International Journal of Health Sciences and Research

www.ijhsr.org ISSN: 2249-9571

Original Research Article

Effect of Retrowalking on Pain, Functional Disability and Functional

Mobility in Patients with Chronic Knee Osteoarthritis
Dr. Sneha Sameer Ganu1, Dr. Ankita Jayesh Merchant2
1
Associate Professor, MGM College of Physiotherapy, Navi Mumbai
2
B.P.Th., MGM College of Physiotherapy, Navi Mumbai
Corresponding Author: Dr. Sneha Sameer Ganu

ABSTRACT

Osteoarthritis is a degenerative joint disease involving the cartilage and surrounding tissues. The aim
of this study was to investigate the effectiveness of retro walking in comparison with the
Conventional closed chain exercise programme in chronic knee osteoarthritis patients.
Study Design: Forty subjects participated in this study who had chronic Osteoarthritis of knee.
Subjects were randomly assigned to two groups: Experimental and Control group. Experimental
group followed Retrowalking and the Control group followed Conventional Closed kinematic chain
exercises. Two primary outcome measures used were pain with functional disability and functional
mobility which were measured using Western Ontario and McMaster Universities Arthritis Index and
Timed up and go test respectively. The secondary measures included pain intensity, Strength of hip
abductors, extensors, knee extensors muscles and knee flexion range of motion which were measured
using Numerical Pain Rating Scale, manual muscle testing and universal goniometer respectively.
Results: After comparing values using independent t-test, functional disability and mobility showed
highly significant difference in experimental group than control group. Changes in pain intensity were
equal for both the groups. Strength of hip muscles and knee Range of motion improved significantly
in the Experimental group than control group.
Conclusion: The study concluded that retrowalking was more effective than conventional closed
kinematic chain exercises in reducing symptom, improving functional mobility, overcoming physical
dysfunction and increasing strength of hip muscles in osteoarthritis of knee after 4 weeks of
rehabilitation.

Key words: Retrowalking, Closed kinematic chain exercises, Knee Osteoarthritis.

INTRODUCTION rheumatologic problem with a prevalence of

Osteoarthritis (OA), a chronic 22% to 39% in India. [3-5] Among all, there
degenerative joint disease, is a progressive is high prevalence of knee OA
disorder of the joints involving the cartilage (osteoarthritis) affecting 15-40% of people
and the surrounding tissues. [1] OA is a non- aged 40 and 60-70% of the population older
inflammatory progressive disorder of than 60 years. [6]
movable joints, particularly weight bearing The physical disability arising from
joints. The disease limits everyday knee OA prevents the performance of daily
activities, such as getting in and out of bed, life activities and negatively affects life
dressing and climbing stairs. [2] It is a quality. Several factors play roles in the
commonest cause of severe pain and occurrence of physical disability. These
functional limitation that affects individuals include pain, joint movement restriction,
worldwide. It is the second most common muscle weakness, and coordination

International Journal of Health Sciences & Research (www.ijhsr.org) 109

Vol.8; Issue: 11; November 2018
Sneha Sameer Ganu et.al. Effect of Retrowalking on Pain, Functional Disability and Functional Mobility in
Patients with Chronic Knee Osteoarthritis

