Physiotherapy for Parkinson’s Disease

Parkinson's disease (PD) is a progressive neurodegenerative disorder that affects movement, causing symptoms such as tremors, rigidity (stiffness), bradykinesia (slowed movement), and postural instability. Physiotherapy plays an important role in managing PD, as with most chronic conditions we are not going to cure this, however, with effective physiotherapy this can significantly improve quality of life and overall well being (both physical and mental).

Parkinson's disease (PD) is a progressive neurodegenerative disorder that affects movement, causing symptoms such as tremors, rigidity (stiffness), bradykinesia (slowed movement), and postural instability.

Physiotherapy plays an important role in managing PD, as with most chronic  conditions we are not going to cure this, however, with effective physiotherapy this can significantly improve quality of life and overall well being (both physical and mental). What this looks like to you will be drastically different to the next person so an individualised program is the key.

This blog, however, will discuss general advice and summaries of the latest research for physiotherapy. There is, however, a very important need to discuss your condition with a doctor (or specialist) and have them involved in your care to discuss medications and medical management.

But first, what is PD?

PD is characterised by the degeneration of dopamine-producing neurons in the substantia nigra, a region of the brain that regulates movement. The resulting dopamine deficiency leads to motor and non-motor symptoms that progressively worsen over time

Physio for PD

Physiotherapy focuses on optimising movement and function (no surprise there!). Evidence suggests that regular physiotherapy can lead to significant improvements in mobility, balance, and physical fitness. Here are some of the most effective interventions supported by the latest research.

1. Stretching and Aerobic Exercises: (i.e. walking, cycling) are beneficial for movement control, mood, cognitive (brain) function and quality of life. Regular stretching can also improve range of motion, reduce stiffness, and improve mobility. 

2. Strength Training: Research indicates that this can help reduce slow movement and improve muscle strength in PD. This should be performed twice a week and the exercises should be specific to you, however, leg strengthening (for stairs, walking etc), abdominal (for getting in and out of bed etc), and arm strength (holding items, lifting etc) should be included.

3. Balance Training: is crucial in preventing falls and improving stability in individuals with PD. Exercises that challenge balance can enhance postural control. These might also look like walking while turning your head or stepping in challenging directions, however, no two persons have the same balance so this requires careful assessment to determine the correct exercises.

4. Gait Training: Gait disturbances, including shuffling steps and freezing of gait, are common in PD. Gait training involves exercises that improve walking patterns, speed, and stride length. Gait training, particularly with cueing, significantly enhances walking ability and reduces freezing episodes in people with PD. Particular areas we may target are arm swing and rotation as this is a common contributing factor to stride changes (yes we may get you to walk with ‘swagger’).

5. Proprioceptive Neuromuscular Facilitation: (PNF) is another technique we can use to improve joint movement and muscular performance. PNF involves a combination of stretching and contracting targeted muscle groups, performed with the assistance of a therapist. The technique essentially increases neuromuscular control, facilitating movement.

6. BIG therapy: is an approach designed specifically for individuals with PD. This involves amplifying body movements through exercises with large, exaggerated motions. The aim is to counteract the small, shuffling movements by training the brain to recognise and adopt larger, more deliberate movements. Patients often experience enhanced motor control, reduced risk of falls, and greater confidence in their physical abilities.

Group Therapies for PD

Group exercise settings are an excellent way to integrate these practices, however, with the complex nature of PD and the requirement for individualised care it is more beneficial for these to be 1:1 or in a group with your own personal program.

Conclusion

At Fleurieu Coast Physio we offer group pilates classes based on an individualized assessment, however, if you would also prefer we offer 1:1 therapy sessions with the physiotherapists in our studio with pilates, cardiovascular and strengthening equipment. As research continues to evolve, we will continue to integrate this into practice to empower your movement and unlock your potential. If you or a loved one is living with PD, consider calling us to book an appointment to develop a tailored exercise program that addresses specific needs and goals.

Written by Kara Ballard

Physiotherapist

Fleurieu Coast Physio

Great Resources:

Tomlinson, C. L., Herd, C. P., Clarke, C. E., Meek, C., Patel, S., Stowe, R., Deane, K. H., Shah, L., Sackley, C. M., Wheatley, K., Ives, N., & Tomlinson, C. L. (2014). Physiotherapy for Parkinson’s disease: a comparison of techniques. Cochrane Database of Systematic Reviews, 2014(6), CD002815–CD002815. https://doi.org/10.1002/14651858.CD002815.pub2

Tomlinson, C. L., Patel, S., Meek, C., Herd, C. P., Clarke, C. E., Stowe, R., Shah, L., Sackley, C., Deane, K. H. O., Wheatley, K., & Ives, N. (2012). Physiotherapy intervention in Parkinson’s disease: systematic review and meta-analysis. BMJ (Online), 345(7872), 11–11. https://doi.org/10.1136/bmj.e5004

Radder, D. L. M., Lígia Silva de Lima, A., Domingos, J., Keus, S. H. J., van Nimwegen, M., Bloem, B. R., & de Vries, N. M. (2020). Physiotherapy in Parkinson’s Disease: A Meta-Analysis of Present Treatment Modalities. Neurorehabilitation and Neural Repair, 34(10), 871–880. https://doi.org/10.1177/1545968320952799