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How Physical Therapy helps in Parkinson's disease

Updated: Nov 18, 2020



If you or your family member or the person you care for has Parkinson’s disease, this guide is for you. This guide includes general Physical Therapy exercises, prevention and cure of Parkinson’s disease

Parkinson’s disease (PD) is a neurodegenerative disorder that affects predominately dopamine-producing neurons in a specific area of the brain called substantia nigra. Parkinson’s disease was first described as “the shaking palsy” by James Parkinson in 1817 and refers to those cases where the cause is unknown or genetically determined. 8-10 million People are living with Parkinson’s disease with projections to double by 2040.




I, as a Neurology Physical Therapist, have seen Parkinson’s patients in all stages of disease and have helped with the following:


⦁ Walking: slowness, small steps, or freezing (feeling glued to the floor or difficulty getting started)

⦁ Balance or stability

⦁ Posture

⦁ Pain

⦁ Moving around the house (getting up from a chair, moving around in bed)

⦁ Getting around (in/out of a car or bus, elevators, stairs and uneven ground)

⦁ Address fear of falling, have fallen or are worried about your safety.

⦁ Other health problems that affect mobility, including joint or muscle pain from arthritis, problems with endurance due to a heart or lung condition, a broken bone or surgery


Physical Therapy Exercises in Parkinson’s disease:

The largest clinical study of Parkinson’s research from the Parkinson’s Foundation suggests that people with PD do at least 2.5 hours of exercise a week for a better quality of life.

Here are some types of exercises that have been found to help people with PD:


Yoga therapy has been shown to visibly reduce tremors and improve the steadiness of a patient’s walking. Yoga is one of the most beneficial complementary therapies for Parkinson’s disease (PD), helping to increase flexibility; improve posture; loosen tight, painful muscles; build (or rebuild) confidence; and, through these benefits, enhance quality of life. Some recommended poses for Parkinson’s disease are

⦁ Mountain Pose.

⦁ Upward Salute.

⦁ Standing Forward Bend.

⦁ Warrior II.

⦁ Tree Pose.

⦁ Locust Pose.

⦁ Child's Pose.


Tai chi: Tai Chi​ improves balance and motor control in patients with Parkinson’s disease.

Boxing helps improve strength, hand-eye coordination, posture, balance and agility and improve reaction time

Aerobic exercise: Aerobic exercise is any type of cardiovascular conditioning. It includes activities like brisk walking, swimming, running, or cycling. Aerobic exercise means “with oxygen.” Your breathing and heart rate will increase during aerobic activities. Aerobic exercise helps keep your heart, lungs, and circulatory system healthy. The Parkinson’s Foundation recommends doing 30 minutes of aerobic exercise a day, five times a week.


Stretching exercises:

The American College of Sports Medicine and the American Heart Association recommend the following guidelines for everyone while doing stretching exercises • Perform at least 10 minutes of stretching at a time.

⦁ Perform stretches at least 3-4 times per week; daily is better.

⦁ Hold stretches for 10-30 seconds.

⦁ Perform 3-4 repetitions of each

⦁ Hamstrings stretch with towel:



While lying down on your back, hook a towel or strap under your foot and draw up your leg until a stretch is felt along the backside of your leg. Keep your knees in a straight position during the stretch.

⦁ Lower Trunk rotation stretch:


Lying on your back with your knees bent, gently rotate your spine as you move your knees to the side, and then reverse directions and move your knees to the other side.

⦁ Quadriceps stretching in standing:




While in a standing position, bend your knee backwards and hold your ankle/foot. Hold this position until a stretch is felt on the front of the thigh.

⦁ Calf stretching in standing:


Start by standing in front of a wall or other sturdy object. Move your one leg forward and maintain your toes on both feet to be pointed straight forward. Keep the leg behind you with a straight knee during the stretch. Bend your front knee and support yourself with your arms as you allow your front knee to bend until a gentle stretch is felt along the back of your leg that is most behind you.

Strengthening exercises:


The American College of Sports Medicine and the American Heart Association recommend the following guidelines for everyone doing strengthening exercises

⦁ Perform at least one set of each exercise, 10–15 times.