impairment. [7] Exact cause of OA is not exercises help to promote muscle strength,
known. However it is strongly believed that improve range of motion, increase mobility
it Knee has a multifactorial etiology and ease pain. Closed kinematic chain
characterized by wear and tear of articular exercises for knee joint can be incorporated
cartilage, hypertrophy of bone at the in many ways; Mini-squats, lunges, step
margins and a host of biochemical and ups, press legs, etc. Those are the
morphological alterations of the synovial conventional closed chain exercises used
membrane and joint capsule. Sub chondral from many years. Retro-walking, also a part
bone in turn can then become sclerotic and of closed chain exercises, has recently
stiffer than normal bone. These changes in gained importance in management of OA
cartilage result in increased friction, knee.
decreased shock absorption and greater Retro walking is walking backwards.
impact loading of the joint. [8] Since there is propulsion in backward
Risk factors for OA knee includes direction and reversal of leg movement in
age, gender, obesity, occupation, sports, Retro walking, different muscle activation
osteoporosis, previous trauma, irregularity patterns from those in forward walking are
in joint surfaces, internal derangement, required. [16] A gait cycle during
heredity, leisure and diseases leaving retrowalking can be defined as toe-on of a
articular cartilage damage. [9] In patients limb to the subsequent toe-on of the same
with knee OA, there is a prominent loss in limb. [17] Along with a unique muscle
proprioception compared with control activation pattern; Retro walking is
subjects of the same age and gender. [10] It associated with increased cadence,
has been demonstrated that impaired decreased stride length and different joint
proprioception adds to functional kinematics as compared to forward walking
insufficiency by generating impairment in and hence may offer some benefits over
walking rhythm, shortening step distance, forward walking alone. [18] It has been
and a decrease in walking speed and total suggested that retro-walking may provide
walking time. [11] additional benefits beyond those
Management of OA Knee experienced by forward walking in healthy
necessitates a multidisciplinary approach adult males and females. [19,20] Retro-
including both conservative and surgical. walking significantly lowers peak
Physiotherapy is the main choice of patellofemoral joint compressive force and a
treatment wherein the conservative part is significantly slower rate of loading has been
concerned, which includes exercise therapy- found during backward walking.
supervised strengthening exercise, [3,5,6] Consequently, trauma to the articular
manual therapy, [12] taping [13] and electrical cartilage is reduced during retro-walking;
modalities with or without thermal therefore it could be used as a mode of
modalities as measures for pain reduction. training after sustaining injuries to the lower
[14]
A growing body of evidence suggests limb. Retro-walking could be an effective
the role of exercises in improvement of tool to increase quadriceps strength after
symptoms and joint function in knee OA. immobilization or surgery since the
Recently, closed kinematic chain quadriceps is activated for a longer period.
[17]
exercises have drawn much attention in the
management of knee OA. Studies suggest Though retro walking is a part of
that these exercises are more effective and CKC, we have very less evidences
functional than the traditionally employed regarding the functional rehabilitation of
open kinematic chain exercises. [15] patients with degenerative diseases around
Conventional closed kinematic chain (CKC) the knee joint. Considering the
exercise programme aims to increase the advantageous effect of retro-walking with
strength and stability of knee joint. These respect to forward walking in decreasing the

International Journal of Health Sciences & Research (www.ijhsr.org) 110

Vol.8; Issue: 11; November 2018
Sneha Sameer Ganu et.al. Effect of Retrowalking on Pain, Functional Disability and Functional Mobility in
Patients with Chronic Knee Osteoarthritis

compressive load on knee and improvising pain, stiffness and physical function levels
the muscular strength, the current study in the subjects. It measures 5 items for pain,
aimed at finding out the effectiveness of 2 for stiffness, and 17 for functional
retro walking in comparison with the limitation. Physical functioning questions
Conventional closed chain exercise cover activities of daily living. Its
programme in chronic knee osteoarthritis Psychometric properties have been
patients. established. It has good test‑retest reliability
in pain and physical function
MATERIALS AND METHODS domain.7Timed up and go test (TUG), was
40 subjects, both male and female, in used to assess functional mobility related to
age group of 40-60 (mean age=51, balance. [22] A firm chair with arms (seat
SD=6.05) were recruited fulfilling the height of 46 cm) will be placed at one end
inclusion and exclusion criteria. The and an object will be placed at the other end
participants fulfilling three out of the six at a distance of 3-m. The participants was
clinical criteria listed by The American instructed as follows: “On the word „go‟,
College of Rheumatology were diagnosed stand up, walk comfortably and safely to the
as knee OA which was confirmed using object at the end on the floor, walk around
radiological investigations. [21] The criteria the object, come back, and sit all the way
are (1) Knee pain (2) Morning stiffness back in your chair.” Timing was started on
lasting <30 min, (3) Crepitus with active the word “go” and ended when the
motion, (4) Bony tenderness, (5) Bony participant returned to the chair, with back
enlargement, and (6) No warmth to touch. resting against the chair. The average of the
Patients in the age group of 40-60, having 2 recorded trials was used for data analysis.
knee pain for more than 6 weeks were A 10 cm Numerical Rating Scale (NRS) for
included. Patients with bilateral rating the intensity of perceived pain was
involvement, a history of any lower used. The patient was asked to tell his/her
extremity injury or underlying pathology, a pain on a scale of 0-10 where 0 indicates no
history of any inflammatory joint disease pain and 10 indicates maximal pain. [23]
and balance problems or using an assistive Medical Research Council grading (MRC)
device for ambulation were excluded. was used to assess concentric strength of hip
Patients with cardiovascular and abductors, extensors and knee extensors
neurological problem (Motor and sensory muscles. A Universal Goniometer was used
loss) were also excluded. to assess knee flexion ROM in prone
Two primary outcome measures position. [24]
used in this study were pain with functional Forty subjects were taken having
disability and functional mobility which knee osteoarthritis. All the subjects went
were measured using Western Ontario and through a physical screening performed by a
McMaster Universities Arthritis Index physical therapist to confirm with inclusion
(WOMAC) and Timed up and go test and exclusion criteria. Written informed
(TUG) respectively. The secondary outcome consent was obtained from each participant.
measures included pain intensity, Strength The study was approved by institutional
of hip abductors, extensors, knee extensors ethical committee. The assessments of each
muscles and knee flexion range of motion group were performed before and after the
which were measured using Numerical Pain intervention. The interventions were based
Rating Scale, manual muscle testing (MRC on outpatient rehabilitation programs in
grading) and universal goniometer both groups. An experimental type of study
respectively. Western Ontario and was conducted and subjects were divided
McMaster Universities Arthritis Index randomly in 2 groups having 20 subjects
(WOMAC) of OA, (CRD, Pune version) a each: Experimental and Control Group.
patient reported scale, was used to assess Both the groups received regular

