FND Education Project

REFERENCE · RECOVERY TECHNIQUE

Backward, Sideways and Direction-Change Walking for Functional Gait Disorder

Most likely fit: Forward walking is markedly hesitant, dragging or disorganized, while a safely tested backward or sideways step is more fluent. A brief direction change can reveal another available movement pattern and provide a bridge back to forward walking. [Clinical consensus; not helpful or safe for everyone]

Not the same as: Prescribing backward walking because it appears on a list, using it during an uncontrolled flare, or asking a person with impaired balance, vision, sensation or cognition to move into unseen space without adequate protection.

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Why changing direction may change the pattern

Backward and sideways steps are different tasks from ordinary forward walking. They change where you look, which part of the foot reaches first, and how the hips and trunk organize movement. For some people, this difference interrupts the familiar difficult pattern and produces a smoother step.

The alternative direction is usually a short bridge. A therapist may use one or two better-organized steps, turn or change the cue, and immediately try to carry that organization into forward walking. If backward walking makes your gait worse—as it does for some people—it should not be pursued as proof that it ought to work.

Anatomy in everyday language

Forward, backward and sideways walking all transfer the centre of mass over a changing base, but the joint actions and sensory demands differ. Backward stepping often begins with the toes moving into space and uses hip extension differently from forward swing. Side stepping relies strongly on the hip abductors and adductors—the muscles that move and control the leg away from and toward the body’s midline.

Vision also changes. During forward walking you can see the route ahead; during backward walking the landing area may not be visible. Your vestibular system in the inner ear and somatosensory information from the feet and joints therefore become especially important. In plain language, a direction change may unlock a different movement plan, but it can also remove information needed for safety.

What safe practice may look like

The therapist may begin at parallel bars or a rail with a clear route and close guarding. Side stepping may be tested before backward stepping. Only a few steps are needed to learn whether the pattern helps. The therapist then links that change to a turn, a weight shift or forward steps toward a visible destination.

Do not practise this alone near stairs, traffic, furniture, pets or uneven ground. Stop if you cannot control the landing, cross your feet unexpectedly, become dizzy, develop new pain or lose awareness of the route.

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Backward or sideways walking should be used at home only when the therapist has specified the route, support and guarding. Clear the entire space first. Do not walk behind and pull the person, surprise them with a direction change or ask them to demonstrate the technique during a flare.

If the technique is part of the plan, use one cue and help the person return to forward walking at the agreed point. Report worsening as useful information; it does not mean the person performed the technique incorrectly.

For the Person With FND
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Selection and safety screen

Use direction change only after observing a reproducible, safer or more organized pattern and determining its therapeutic purpose. Assess visual field and acuity, vestibular symptoms, proprioception, cognition, impulsivity, orthostatic symptoms, joint range, strength, foot placement and ability to stop. Review recent falls and the need for parallel bars, a gait belt, a second clinician or body-weight support.

Differentiate a positive functional transformation from patterns associated with Parkinsonism, frontal gait disorders, cerebellar or sensory ataxia, vestibular disease, spasticity, pain and musculoskeletal restriction. Improvement in one direction supports a functional formulation only in the context of the full examination.

Explicit procedure

  1. Record forward gait and define the specific feature to compare: initiation, clearance, rhythm, knee control, base or trunk motion.
  2. Prepare a short unobstructed route with the endpoint, hand support and stopping cue agreed in advance.
  3. Test lateral weight transfer or one side step before adding a sequence.
  4. If appropriate, test one or two backward steps with close guarding and no unseen obstacle.
  5. Compare movement quality and safety immediately; discontinue if the alternative direction is worse.
  6. When a useful pattern appears, turn, pivot only if safe, or use a weight-shift cue to transition into forward stepping.
  7. Keep the alternative-direction dose brief so it remains a bridge rather than a new compensatory gait.
  8. Progress forward distance or reduce cueing before increasing backward distance.
  9. Record where the method is prohibited, including unguarded home use if applicable.

Outcomes and evidence boundary

Track assistance, foot placement, step initiation, clearance, continuity, crossover, balance reactions, forward carryover, falls or near-falls and symptom response. Success is improved ordinary function, not the ability to walk far backward.

Backward and sideways transformations are described in functional-motor consensus and sign-based gait examination. They have not been isolated in controlled treatment trials, and public lived experience includes direct reports of worsening with backward walking. [1][2]

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Research and Sources

Citation Full citation
[1] Nielsen G, Stone J, Matthews A, et al. Physiotherapy for functional motor disorders: a consensus recommendation. Journal of Neurology, Neurosurgery & Psychiatry. 2015;86(10):1113–1119. FND-CIT-0028. https://doi.org/10.1136/jnnp-2014-309255
[2] Nonnekes J, Růžička E, Serranová T, Reich SG, Bloem BR, Hallett M. Functional gait disorders: a sign-based approach. Neurology. 2020;94(24):1093–1099. FND-CIT-0020. https://doi.org/10.1212/WNL.0000000000009649

Detailed technique page created September 12, 2026 · Clinical and accessibility review pending

For the Person With FND
For Family, Friends, and Other Supporters
For Clinicians and the Care Team
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