Frenkels Exercises

Introduction[edit | edit source]

Heinrich Frenkel created the Frenkel's exercise as a coordination and proprioception exercise for people with tabetic ataxia, a gait characteristic of somebody with untreated syphilis . In these exercises, the central nervous system is educated through precise repetition of exercise, particularly in the lower limbs, with high level of concentration. The exercises are carried out in three different positions: sitting, lying down, and standing.[1] Frenkel could be regarded as the father of rehabilitation medicine because he was the first to propose the idea of exercise to improve ambulation and regain dexterity.[2] Although the exercise was created for persons with tabetic ataxia, a form of sensory ataxia, it has been proven effective for other neurological conditions involving coordination and proprioception affectation.[3][4][5]

Principle[edit | edit source]

These exercises require:

  • Concentration or attention
  • Repetition
  • Precision


Throughout the workouts, the physical therapists should give verbal feedback. Through these exercises, the patients would learn how to stay balanced and prevent falls by using their visual, somatosensory, and vestibular systems. Exercises are performed with the eyes closed as somatosensory development improves.[1]

The Exercises[edit | edit source]

In lying position[edit | edit source]
  • flexion, extension, abduction, and adduction of the hip
  • flexion and extension of the knee
  • moving the heel to the patella, the middle of the tibia, and to the ankle joint of the contralateral leg
  • dragging the heel along the tibia
In sitting position[edit | edit source]
  • lifting the thigh with the knee flexed and returning the foot firmly on the ground
  • sitting down with the knees flexed and the body bent slightly forward
  • standing up when the feet are firmly planted on the ground
In standing position[edit | edit source]
  • walking forward
  • walking sideways and returning to the original position
  • walking backwards
  • using predetermined short, medium, and long steps to do the preceding exercises
  • turning at an angle between 90 and 180 degrees
  • walking in a zig-zag
  • walking heel to toe just like the tandem stance
  • walking up and down stairs

These exercises could be practiced initially from one leg, then progressed to both legs moving simultaneously.



Although Frenkel originally created these exercises for the lower limbs, several upper limbs variations have been devised even though there is little evidence to that regard. Check the video below for an example:


References[edit | edit source]

  1. 1.0 1.1 1.2 Ko EJ, Chun MH, Kim DY, Kang Y, Lee SJ, Yi JH, Chang MC, Lee SY. Frenkel's exercise on lower limb sensation and balance in subacute ischemic stroke patients with impaired proprioception. Neurology Asia. 2018 Sep 1;23(3).
  2. Zwecker M, Zeilig G, Ohry A. Professor Heinrich Sebastian Frenkel: a forgotten founder of rehabilitation medicine. Spinal Cord. 2004 Jan;42(1):55-6.
  3. Ghasemi E, Shaygannejad V, Ashtari F, Fazilati E, Fani M. The investigation of Frenkel’s exercises effection on ataxia, balance, activity of daily living and depression in patients with multiple sclerosis. Journal of Research in Rehabilitation Sciences. 2008 Jun 1;4(1).
  4. Vafaeenasab MR, Amiri A, Morowatisharifabad MA, Namayande SM, Tehrani HA. Comparative study of balance exercises (frenkel) and aerobic exercises (walking) on improving balance in the elderly. Elderly Health Journal. 2018 Dec 30.
  5. Rathi M, Hamdulay N, Palekar TJ, Joshi R, Patel R, Shah R, Kulkarni M. Effectiveness of Frenkel's balance exercises on elderly people. Indian Journal of Gerontology. 2021;35(4):483-94.
  6. Frenkel HS, Freyberger L. The treatment of tabetic ataxia by means of systematic exercise: an exposition of the principles and practice of compensatory movement treatment. Philadelphia: Blakiston; 1902:208.
  7. Physio Mentor. Frenkel Exercises for Ataxia Patients | Physiotherapy | physiomentor. Available from: [last accessed 4/10/2020]
  8. Physio Mentor. Frenkel Exercises For Upper Limb For Ataxia | physioMentor. Available from: [last accessed 5/11/2020]