunk and lower limbs. The results showed that there were significant differences in hip, knee and
ankle angles after backward walking treadmill training. The angles showed a decrease in the hip and
the knee joints after backward walking treadmill training. At initial contact, midstance, heel-off and

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midswing, the angles decreased at the hip joint; at initial contact, heel-off and mid swing the angles
decreased at the knee joint. The angles showed an increase in the ankle joint after backward walking
treadmill training at initial contact, midstance and midswing.
A previous study by Van Ingen Schanou [22] suggested that visual information is particularly
important in maintaining equilibrium and stability during locomotion; while in over-ground locomotion
the surroundings move with respect to the subject, this is not the case in treadmill walking. This
implies that equilibrium and stability decrease on the treadmill causing a fear of falling, and resulting in
the reduced gait speed. This reduction in speed causes a reduction in cadence and an increase in step
length, which is a possible cause of an increase in the hip and knee angles. Thus such decreased
equilibrium and stability showed an increase in kinematics for the hip and the knee before backward
walking treadmill training and the decreased kinematics for the hip; the differences shown in the results
after backward walking treadmill training could have been due to the habituation in all subjects to backward
walking on the treadmill. A 15 minutes' period of familiarization was given to all subjects on the treadmill
but, according to Wall and Charteris [25], a steady state cannot be achieved even after 10 minutes of
treadmill walking. Wall and Charteris [24] investigated the process of habituation to the treadmill and
showed stride-to-stride variations in walking even after 15 min on the treadmill.
The study did not include a control group as it was felt that since the procedure of walking
backward requires considerable habituation, the unprepared subjects would not be able to walk
backward properly so hardly any changes could be expected.
The result of the present study showed a decrease in the angles for the hip and the knee and
an increase in the angle for the ankle joint after backward walking treadmill training. The decrease in
the ankle angle before backward walking treadmill training could have been due to the gastrocnemius,
a two-joint muscle, which, while acting on the knee to produce more knee flexion, would show an
active insufficiency at the ankle joint thus causing a sharper ankle angle. Therefore an increase in the
ankle angle shown after backward walking treadmill training was caused by less knee flexion allowing
the gastrocnemius to act more on the ankle joint.

CONCLUSIONS AND PRACTICAL APPLICATION

The present study has shown a decrease in the hip and knee angles and an increase in the ankle
angle after 2 weeks of backward walking treadmill training. The study has shown a variance in
kinematics after backward walking treadmill training due to the habituation process. Hence, designing
a training or rehabilitation protocols should be based on the values of post-training kinematic analysis
of backward walking.
Future research can be done by analyzing the EMG of lower limbs in addition to the kinematics
of the trunk and lower limbs after backward walking treadmill training.

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Address for correspondence:

T. R. Nanda Kumar, MPT

Head, Department of Physiotherapy,
Dolphin (PG) Institute of Biomedical & Natural Sciences,
VPO Manduwala, Chakrata Road,
Dehradun, Uttarakhand, India
E-mail: nandhu_tr@rediffmail.com

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