International Journal of Health Sciences & Research (www.ijhsr.org) 111

Vol.8; Issue: 11; November 2018
Sneha Sameer Ganu et.al. Effect of Retrowalking on Pain, Functional Disability and Functional Mobility in
Patients with Chronic Knee Osteoarthritis

physiotherapy treatment followed by Outcome measures were assessed pre and

retrowalking for the experimental group and post intervention which was for a period of
conventional closed chain exercises for the 4 weeks.
control group. Regular Physiotherapy Statistical Analysis: The obtained data was
Treatment included: (1) Deep heating calculated using SPSS. The relative values
modality (Short wave diathermy) for 10 for each individual subject before and after
minutes for pain relief. (2) Free exercises the experimental protocol was compared
for hip and knee (Static and dynamic using paired-t test. After that, the
quadriceps, knee bending exercises in prone independent t-test was used to compare the
lying, hip flexion exercises in supine, hip relative changes between the two treatment
abduction in side lying and hip extension in groups. Statistical significance was accepted
prone lying position); 3 sets of 10 for values of p < 0.05.
repetitions. Experimental group received
retro walking along with the regular RESULTS
physiotherapy treatment as mentioned The data derived from both the
above; 3 sessions of walking per day (10 groups at the end of 4 weeks were compared
mins per session). Walking backward on a statistically using paired-t test and
flat surface at their maximum pace [1 independent-t test. The change between the
session was supervised and rest was given pre-and post readings of every individual for
as home programme]. [25] Control group WOMAC score, TUG score, NPRS, hip
received conventional closed chain abductors strength, hip extensors strength,
exercises along with regular physiotherapy knee extensor strength and knee flexion
treatment which included mini squats, ROM was done using paired-t test. The
Lunges (Forward & Lateral), Step ups comparison between the Experimental
(Forward& Lateral); 3 sets of 10 repetitions group and Control group was performed
per day.[1 set was supervised and rest was using independent-t test
given as home programme]. The above
Table 1: Comparison of Study Parameters Pre and Post Intervention for Experimental and Control group.
1.1 Primary outcome measures
EXPERIMENTAL GROUP CONTROL GROUP
PRE POST p-VALUE PRE POST p-VALUE
WOMAC Score 52.22±10.15 37.10±10.15 <0.001 50.35±7.22 41.40 ±7.61 <0.001
TUG Score 19.70±4.35 12.10± 2.67 <0.001 18.50±4.71 14.95 ±4.46 <0.001
Inference: There is a statistical difference in WOMAC score and TUG score in both experimental and control
group.

