Walking Rehabilitation After Stroke: Physiotherapy Approaches

Why walking is affected

A stroke can affect walking in several ways: weakness in the hip, knee or ankle on one side, poor balance, reduced sensation, spasticity or difficulty coordinating movement. Most people have a combination.

Common patterns include difficulty lifting the foot (foot drop), the knee snapping back or buckling, and shorter steps on one side.

Building the foundations

Before walking, the body needs some key abilities: sitting balance, standing, shifting weight onto the affected leg and taking a step. Rehabilitation builds these first. Weight shifting and sit to stand are early exercises.

Walking practice

Once standing is steady, walking practice begins, often with support: parallel bars, a walking frame or a physiotherapist's hands. Practice gradually reduces support as control improves.

Specific techniques include:

• step practice, stepping forward and back with the affected leg
• body-weight supported walking, using a harness to allow early practice
• walking with rhythm cues
• treadmill training, where appropriate
• walking on different surfaces and around obstacles

Walking aids and splints

The right aid, such as a quad stick or walker, can make walking safer and allow more practice. An ankle-foot orthosis can help with foot drop. Aids are reviewed as recovery progresses.

Strength and fitness

Strengthening the affected leg and building overall fitness both support walking. Walking itself is exercise, and building endurance allows longer distances.

How long it takes

Many people regain some walking ability within the first few months. Improvement can continue beyond that with practice. Recovery varies widely depending on the stroke.

The mistakes that slow walking recovery

The most common one is walking too little because walking is hard. Stroke survivors often wait to feel "ready" before practising. Walking readiness comes from walking practice, done safely and often, not before it.

The second is relying on the unaffected leg. It's natural to lean on the stronger side, but walking that avoids the weaker leg trains the avoidance. Exercises that deliberately load the affected leg, like standing with weight shifted onto it or stepping the strong leg forward so the weak one takes the load, matter a great deal.

The third is keeping the same walking aid for too long, or dropping it too early. A frame that was right in week three may be holding someone back in week ten. A stick given up for appearance can mean a fall. Aids should be reviewed at regular points, not left as they were at discharge.

Finally, speed matters. Walking that is safe but extremely slow can still limit independence outside the home, such as crossing a road. Once walking is steady, practising a slightly faster pace becomes part of the plan.

Balance matters

Balance problems often limit walking even when strength returns. Our article on balance problems after stroke explains how that's addressed.

Our gait training guide covers walking retraining in more detail.