The biomechanics of gait refers to the way we walk, run, or jog—a complex movement involving muscles, joints, nerves, and the cardiorespiratory system. A person’s gait reflects not only physical coordination but also balance, control, and even confidence. The basic unit of movement is the gait cycle, which consists of two main phases: stance (when the foot is on the ground) and swing (when it moves forward). The stance phase includes heel strike, flat foot, mid-stance, heel-off, and toe-off, while the swing phase involves acceleration, mid-swing, and deceleration as the leg prepares for the next step.
Disorders such as arthritis can disrupt this rhythm, reducing joint mobility and causing compensatory movements that increase stress on the hips, knees, or ankles. This often results in pain, imbalance, and reduced independence. Gait training—a form of physical therapy—can correct imbalances, improve strength, flexibility, posture, and endurance, and even reduce risks of falls and joint degeneration. Recent research suggests gait retraining may delay or avoid knee replacement surgery by lowering cartilage wear in osteoarthritis patients. Simple exercises like ankle pumps, step-ups, or retro walking can enhance lower-body strength and coordination. Practiced regularly, gait training protects joint health, boosts mobility, and supports long-term quality of life.
The way a person walks is their “gait”. It is the pattern or particular manner in which they move, inclusive of walking, jogging and running. When a person walks, there is a complex coordinated effort from the muscles, the nerves, the skeleton and the cardiorespiratory system. Gait also factors in speed, control, balance and the cognitive efforts behind the movement. When someone is confident, their gait reflects it. Gait disorders and problems that restrict range of motion can lead to an increased risk of injury and reduce independence and quality of life.
A “gait cycle” is the basic unit of movement. In simple terms, it is the whole process of taking a single step forward. This basic unit is repeated over and over, with alternating feet. The gait cycle has 2 components – The “stance” and the “swing”.
The “stance” accounts for the time during which your stationary foot and active foot are both in contact with the ground. The stance phase is divided into 5 “sub-phases”:
Initial Contact (heel strike) – The heel of the foot makes contact with the ground.
Loading response (flat foot) – The foot rolls forward and the entire sole makes contact with the ground. The foot is laid down flat.
Mid-stance – The weight of the body is propelled forward and falls on the foot. The knee is directly above the foot and the body weight is balanced on the planted foot.
Terminal stance (heel off) – The heel is lifted off the ground. The body weight shifts forward again and shifts to the other leg.
Pre-swing (toe off) – The toes push into the ground, and the entire foot lifts off.
This is the second half of the gait cycle, where the foot swings and moves towards the next step. It covers the following 3 sub-phases:
Early swing – This is the acceleration phase. The foot is lifted off the ground. The ankle and the knee are flexed. The hip flexors move the leg forward, directly under the body.
Mid-swing – The moving leg swings past the load-bearing foot, moving forward while keeping the upper body balanced.
Late swing – This is the deceleration phase. The moving foot has swung in front of the body, and the knee extends out. The momentum of the moving foot decreases and the knee is lowered to prepare the heel to land on the ground.
While the right leg is in the stance phase, the left leg moves through the swing phase. This alternating action happens simultaneously, and the brain and nervous system co-ordinate the activity to help you move with balance and agility.
Arthritis causes pain and stiffness in the joints. It may affect the joint angles, range of motion and coordination of the hips, knees, ankles and feet. Patients with arthritis have significant deviations from the gait cycle. An arthritic hip, for example, can reduce range of motion during the swing phase, causing the other hip to compensate with an exaggerated “hip hike”. Weak hip abductors can cause problems with the stability of the stationary leg. Weak hip extensors can cause the patient to take smaller steps. The imbalances in a person’s gait due to arthritis can put undue stress on the knees and ankles, causing accelerated wear and tear in these joints. It can also cause a lot of pain. Gait training is a great way to address these imbalances.
Gait training is a type of physical therapy to improve a patient’s gait pattern. Patients may be recommended gait training if they have a gait pattern that puts a lot of stress on their joints, particularly knees, hips and ankles. The objective of gait training is to improve muscle strength, joint mobility, posture, balance and endurance. Gait training is also designed to develop muscle memory, retrain legs for repetitive motion without putting stress on sensitive joints and to lower the risk of falls. Gait training can also help reduce your risk of comorbidities like heart disease and hypertension, because it gets you moving every day and increases physical activity.
Physiotherapists may recommend gait training to patients who find it difficult to walk independently. This includes patients with spinal cord injuries, fractured pelvis or legs, arthritis in the knees and hips, lower limb amputation, muscular dystrophy in the legs and joint replacements. Some patients who have had a stroke or other neurological disorders may also benefit from gait training.
The hip, knee and ankle joints work together in a chain as you walk, with one movement impacting the next. Any changes in gait will have an effect on the other joints, muscles and connective tissue in the chain. Knee pain, caused by arthritis, is a result of the degeneration of the cartilage in this joint. The cartilage cushions the bones of the knees, like a shock absorber. When this cushion gets worn out, the ends of the femur (thigh bone) and the tibia (shin bone) rub against each other, increasing the friction and rate of degeneration. This causes pain and inflammation. Conventional treatment for this typically includes oral pain medication, corticosteroid injections to reduce inflammation, hot and cold therapy, and topical NSAIDs. These solutions offer relief, but none of them are long-term solutions. Eventually, the degeneration will get worse, and knee replacement surgery will be needed. Gait training, however, may offer a tangible way to reduce stress on the knees long-term.