1.2 Secondary outcome measures

EXPERIMENTAL GROUP CONTROL GROUP
PRE POST p-VALUE PRE POST p-VALUE
NPRS 6.35± 1.03 4.50± 0.82 <0.001 6.75 ± 1.06 4.70 ± 0.92 <0.001
Hip Abductors strength 3 ± 0.4 3.72± 0.6 <0.001 3 ± 0.2 3.17± 0.5 <0.001
Hip Extensors Strength 3.53± 0.7 4 ± 0.8 <0.001 3.07± 0.2 3.25± 0.5 <0.001
Knee Extensors Strength 3.45± 0.7 4± 0.3 <0.001 3.25± 0.5 3.50± 0.8 <0.001
Knee Flexion ROM 114.4±6.32 122.2 ±5.355 <0.001 117.4 ± 6 120.5 ±6.84 <0.001
Inference: There is a statistical difference in NPRS, hip abductors strength, hip extensors strength, knee extensor
strength and knee flexion ROM in both experimental and control group.
Table 2: Comparison of Mean Improvement in Parameters between Experimental and Control group
EXPERIMENTAL GROUP CONTROL GROUP P VALUE
WOMAC score 15.450 ± 5.104 8.950 ±4.817 < 0.001
TUG score 7.600 ± 3.817 3.550 ± 1.395 < 0.001
NPRS 1.850± 1.182 2.050 ± 0.999 0.567
Hip Abductors strength 0.7250± 0.571 0.1750± 0.2447 < 0.001
Hip Extensors Strength 0.4750± 0.5730 0.0750 ± 0.1832 < 0.001
Knee Extensors Strength 0.5500± 0.3591 0.2500 ± 0.3804 < 0.05
Knee Flexion ROM 7.800± 3.238 3.150 ± 4.234 < 0.001
Inference: There is a statistical significant difference in all the parameters between experimental & control
group except for NPRS.

International Journal of Health Sciences & Research (www.ijhsr.org) 112

Vol.8; Issue: 11; November 2018
Sneha Sameer Ganu et.al. Effect of Retrowalking on Pain, Functional Disability and Functional Mobility in
Patients with Chronic Knee Osteoarthritis

DISCUSSION However, the improvement in

Present study examined the efficacy Experimental is greater than that of Control
of Retro walking and Conventional closed group. Improvement in function may be
chain exercises (CKC) as an adjunct to attributed to the reduction of pain, reduction
conventional treatment in reducing pain and in abnormal joint kinetics and kinematics
disability in patients with chronic knee OA. during functional movements and improved
Study revealed that there was significant muscle activation pattern. Firstly, there is a
improvement in function and pain in both toe heel contact pattern, unlike normal,
the CKC and Retro walking group. Also which reduces the direct vertical forces and
showed that, Retro‑ walking is more impulsive forces on knee joint [Flynn et al
effective in reducing disabilities as (1993]. There is dissipation of vertical
compared to conventional CKC treatment. forces throughout dorsi flexion of ankle
Individual with OA knee walked controlled by eccentric contraction of the
more slowly, with less knee excursion, posterior compartment musculature (calf
increased adduction moment and with more muscle), just prior to the heel strike in retro
joint stiffness. These secondary walking. [28] Studies have shown that
compensatory gait adaptations in OA knee compared to forward walking; backward
patients helps in reducing pain by walking creates more muscle activity in
decreasing ground reaction loading on knee. proportion to efforts. According to a study
This prolonged usage of secondary gait by Neptune and Kautz (2000), backward
compensation creates greater imbalance of walking allows increased hamstrings
muscle, progressively reduces muscle activation which generates reduced patello-
strength, endurance, flexibility and later femoral and lower tibiofemoral compression
ending to deformity. [26] During forward load stress and ACL strain, and therefore
walking knee joint flexes, extends and then BW reverses the shear forces in the knee
flexes in support phase, whereas in joint. Also, a study done by Balraj AM,
backward walking knee initially extends, Kamraj B and Saji VT (2018), concluded
flexes and extends in support phase, prior to that retrowalking is helpful in reducing
flexing and extending during swing. disability parameters in patients with
However support swing ratio of retro- chronic Osteoarthritis of knee. [29]
walking is similar to forward walking with As advantages of Retro walking
60% support and 40% swing. include improvement in muscle activation
Muscular structure supporting ankle pattern, reduction in adductor moment at
and knee reversed their role during retro- knee during stance phase of gait and
walking (In, retro-walking knee provides the augmented stretch of hamstring muscle
primary power producer {co-contraction of groups during the stride; all of these may
hamstring and quadriceps} and ankle plantar have helped in reducing disability thus
flexors as shock absorber). Direction of leading to improved function. [30] Retro
knee joint shear force directed forward walking also has effect on improving
initially during retro-walking whereas strength of hip extensors leading to reduced
backward in forward walking. Retro- hip flexion moment during stance phase and
walking produce significantly lower patellar thus preventing abnormal loading at knee
compressive force than forward walking. joint and, in turn, the disability.
Retrowalking helps to reduce maximal Also from the study, both group
vertical force and impulsive force on knee showed equal effectiveness in relieving
compare to forward walking because of toe- pain. Pain relief could be attributed to the
heel contact pattern. Numerous studies thermal effects associated with deep heating
revealed pain in OA knee is due to increased modality, strengthening exercises for hip
abnormal ground reaction force loading on and knee helping to steady the knee and
joint and decreased extensor moment. [27] give additional joint protection from shock

