Happy Monday everyone and Happy Memorial Day to my American readers! I hope you had a smooth, relaxing weekend and are planning to hit the next week with a full head of steam.

Today I wanted to share a recent personal story that sparked some research that I think you will all benefit from.

About 5 months ago I tore my ACL, which leads us to the first lesson of this newsletter: Do not get ahead of yourself skiing and try to do more than you can...

Three months ago I did surgery to reconstruct the knee, using what is known as a patellar tendon graft, and have been doing physical therapy since.

Lesson #2: The ACL

ACL is short for anterior cruciate ligament, which is one of the four main ligaments in the knee. Ligaments are bands of tissue that connect bone to bone. The ACL serves a purpose of making sure the knee is sturdy and stable, mainly preventing your tibia (shin bone) from sliding forward and rotating away from the femur, which is your thigh bone.

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I am sure many of you have seen ACL injuries somewhere, whether in sports news or just know someone who has gone through it. Injuries are incredibly common, with roughly 500,000 being reported every year.

Nonetheless, it sucks. Ligaments cannot really heal themselves so surgery is almost always needed. In my case, what the surgeons did was take out a piece of my patellar tendon and drilled it into where the ACL used to be, basically putting in a new one.

Here is a great video on it:

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The rehab process has been very long and takes a ton of determination and patience. One thing that I have been instructed to do a lot whether as a warm-up or cool down has been backwards walking.

I have seen the trend of backwards walking before in non-getting-your-knee-drilled-into settings and have always been curious of why people do it.

So I went looking and I was pleasantly surprised by what I found.

Backward walking (retro-walking or retro-gait as researchers call it) has a genuinely solid body of evidence behind it. It is not just bro-science findings either. It has peer-reviewed trials, meta-analyses, and real patient populations that help support its data.

Your muscles work completely differently going backwards

Backward walking isn't just forward walking flipped around, as the muscle patterns are drastically different.

Think of it this way. Your body has been walking forward since day one of you knowing how to. The movement is so automatic your brain barely registers it. It's like driving a route you've done a thousand times, with muscle memory handling everything.

Go backwards? Suddenly your brain has to actually pay attention again. Unfamiliar signals, unfamiliar coordination, unfamiliar demand on your muscles. Research measuring electrical activity in leg muscles found those muscles working significantly harder during backward walking even at the same speed.

The result: your heart and lungs have to work 17 to 20% harder walking backward at the same pace as forward.

• 17–20% more oxygen used vs. forward walking at the same speed
• 21 studies pooled in the key knee arthritis meta-analysis
• 6 wks of 3x/week sessions produced measurable pain relief in knee arthritis trials

What the research actually shows

This is where it gets genuinely impressive. Retro-walking has been studied across a surprisingly wide range of conditions that is not just the knees.

• Knee Osteoarthritis - A meta-analysis pooling 635 patients found that backward walking added to standard physio significantly reduced pain, improved function, and built quad strength more than physio alone. One trial found just 10 minutes, 3x per week for six weeks beat both forward walking and standard therapy for pain relief.
• Stroke Recovery - A meta-analysis of stroke patients showed backward walking training improved walking speed, balance scores, and overall mobility compared to conventional rehab. The brain has to forge new patterns and that novelty seems to be part of the benefit.
• Parkinson's Disease - An 8-week trial found backward gait training improved stride length and cadence beyond what forward walking achieved. These are meaningful gains for a condition where movement quality is everything.
• Chronic Low Back Pain - A single 15-minute session of backward treadmill walking was enough to measurably reduce pain intensity and improve how people controlled their lower back and hips. One session.

Why does it seem to help so many different things?

The leading theory: backward walking forces your body to load joints in a completely different pattern that puts less stress on the front of the knee, creates a different spinal alignment and calls for different balance demands. It also demands far more from your brain, rebuilding neuromuscular coordination that injury or disease has degraded.

It's not magic, but just a novel enough stimulus that a body which has adapted to pain and compensation has to reorganize and sometimes that reorganization is exactly what's needed.

Ever tried something weird that actually worked during recovery? Hit reply! I'd love to hear it!

The bottom line and how to actually try it

You do not need equipment, a gym membership, or special shoes. Just a safe, flat surface and a bit of space behind you.

Start slow at ten minutes on a track, a flat sidewalk, or a treadmill at low speed. Keep your core engaged, your steps controlled, and ideally something nearby to steady yourself while you find your footing. If you have balance issues, a treadmill with rails is ideal.

The research doses were modest: 10–15 minutes, a few times a week. That's it. The bar to try it is about as low as exercise gets.

Sometimes the simplest prescription really is the strangest one. And sometimes walking backwards is exactly the right step forward (see what I did there… ba dum tssss).

Rehabbing an injury or studying for a health exam? Advanced Medical Certification offers accredited courses in CPR, BLS, and more, built for healthcare pros and students who need credentials that actually hold up.

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​Disclaimer: This newsletter is for educational purposes only and not a substitute for professional medical advice. Always consult your doctor about your specific health situation.