A new study published in The Lancet Rheumatology has lent further credibility to gait retraining as a solution to delay and possibly avoid knee replacement surgery. The study was conducted on 68 participants with early-stage knee osteoarthritis. The test group was made to walk on a pressure-sensitive treadmill to record and analyze their gait biomechanics. Then, the researchers devised an ideal foot orientation for each subject, while walking, to reduce stress on their knees. This typically involved pointing their foot in or out by about 5 – 10 degrees, as the case may be. The control group did not have their individual gait corrected by the researchers.
The test subjects practiced their corrected gait, under careful supervision, for 6 weeks. They did this for at least 20 minutes a day, until it began to feel natural. They were then encouraged to always walk using their new, corrected gait, for the next year. After a year, patients underwent an MRI scan. The test subjects, overall, had less knee pain compared to the control group. The MRI scans also showed lower rates of cartilage degeneration. This study has made doctors hopeful that people with osteoarthritis in their 30s and 40s can learn to manage their knee pain without surgery.
Anyone who walks in an imbalanced way could benefit from gait training – You don’t need to wait until the improper gait has started to hurt your joints. By doing some simple exercises at home, you can improve your range of motion, lower body strength, joint flexibility and stability. Improving these skills can help protect young people from falls and excessive joint degeneration in the long run.
Ankle Pumps – Lie on your backend flex your toes towards your knees for 5 seconds. Then point your toes away from your knees. Start slow and speed up as you go. This stretch improves the range of motion in your ankles.
Calf towel stretch – Sit on the floor and stretch your legs out in front of you. Take a towel, belt or yoga strap, and loop it around the arch of your right foot. Slowly pull the ends of the towel towards you, until you feel a stretch in your right calf muscle. Hold the stretch for 10 seconds and then repeat on the left side. This exercise activates the calf muscles.
Straight Leg Raises – Lie on your back, with your arms extended to either side. Bend your right knee and place your right foot flat on the floor. Extend the left leg out straight. Lift your left leg about 6 inches off the floor and hold for a few seconds. Lower it slowly and repeat the movement. For more of a challenge, when you lower your foot, don’t let it touch the floor before you lift it back up. Repeat on the left side. This exercise increases lower body strength.
Step-ups – Stand facing a staircase, or a couple of steps. Place your right foot on the first step, and step up, raising your left foot. Then lower your left foot down and step off with your right foot. Repeat this 10 times and then switch to the other side.
Obstacle training – Get yourself a set of small obstacles – could be athletic hurdles, small traffic cones or stacks of books. Set them up about 15 inches apart in a line. Stand facing the line of obstacles and step over them one by one, bringing both feet together after each obstacle. This strengthens the hips and the knees and improves flexibility.
Side-stepping Exercise – The setup for this exercise is similar to obstacle training. Get your obstacles in a line and join the line on one end. The line of obstacles should be to your right. Now step over the first obstacle, by raising your right knee high, and moving sideways. Then lift your left knee high and lower your left foot down next to your right foot. Repeat this movement till you reach the end of the line. Then go back. This exercise improves stability.
Retro Walking – Retro walking, also referred to as backward walking, is a good exercise to improve gait. It improves balance, co-ordination, walking speed and step length. Hamstring flexibility also improves. To perform this exercise, you need a treadmill. Set it to the lowest speed, and turn around, facing the back of the treadmill. Make sure the emergency stop clip is fixed on your clothes. Start the treadmill, and slowly walk backwards, moving through the toes, mid foot and heel. Think of this movement as performing each gait cycle in reverse. Do it very slowly, until you get used to the movement. Do not do this exercise unsupervised if you have any knee, hip or ankle pain.
These exercises can be performed by people in their 20s and 30s, to strengthen their lower body, particularly knees and hips. All these exercises should only be attempted under the supervision of a licensed physical therapist if you have arthritis or any lower body pain. Please consult your physiotherapist before trying these exercises for knee pain.
For expert evaluation and personalized gait training to protect your joints and improve mobility, consult Kauvery Hospital, with branches in Chennai, Hosur, Salem, Tirunelveli, and Trichy. Our orthopaedic and physiotherapy specialists offer comprehensive care to reduce pain, enhance movement, and support long-term joint health.
What is gait training?
Gait training is a form of physical therapy that helps correct walking patterns to improve balance, strength, joint mobility, and reduce stress on the hips, knees, and ankles.
Why is gait important for joint health?
An imbalanced gait increases stress on joints and accelerates wear and tear, leading to pain, instability, and reduced mobility over time.
How does arthritis affect walking patterns?
Arthritis causes pain and stiffness that alter joint movement, leading to compensatory walking patterns that place extra strain on other joints.
Can gait training reduce knee pain?
Yes. Gait training can reduce stress on knee cartilage, lower pain levels, and slow joint degeneration in people with knee osteoarthritis.
Can gait retraining delay knee replacement surgery?
Research shows that correcting gait patterns can reduce cartilage wear and pain, potentially delaying or avoiding knee replacement in early-stage osteoarthritis.
Who can benefit from gait training?
People with arthritis, joint replacements, neurological conditions, injuries, balance problems, or difficulty walking independently can benefit from gait training.
Are gait training exercises useful for younger adults?
Yes. Regular gait exercises improve strength, flexibility, coordination, and stability, helping prevent falls and joint degeneration later in life.
Kauvery Hospital is globally known for its multidisciplinary services at all its Centers of Excellence, and for its comprehensive, Avant-Grade technology, especially in diagnostics and remedial care in heart diseases, transplantation, vascular and neurosciences medicine. Located in the heart of Trichy (Tennur, Royal Road and Alexandria Road (Cantonment), Chennai (Alwarpet, Radial Road & Vadapalani), Hosur, Salem, Tirunelveli and Bengaluru, the hospital also renders adult and paediatric trauma care.
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