International Journal of Health Sciences & Research (www.ijhsr.org) 113

Vol.8; Issue: 11; November 2018
Sneha Sameer Ganu et.al. Effect of Retrowalking on Pain, Functional Disability and Functional Mobility in
Patients with Chronic Knee Osteoarthritis

and stress. In addition to this, Retro walking and first information report,APLAR. J
may have effect on pain relief by reducing Rheumatol.1997;1:145-54.
excess adductor moment at knee joint 4. Chopra A, Patil J, Bilampelly V, Relwane J,
decreasing the compressive forces on TandleHS. Prevalence of rheumatic disease
in rural population in Western India: A
medial compartment of knee joint
WHO-ILAR-COPCORD study. J Assoc
An improvement seen in Control group is Physicians India.2001;49:240-46.
attributed to the multi-joint movement 5. Mahajan A, Jasrotia DS, Manhas AS,
which mimics the activities of daily living. Jamwal SS. Prevalence of major rheumatic
Also helps in facilitating various muscles at disorders in Jammu. JK Science.2003;5:63-
a time and stimulates proprioceptors of knee 66.
joint. These Co-contraction and 6. Brotzman BS, Manske RC. The arthritic
Proprioception enhances the joint lower extremity. Clinical Orthopedic
stabilization and increases the compressive Rehabilitataion: An Evidenced Based
forces on knee joint, helping in improving Approach. 3rd ed. USA: Elsevier MOSBY;
balance while weight bearing activities. [15] 2011. p. 380-1.
7. McConnell S, Kolopack P, Davis AM. The
Also strengthens the muscles around the
western ontario andmcmaster universities
joint unlike open chain exercises causing osteoarthritis index (WOMAC): A review of
shear forces leading to more and more its utility and measurement properties.
injuries. Thus, the combination of Arthritis Rheum.2001; 45: 453-461.
Retrowalking and closed kinematic chain 8. Mahajan A, Verma S, Tandon V.
exercises can help in reducing pain and Osteoarthritis. J Assoc Physicians India.
symptoms in patients with chronic 2005;53:634‑41.
Osteoarthritis of knee. 9. Iorio R, Healy WL. Unicompartmental
arthritis of the knee. J Bone Joint Surg
CONCLUSION Am.2003;85-A: 1351-1364.
The study concludes that 10. Litwic A, Edwards MH, Dennison EM,
retrowalking is more effective than Cooper C. Epidemiology and burden of
osteoarthritis. Br Med Bull.2013; 105: 185-
conventional closed kinematic chain
199.
exercises in reducing symptom, improving 11. Foroughi N, Smith R, VanwanseeleB. The
functional mobility, overcoming physical association of external knee adduction
dysfunction and increasing strength of hip moment with biomechanical variables in
muscles in osteoarthritis of knee after 4 osteoarthritis: A systematic review. Epub.
weeks of rehabilitation. Thus, our findings 2009;16: 303-309.
may broaden the options for rehabilitation 12. Henry Pollard, Graham Ward et al. The
program planning and can be used as a new effect of manual therapy knee protocol on
approach for treatment. Future studies are oa knee pain: a randomised controlled trial.
needed to be done with more precise J Can Chiropr Assoc. 2008 Dec; 52(4): 229–
instruments for strength measurements 242
13. Hinman RS1, Bennell KL, Crossley KM et
rather than manual measurement and with a
al. Immediate effects of adhesive tape on
large sample size. pain and disability in individuals with knee
osteoarthritis. Rheumatology (Oxford).
REFERENCES 2003 Jul;42(7):865-9..
1. Woolf AD, Pfleger B. Burden of major 14. Pisters MF, Veenhof C, Schellevis FG et al.
musculoskeletal conditions. Bull World Long-term effectiveness of exercise therapy
Health Organ. 2003;81:646–56. in patients with osteoarthritis of the hip or
2. Litwic A, Edwards MH, Dennison EM, knee: a randomized controlled trial
Cooper C. Epidemiology and burden of comparing two different physical therapy
osteoarthritis. Br Med Bull.2013; 105: 185- interventions. Osteoarthritis Cartilage. 2010
199. Aug;18(8):1019-26.
3. Chopra A, Patil J, Bilampelly V. The 15. Lim BW. A comparative study of open and
Bhigwan (India)COPCORD: Methodology closed kinetic chain exercise regimes in

