Background <p>While immobilization is a common clinical intervention, its isolated effects on gait mechanics and the efficacy of subsequent rehabilitation strategies remain poorly understood. Understanding these isolated effects is crucial as immobilization-induced deficits may persist despite rehabilitation, potentially affecting long-term functional outcomes and quality of life. This case examines controlled knee immobilization in a healthy individual without confounding injury factors, providing insight into the isolated effects of immobilization on gait mechanics.</p> Case presentation <p>A healthy 29-year-old male underwent controlled 14-day knee immobilization using a locking knee brace, followed by an 8-week resistance training program. Gait analysis was conducted using wireless inertial sensors at four time points: baseline, post-immobilization, post-resistance training, and 14-week follow-up. Key findings revealed that while resistance training partially restored basic gait parameters, complex motor control deficits, characterized by impaired bilateral coordination and reduced neuromuscular control affecting inter-limb timing and anti-phase gait patterns, persisted. The Phase Coordination Index showed a 47.0% decrease post-immobilization at comfortable speeds, with a 26.1% deficit remaining after rehabilitation. Fast walking speeds showed even more pronounced deficits, with 62.9% below baseline at follow-up. The participant reported persistent hip pain and functional limitations preventing return to pre-immobilization activities.</p> Conclusions <p>This case demonstrates that resistance training alone does not fully address the complex neuromuscular deficits induced by immobilization. The persistent coordination deficits suggest that traditional strength-focused rehabilitation may be insufficient for complete functional recovery, indicating the need for more comprehensive rehabilitation strategies incorporating gait-specific training and bilateral coordination exercises.</p>