Management involves an interdisciplinary approach with early intervention helping to slow down deterioration.

Physiotherapy can significantly improve signs & symptoms by addressing issues with walking, falls, reduced flexibility, postural instability, balance and transfers (Radder et al, 2020).

Physiotherapists are experts in movement analysis and can spot early changes in movement and function. Your Physiotherapist can help to advise on these issues before they become more difficult to change (Parkinson's UK).

A 2022 meta-analysis found that progressive resistance training in people with Parkinson's improved freezing of gait, increased muscle strength and improved quality of life during rehabilitation. Parkinson's UK recommended seeing a physiotherapist as soon as possible after diagnosis.

People with Parkinson’s may find after an illness or injury that activities and walking become more difficult. Physiotherapy can facilitate a quicker recovery by providing tailored exercises to aid rehabilitation and prevent further decline.

Pain-

You may experience pain in the muscles associated with reduced flexibility and rigidity. Some people may have kyphosis of the spine (curving) which can limited the movement of the trunk and put more strain through the soft tissues and joints.

You may have involuntary muscle contractions (dystonia) which can cause pain.

Your physiotherapist can help assess the source of pain and assist with flexibility exercises for the joint and muscles, manual techniques and advise on the use of heat or cold to ease pain.

Mobility and movement-

Physiotherapy can help build or maintain muscle strength and fitness levels and help address changes as they arise with movement, posture and balance. Physiotherapy can be helpful with all stages of the disease.

Walking- You may walk with small shuffling steps (Parkinsonian gait), have involuntary increases in pace (festination) and experience freezing episodes which can make walking difficult. These changes can significantly increase the risk of falling and risk of serious injury.

Cueing techniques- Your physiotherapist can advise on cueing techniques to help improve your walking which act as an external stimuli to control symptoms.

Auditory cues include use of sound such as walking to the beat of metronome or music to reduce freezing episodes and make walking more fluid.

Visual cues can be used such as applying tape on the floor to increase step/stride length, using a laser or visualising stepping over something when outside (Muthukrishnan et al, 2019).

Your physiotherapist can help guide you with the best cues and techniques that work well for you. A regular, tailored exercise programme targeting key areas of strength, flexibility and balance can help maintain your independence, keep you active, prevent falls and slow down progression of the disease.

Posture-

Typically, people with Parkinson's experience changes in their posture over time which can include rounding of the shoulders, thoracic kyphosis, forward head position, flexed spine, bending of the knees and they may lean to one side.

Postural changes can lead to an increased risk of falls, difficult speaking loudly, reduction in balance, reduced strength of core muscles and reduced flexibility. Stooped posture can also affect your ability to take a deep breath (Parkinson's UK).

Your physiotherapist can help you recognise these changes and address the key areas of concern. Treatment may include use of a mirror for postural awareness and correction, strengthening postural muscles and stretches to tight muscles and joints.

Parkinson's UK website is a great source of knowledge https://www.parkinsons.org.uk

Cueing Paradigms to Improve Gait and Posture in Parkinson’s Disease: A Narrative Review

Niveditha Muthukrishnan,1 James J. Abbas,1 Holly A. Shill,2 and Narayanan Krishnamurthi. Sensors (Basel). 2019 Dec; 19(24): 5468. Published online 2019 Dec 11.

Physiotherapy in Parkinson’s Disease: A Meta-Analysis of Present Treatment Modalities

Danique L. M. Radder, MD,1,* Ana Lígia Silva de Lima, PhD,1,* Josefa Domingos, MSc,1,2 Samyra H. J. Keus, PhD,1,3 Marlies van Nimwegen, PhD,1 Bastiaan R. Bloem, MD, PhD,1 and Nienke M. de Vries, PhD1 Neurorehabil Neural Repair. 2020 Oct; 34(10): 871–880. Published online 2020 Sep 11