Physical Therapy for Parkinson’s Disease
Physical therapy can improve strength and flexibility, and decrease pain and stiffness in people with chronic conditions like early onset Parkinson’s Disease. It’s part of an array of Parkinson’s disease treatments.
Preventing and Minimizing Disability
Most of us are referred to a physical therapist at one time or another. Whether you are experiencing disability as a result of pain, injury, or illness, physical therapists provide physical therapeutic intervention (as opposed to medical or surgical intervention) with the goal of preventing or minimizing disability.
It’s well-known that exercise of all kinds is beneficial for patients with Parkinson’s disease. But physical therapy, in particular, is key. Why? A professional can guide you through the right moves to increase mobility, strength and balance, and help you remain independent.
Note: Please discuss any exercise program with your physician/neurologist and get a referral to a physical therapist with expertise in Parkinson’s Disease before starting any specific program
Parkinson disease (PD) is the second most common degenerative brain disorder affecting adults. (Alzheimer disease is the most common.) Physical therapists partner with people with PD and their families to manage their symptoms, maintain their fitness levels, and help them stay as active as possible.
What is Parkinson's Disease?
Parkinson disease is related to a loss of nerve cells in the brain that produce a chemical called dopamine. Dopamine and other brain chemicals are normally in balance and are important for the control of body movements, thought processes, decision making, moods, and other behaviors.
The exact cause of PD is not yet known. It is a chronic degenerative disease, which means that it gets worse over time; however, people usually do not die from it.
Signs and Symptoms
Non-motor symptoms of PD, such as a decreased sense of smell, sleep problems, and lightheadedness when first standing up, can begin many years before motor (movement) symptoms develop. Motor symptoms of PD, which typically include muscle and joint stiffness (rigidity), shaking (tremors) in the hands and limbs, slowed movement, and balance problems, most often begin at or around age 60. However, early-onset PD can affect people at a younger age.
The motor symptoms of PD can be very mild at first. A common early symptom is a tremor in 1 hand, most often when you are at rest. It might look like you are rolling a pill between your thumb and forefinger. Tremors also can occur in your legs or jaw when you are at rest. Since the tremors are most apparent during rest, they usually go away when moving and typically don't interfere substantially with daily functions.
As the condition progresses, people with PD may notice other motor symptoms, such as:
Movements that become smaller, possibly resulting in:
the voice becoming quieter
the arms swinging less when walking
shuffling when walking
Muscle stiffness or rigidity, causing discomfort in the neck, trunk, or shoulders
Pain due to muscle stiffness
Postural instability, resulting in poor balance and a greater risk of falling
Movements that become slower during daily activities such as dressing, showering, or moving in bed
A feeling of the feet being "frozen" to the floor, making it hard to take a first step, or to turn around when walking
Difficulty speaking at a normal voice level
Difficulty performing tasks that were once easy to do, such as gardening or swinging a tennis racquet or golf club
Difficulty making facial expressions
Difficulty holding and releasing urine (bladder urgency and incontinence)
Non-motor symptoms might include:
Difficulty paying attention to a task for a long period of time or dividing attention between 2 or more tasks
Lack of motivation
How a Physical Therapist Can Help?
Because PD affects each person differently, your physical therapist will partner with you to manage your specific situation—now and as your condition changes. You are not alone!
Following a diagnosis of PD, your physical therapist will conduct a comprehensive evaluation, including tests to examine your posture, strength, flexibility, walking, endurance, balance, coordination, and attention with movement. Based on your test results, your physical therapist will develop an individualized treatment plan to help you stay as active and as independent as possible. Your program will include exercises and techniques to combat the symptoms of PD.
Depending on the nature and severity of your condition, your treatment program may focus on activities and education to help you:
Improve your fitness level, strength, and flexibility
Develop more effective strategies to get in and out of bed, chairs, and cars
Turn over in bed more easily
Stand and turn to change directions more efficiently
Improve the smoothness and coordination of your walking
Improve your ability to perform hand movements
Decrease your risk of falling
Improve your ability to climb and descend stairs and curbs
Perform more than 1 task at a time more efficiently
Participate in activities that are important to you
Your program will include:
Amplitude training-A specific form of physical therapy for Parkinson’s disease is over exaggerated physical movements, like high steps and arm swings. It’s a way to retrain the muscles and slow down the progression of hypokinesia, the increasingly smaller, more shuffling movements that happen with Parkinson’s.
Reciprocal movements are side-to-side and left-to-right patterns, such as swinging your arms while taking steps as you walk. Parkinson’s disease may affect these patterns. Your therapist may help you reinforce reciprocal patterns.
Normal balance is an interplay among what you see (visual feedback), your inner ear (which helps you orient yourself) and how your feet sense the ground beneath them. Parkinson’s disease can affect this balance system, making your gait (how you walk) unstable, which in turn may make you fearful to be in public or crowded spaces. Gait training (practice walking) can help. Exercises that aim to improve balance should be guided by a physical therapist, who can work with you to understand any issues with balance and teach you ways to compensate.
Stretching and Flexibility
It’s common for patients with Parkinson’s disease to develop tight hip flexor, hamstring and calf muscles. To counteract that stiffness, it’s best to stretch at frequent intervals throughout the day, rather than just once, says Padilla-Davidson. Ask a qualified therapist who specializes in Parkinson’s to show you how.
Muscles naturally weaken with age, so strength training is important for everyone. But research suggests that muscle weakness is a bigger problem for patients with Parkinson’s Disease. A physical therapist will develop a targeted exercise program that is specific to your individual needs.
How To Optimize You Function With On-Going Physical Therapy
Your physical therapist will know how to time treatments, exercise, and activity based on both the schedule and the effects of your medications to get the best results.
As your condition changes, your treatment program will be adjusted to help you be as independent and as active as possible.
Some people with PD benefit from using a cane or a walker. Your physical therapist can work with you to determine if any of these devices may be helpful to you. If you need physical assistance to help you with moving in bed or getting out of a chair, your physical therapist can team with you and your family to develop strategies to make moving easier and help prevent injury. In addition, your physical therapist can make suggestions on changes to your home environment to optimize safe and efficient daily function at home.
Studies have shown that physical therapy improves walking, balance, strength and functional fitness.
All physical therapists are prepared through education and experience to treat patients with PD. You may want to consider: A physical therapist who is experienced in treating people with neurological disorders. Some physical therapists have a practice with a neurological focus.
During your first visit with the physical therapist, be prepared to describe your concerns in as much detail as possible, and let the physical therapist know what you would like to accomplish by going to physical therapy.
Maintaining Your Function As You Age
People with PD gradually lose the gains they make when their supervised exercise program ends. It’s important to work with your physical therapist to help develop good long-term exercise habits.