Mindful Walking to Beat Foot, Hip, and Knee Pain

Walking is a fantastic form of exercise with health benefits. Walking for 30 minutes, four to five days a week has profound health benefits, including(1):

  • Improves circulation and fights heart disease
  • Better blood sugar control
  • Fights osteoporosis
  • Supports stress management 
  • Helps reduce insomnia
  • Boosts endorphins

Even though we promote walking for its many benefits, it is also a repetitive motion. In repetitive motion, it’s possible to overuse muscles and joints causing aches and pains over time. The reason walking can end up causing pain is from aberrant mechanics. There is a way our body’s joints are designed to move, so if we walk outside of our intended mechanics, it can lead to low back, hip, knee, or foot pain. Read on to see how you can work on correcting your walking mechanics to beat pain. 

Mechanics of Walking

In walking, there is a cycle and pattern our gait naturally falls into. When we walk, we have one leg in contact with the ground while the other leg swings from back to front to propel us forward. The leg on the ground is defined by the components of the Stance Phase while the leg swinging through is defined by the components of the swing phase.The detailed components of each phase of the gait cycle are as follows(2):

The Stance Phase:

  1. Heel strikes the ground
  2. Entire foot comes in contact with the ground
  3. Heel lifts placing weight on the ball of the foot
  4. Big toe provides the propulsion for the lift and swing

The Swing Phase:

  1. Toe-off from the ground
  2. Leg swings through mid-swing
  3. Terminal swing preparing for heel strike of the Stance Phase. 
The Components of the Gait Cycle

Also, we know which joints require the most mobility to be involved in the gait cycle: the hip, knee, ankle, and big toe.  

Joints involved in Gait Cycle

Common Gait Abnormalities

Pain shows up in walking when someone has either too much motion or too little motion in the key joints (Hip, Knee, Ankle, or Big Toe) involved in gait. In the office, we see common gait abnormalities that affect the entire kinetic chain. The myriad deviations from a healthy gait pattern is best assessed by a clinician trained to identify the nuanced changes that could be causing you pain. For example, a clinician would observe your gait and identify where your issue may originate from. Below are a few examples of structural and mechanical deviations in gait.

Tibial Torsion

Tibial torsion is when the bones of the lower leg, below the knee, rotate relative to the upper leg bone. This is one way someone may present as walking like Charlie Chaplain, with toes pointed out, or pigeon toed, with toes pointing in. Either one of these deviations from neutral can put extra stress on the knee and hip joints causing wear and tear and pain in the knees and hips. 

Examples of Tibial Torsion

Femoral Rotation

When there is femoral rotation, the deviations in the leg originate from the hip. This can also lead to excess wear and tear at the knee or hip. The rotation that happens at the hip can be caused over time from habit, muscle imbalances, or occasionally from structural reasons. 

Examples of Femoral Rotation

Foot Pronation or Supination

The middle image below shows a foot in a neutral weight-bearing position. The two feet to the left of neutral demonstrate excess pronation (arch rolling in) of the foot and ankle. The two feet to the right of neutral demonstrate excess supination (arch rolling out) of the foot and ankle. Either of these deviations creates an increase in motion at the foot and ankle complex, creating a domino effect up the chain. This can lead to foot pain, ankle pain, knee pain, hip pain, or back pain. 

Examples of Pronation and Supination

Weak Hip Stabilizers

When in the stance and swing phases of the gait cycle, the stance leg should provide hip stability. The hip stabilizer muscles, when active, hold the hip in neutral in the stance phase. However, when the hips have muscle imbalances, like weak hip stabilizers, we can see a decrease in hip stability in the stance phase, specifically a hip dip as seen in B in the image below. This deviation from neutral can cause pain in the low back, hip, and knee. 

Normal versis Weak Hip Stabilizers in Gait

Mindful Walking Drill

Mindful Walking is what we call the drill where you bring your attention to your walking mechanics for several paces. The drill is intended to practice the stance phase and swing phase with intention to establish some muscle memory in a healthy gait pattern. 

Mindful Walking Drill
  • Begin by standing, feet underneath your hips and toes pointed forward. 
  • Tilt the pelvis under (pubic bone forward). 
  • Take a step forward and slowly, mindfully, extended the back foot *toes are peeling off the ground. Gentle squeeze your buttocks when this leg is extended. 
  • After the foot is lifted, bring it forward by lifting the knee and hip and plant with the heel. 
  • Repeat the movement with the other foot.
  • Perform 10 paces with this form. Rest and repeat three sets of these 10 paces. 

When prescribing this drill, we like to begin with a few sets of 10 paces, and work up to incorporating the mindful drill into increasing portions of a standard outdoor walk.

The Takeaway?

Walking is an incredible, benefit-rich form of exercise; however, there are several opportunities for mechanical hiccups that can lead to pain. If you suspect your pain is coming from your gait or you feel the origin of your pain is unknown, gait is a great place to start looking for the root cause. In fact, most clinicians specializing in sports medicine or biomechanics will look at the gait as the beginning of any evaluation since gait is a part of the movements of daily life. 

At Regenexx Tampa Bay, our clinicians are dedicated to finding the root cause of your problem so that you can do what you love, pain free! Contact us today to set up an evaluation for your pain or injury. 


  1. https://www.arthritis.org/health-wellness/healthy-living/physical-activity/walking/12-benefits-of-walking
  2. https://americanbonehealth.org/exercise/the-mechanics-of-walking/
  3. https://www.researchgate.net/figure/Phases-of-the-normal-gait-cycle_fig3_309362425
About The Author
Abby Perone, DC, CES

Abby Perone, DC, CES

Abby Perone, DC is an athlete, a practicing sports clinician, and a teacher.
Abby Perone, DC, CES

Abby Perone, DC, CES

Abby Perone, DC is an athlete, a practicing sports clinician, and a teacher.

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