Falls during walking, often triggered by trips and slips, are a major cause of injury in older adults. Perturbation-based training is promising to prevent the falls, but the key biomechanical strategies—elevating and lowering responses and arm movements—that distinguish successful recovery from falls are not clearly suggested. To synthesize evidence on biomechanical strategies and determinants of successful balance recovery after trip- or slip-related perturbations during walking. A systematic search of PubMed, Scopus and EMBASE (1984–2025) identified studies of healthy young and older adults exposed to unexpected trips or slips while walking. Following PRISMA 2020, 15 studies were included and appraised with a modified Downs and Black checklist. Trip recovery was mainly determined by perturbation timing: elevating responses were more common after early-to-mid swing trips, whereas lowering responses were more common after late-swing trips and required greater inter-joint coordination. Slip recovery depended primarily on rapid compensatory stepping of the unperturbed limb executed within a narrow time window. Across both perturbation types, arm movements supported trunk stabilization, yet age-related slowing reduced the margin for successful recovery. Successful balance recovery after trips and slips depends more on the spatial and temporal precision of elevating, lowering and compensatory stepping and arm movements. These findings suggest that fall-prevention interventions should move beyond general balance exercise and incorporate cause-specific perturbation-based balance training. Clinically, training should emphasize rapid strategy selection after trips, accurate compensatory stepping after slips, and coordinated upper- and lower-limb responses, particularly in older adults with reduced recovery capacity.

INTRODUCTION
MATERIALS AND METHODS
    1. Study Design and Protocol
    2. Search Strategy
    3. Eligibility Criteria
    4. Study Selection
    5. Methodological Quality Assessment
RESULTS
    1. Study Selection
    2. Data Synthesis
    3. Methodological Quality Assessment
    4. Trip Recovery
    5. Slip Recovery
DISCUSSION
    1. Summary of Principal Findings
    2. Age-Related Differences in Recovery Mechanics
    3. Connecting Biomechanical Findings toPerturbation-Based Training Efficacy
    4. Role of Arm Movements as SupplementaryStabilizers
    5. Clinical Implications for Fall Prevention
    6. Limitations
    7. Future Research Directions
FUNDING
ACKNOWLEDGEMENTS
CONFLICTS OF INTEREST
AUTHOR CONTRIBUTIONS
ORCID
REFERENCES

• Sungmin Chun(Injury Prevention and Biomechanics Laboratory, Department of Physical Therapy, Yonsei University, Wonju, Korea)
• Junwoo Park(Injury Prevention and Biomechanics Laboratory, Department of Physical Therapy, Yonsei University, Wonju, Korea)
• Kitaek Lim(Injury Prevention and Biomechanics Laboratory, Department of Physical Therapy, Yonsei University, Wonju, Korea)
• Woochol Joseph Choi(Injury Prevention and Biomechanics Laboratory, Department of Physical Therapy, Yonsei University, Wonju, Korea) Corresponding author