Forward versus backward pedaling in cycling: implications for rehabilitation strategies.

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Pedaling has been shown to be an effective rehabilitation exercise for a variety of knee disorders. Recently, backward gait has been shown to produce greater knee extensor moments and reduced patellofemoral joint loads compared to forward gait. No study has examined the efficacy of backward pedaling as a safe alternative to forward pedaling in rehabilitation programs. Neptune RR et al compared the knee joint loads while knee is performing during forward and backward pedaling. The aim was to determine whether backward pedaling offers theoretical advantages over forward pedaling to rehabilitate common knee disorders.

The study:
1. This study primarily quantified Tibiofemoral and Patellofemoral joint reaction forces.
2. Lower tibiofemoral compressive loads, but higher patellofemoral compressive loads, were observed in backward pedaling.
3. Lower protective anterior-posterior shear force was observed in backward pedaling near peak extension.

Clinical notes for implementation:
1. Backward pedaling offers reduced tibiofemoral compressive loads for those patients with knee disorders such as menisci damage and osteoarthritis, but higher patellofemoral compressive loads.
2. Therefore due to above said reasons, backward pedaling is not recommended for patients experiencing patellofemoral pain.
3. Further, backward pedaling should not be recommended after anterior cruciate ligament injury or reconstruction.

Caution to clinicians:
The results of this study indicate that the design of rehabilitation programs including pedaling exercises should be injury specific with particular attention paid to the mechanics of the task.

Reference:
Neptune RR et al; Clin Biomech (Bristol, Avon). 2000 Aug;15(7):528-35.



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