⦁ Do strengthening exercises 2–3 days per week (but do not work out the same muscles on consecutive days; muscles need a day to rest before training again)

⦁ Wall Squats for strengthening quadriceps:



Leaning up against a wall or closed door on your back, slide your body downward, and then return to upright position. Knees should bend in line with the toes and not pass the front of the foot.

⦁ Prone hip extension for strengthening hip muscles:



While lying face down with your knee straight, slowly raise your leg off the ground. Maintain a straight knee the entire time.

⦁ Bridging for strengthening back muscles:



While lying on your back with knees bent, tighten your lower abdominals, squeeze your buttocks and then raise your buttocks off the floor/bed as creating a "Bridge" with your body. Hold, and then lower yourself and repeat.

⦁ Upright elbow for Triceps strengthening:


Extend your elbow as shown while holding a free weight. Maintain your upper arm in an upward direction, and only bend and straighten at your elbow. Use lightweight dumbbells on the weaker arm

Balance exercises:

⦁ Single leg balance with support:



Stand closely in front of a sturdy table or counter top for support. With your hands not quite touching, but ready to grab the table or countertop if needed, proceed to raise one leg up in the air and maintain balance on your other leg. After about 5-10 seconds, lower your leg back down.

***If you start to lose your balance, play it safe and grab your table/counter top to regain your balance.

⦁ Static Balance: Rhomberg position on floor:



Standing with your feet together, and arms across your chest, practice keeping your balance with your eyes open. Stand next to a wall or stable surface for balance support if needed. Do the same exercise with your eyes closed to make it harder.


Amplitude training (making movements bigger): A specific form of physical therapy for Parkinson's disease is called LSVT BIG® training.


Prevention and cure of Parkinson’s disease:



Currently, there isn’t a known cure for Parkinson’s disease, and it’s not fully understood what causes the dip in dopamine; however, we know that ageing is the single most important risk factor for PD, with stress and inflammation contributing to cell damage.

Most often, individual cases of Parkinson’s disease result from a complex interplay between genetics and environmental and other factors.

Some environmental factors that may play a role in the development of Parkinson’s disease:

⦁ Pesticides/herbicides: Studies have shown a link between exposure to chemicals in pesticides and herbicides, and the incidence of Parkinson’s disease. These substances include the insecticides rotenone and permethrin (which may be found in clothing, or nets treated to kill mosquitoes.

MPTP, a synthetic neurotoxin, Agent Orange, Manganese and other metals may be related to the development of Parkinson’s disease.

⦁ Solvents and Organic pollutants: PCBs, or polychlorinated biphenyls, were used in various industrial processes until they were banned in the 1970s. Researchers have found a high concentration of PCBs in the brains of people who had Parkinson’s. 


Eat Fresh, Raw Vegetables: Studies show that increased amounts of the B vitamin folic acid, found primarily in vegetables, can significantly reduce the risk of Parkinson’s. Researchers have found that about 70 percent of early, untreated Parkinson’s patients have low levels of vitamin D


Regular aerobic Exercise: Exercise is one of the most powerful treatments for Parkinson's disease. In addition to physical benefits like increasing lung capacity, bone density and overall longevity, exercise has a distinct impact on brain health.


Reduce Stress: Exercise has been shown to improve many of the non-motor symptoms of PD, including stress and anxiety.


Natural Remedies for Parkinson’s disease: In India, Mucuna, has been the main healing herb for three thousand years. Mucuna seed powder was marketed as a drug under the brand name Zandopa. The seed contains up to 7% levodopa, which Is used in the treatment of Parkinson’s disease. Curcumin is the main polyphenol found in turmeric. Curcumin has anti-inflammatory and antioxidant properties, which can improve overall brain health.   

It’s important to check with your doctor if you are taking any of the naturals, or alternative medicines.


Summary:


Research in Parkinson’s disease is ongoing, and new treatments may be on the way. Parkinson’s disease not only affects the person who has been diagnosed with this disease; it also affects family members, friends, and co-workers. Consider joining a support group.

Please visit apdaparkinson.org/community/ to find support groups in your area.



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