International Journal of Health Sciences & Research (www.ijhsr.org) 114

Vol.8; Issue: 11; November 2018
Sneha Sameer Ganu et.al. Effect of Retrowalking on Pain, Functional Disability and Functional Mobility in
Patients with Chronic Knee Osteoarthritis

patients with knee osteoarthritis. 24. Walter et al. Reliability of Goniometric

Physiotherapy Singapore.2002;5(2):34-40. Measurements and Visual Estimates of
16. Witvrouw E,Danneels L, Tiggelen DV et al. Knee Range of Motion Obtained in a
Comparative analysis of the kinematics and Clinical Setting. Physical Therapy.1991;
kinetics of forward and backward human 71(2):90-96.
locomotion. ISBS. 1988;6:451‑64. 25. Alghadir A, Anwer S. Effect of retro and
17. Bischoff HA, Roos EM. Effectiveness and forward walking on quadriceps muscle
safety of strengthening, aerobic, and strength, pain, function, and mobility in
coordination exercises for patients with patients with knee osteoarthritis: a protocol
osteoarthritis. Current Opin Rheumatol. for a randomized controlled trial.BMC
2003; 15: 141-144. Musculoskeletal Disorders.2016;17:161
18. Janet S Dufek, Bary T Bates, Amanda 26. Al-Johani AH, Kachanathu SJ, Hafez AR,
tritsch-Backward walking: understand Al-Ahaideb A, AlgarniAD.Comparative
function and the associate benefits. Human study of hamstring and quadriceps
Performance & Wellness.2000 strengthening treatments in the management
19. Terblanche E, Cloete WA, Du Plessis PAL, of knee osteoarthritis. J Phys Ther Sci.2014;
Sadie JN, Strauss A, Unger M. The 26: 817-820.
metabolic transition speed between 27. Van der Esch M, Holla JF, van der Leeden
backward walking and running. Eur J Appl M, Knol DL, Lems WF, et al. Decrease of
Physiol. 2003;90:520–5. muscle strength is associated with increase
20. Terblanche E, Page C, Kroff J, Venter R. of activity limitations in early knee
The effect of backward locomotion training osteoarthritis: 3-year results from the cohort
on the body composition and hip and cohort knee study. Arch Phys Med
cardiorespiratory fitness of young women. Rehabil.2014; 95: 1962-1968.
Int J Sports Medne. 2004;25:1–6. 28. Flynn TW, Souse Little RW, Feb 1993-
21. Shankar P, RenukaM, Bhandiwad A, Pai H. Mechanical power and muscle action during
Effectiveness of Retrowalking in Chronic forward and backward running. J Orthop
OA of Knee joint.Innovative Journal of Sports Phys Ther.1993 Feb;17(2):108-12
Medical and Health Science.2013; 3:19-22. 29. Balraj AM, Kutty RK, Saji VT. Impact of
22. Susan B O‟Sullivan and Thomas J Schmitz. Retro-Walking on Pain and Disability
Textbook of Physical rehabilitation. Parameters among Chronic Osteoarthritis
5thEd.E.A.Davis Company.2007;p 869. Knee Patients. Journal of Physiotherapy and
23. Polly E Bijur, Wendy Silver, E John Physical Rehabilitation.2018;3:2.
Gallagher- Reliability of Visual analog 30. Kachanathu SJ, HafezAR, Zakaria AR.
Scale for measurement of pain. AcadEmerg Efficacy of backward versus forward
Med. 2001 Dec;8(12):1153-7 walking on hamstring strain rehabilitation.
International journal of therapies and
rehabilitation research. 2013;2(1):8-14.

How to cite this article: Ganu SS, Merchant AJ. Effect of Retrowalking on pain, functional
disability and functional mobility in patients with chronic knee osteoarthritis. Int J Health Sci Res.
2018; 8(11):109-115.

******

International Journal of Health Sciences & Research (www.ijhsr.org) 115

Vol.8; Issue: 11; November 2018