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Parkinson’s disease is a long-term condition that affects how the brain controls movement and other functions. It occurs when the brain cells that produce dopamine (a chemical that helps with movement and mood) are gradually lost. Although it mostly affects older adults, younger people can also be diagnosed. While there is no cure, treatments like physiotherapy, medication, and lifestyle adjustments can help manage symptoms.

Signs & Symptoms

The signs of Parkinson’s disease often start gradually and worsen over time, but symptoms can vary greatly.

Common Symptoms

  • Tremor (Shaking): Often seen in one hand or finger, tremors usually appear when the person is at rest.
  • Slow Movements: People with Parkinson’s often move slower than usual (bradykinesia). Simple tasks, like buttoning a shirt, may take longer. Patients often feel “weak” or that their muscles are less effective, but testing usually shows normal muscle strength.
  • Stiffness: Muscles may feel stiff or tight, making movement feel restricted and sometimes painful.
  • Balance Problems: People with Parkinson’s can have poor balance, leading to a higher risk of falls. Some may begin experiencing falls earlier than expected, which may suggest the need for a closer look at their condition.

Other Health Symptoms

  • Problems with Memory and Thinking: Some people with Parkinson’s experience trouble with memory, decision-making, or concentration. When these problems show up early, it may suggest a faster progression or the need for additional support.
  • Sudden Drop in Blood Pressure: Some people feel lightheaded or dizzy when standing up due to a sudden drop in blood pressure. This is called orthostatic hypotension, and while it can happen in Parkinson’s, severe cases are uncommon and might suggest another condition.
  • Bladder Issues: Many people feel the need to urinate more frequently or urgently, and some may experience incontinence (loss of bladder control).
  • Medication Side Effects: Certain medications used for other health conditions, such as some anti-nausea or antipsychotic drugs, can block dopamine and make Parkinson’s symptoms worse, or even mimic the symptoms of Parkinson’s.
  • Reduced Effectiveness of Medications: In typical Parkinson’s, medications like Levodopa often help improve movement. If a person doesn’t respond well to these medications, it might suggest that another condition could be causing the symptoms.

Each individual’s experience with Parkinson’s is different, and understanding both common and less typical signs helps in making an accurate diagnosis and finding the right treatment approach.

Causes and Contributing Factors

The exact cause of Parkinson’s is not fully understood but likely involves a combination of genetic, environmental, and age-related factors.

  • Genetic Factors: Some genetic changes are linked to Parkinson’s, and having a family history of the disease may increase risk.
  • Environmental Factors: Exposure to toxins like pesticides or industrial chemicals is associated with a higher risk.
  • Age and Gender: Risk increases with age, and men are slightly more likely to develop Parkinson’s than women.
  • Other Factors: Repeated head trauma, high levels of stress, and sedentary lifestyles may contribute.

Staging and Progression

Parkinson’s disease progression is often classified into five stages based on symptom severity:

  1. Stage 1: Mild, with symptoms affecting one side of the body and little interference with daily tasks.
  2. Stage 2: Symptoms affecting both sides appear, daily tasks become challenging.
  3. Stage 3: Loss of balance and movement slowness, increased risk of falls.
  4. Stage 4: Severe symptoms, difficulty with independent movement.
  5. Stage 5: Advanced symptoms requiring round-the-clock care, with cognitive impairments becoming more prominent.

Prognosis

While Parkinson’s disease is progressive, it varies in speed and impact among individuals. Though it can lead to significant functional limitations, it is not typically life-threatening. However, complications like falls, infections, and swallowing difficulties can affect life expectancy. Early and consistent treatment can help maintain functionality for longer.

Treatment

No cure exists for Parkinson’s disease, but treatments focus on managing symptoms and improving function. Physiotherapy is a critical component of this approach.

Medications

  • Levodopa and Carbidopa: Levodopa remains the most effective treatment for motor symptoms, converting to dopamine in the brain, while Carbidopa reduces side effects and helps delivery to the brain.
  • Dopamine Agonists: Mimicking dopamine’s effects, these drugs are often used to reduce “off” periods between Levodopa doses.
  • MAO-B Inhibitors: Slowing dopamine breakdown, these are sometimes used in early-stage or as add-ons later.
  • COMT Inhibitors: Extend Levodopa’s effects by preventing its breakdown.
  • Amantadine: Helps control dyskinesia (involuntary movements) in advanced stages.

Physiotherapy in Parkinson’s Disease

Physiotherapy is a cornerstone of treatment for Parkinson’s disease (PD), offering specialised exercises that help manage movement issues, balance problems, and other physical symptoms. Guidelines from organisations like the National Institute for Health and Care Excellence (NICE) encourage people with Parkinson’s disease to start physiotherapy early and continue it throughout their lives. These recommendations focus on helping you stay as active, mobile, and strong as possible, even as Parkinson’s symptoms change over time.

Through personalised exercise programs, physiotherapy can support balance, flexibility, and walking patterns, which can help with daily tasks, reduce the risk of falls, and keep you feeling independent. Your physiotherapist will work with you to tailor exercises that fit your needs, so you can maintain the best possible quality of life.

Key Areas of Focus in Parkinson’s Physiotherapy

Gait Training

Improving walking (gait) is crucial in Parkinson’s, as patients often face issues like shuffling, sudden “freezing” (inability to move), and reduced arm swing. Physiotherapists work with patients to enhance stride length, coordination, and walking smoothness, which can reduce fall risks and improve overall mobility.

Balance and Postural Stability

Falls are common as PD progresses, making balance exercises essential. Physiotherapy often includes techniques like Tai Chi, modified dance, or balance exercises that promote stability, coordination, and confidence in movement​

Strength and Flexibility

Building strength, especially in the core, helps support better posture and stability. Flexibility exercises, including daily stretching, relieve muscle stiffness and improve range of motion. The following exercise recommendations are specifically tailored to Parkinson’s:

  • Aerobic Training: Engage in aerobic exercises (e.g., brisk walking, cycling) 3–5 days per week, aiming for 20–60 minutes per session at a moderate intensity.
  • Resistance Training: Include resistance or strength training 2–3 days per week. Exercises should focus on major muscle groups and involve 1–3 sets of 8–12 repetitions, at a load of about 40–50% of the individual’s maximum strength (1-RM, or “one-repetition maximum”)​

Breathing and Voice Control

Parkinson’s disease can affect both breathing and speech volume. Physiotherapists, often in collaboration with speech therapists, provide exercises to improve lung capacity and strengthen the voice. Breathing exercises and vocal exercises help patients maintain clear and strong speech, as well as better respiratory function.

Lifestyle Modifications and Alternative Therapies

  • Regular Exercise: Aerobic and strength-based exercises, such as walking or cycling, have been shown to slow functional decline and improve mood.
  • Nutrition: High-fibre diets and hydration can prevent constipation. Avoiding high-protein meals when taking Levodopa can enhance its effectiveness.
  • Mind-Body Practices: Meditation, relaxation techniques, and yoga may reduce stress and improve body awareness, providing relief for both physical and emotional symptoms.
  • Deep Brain Stimulation (DBS): In cases where medications are no longer effective, DBS is an option. This surgical procedure, which uses implanted electrodes, may reduce severe motor symptoms.

Information is provided for education purposes only. Always consult your physiotherapist or other health professional.

References

Bouça‐Machado, R. et al. (2019) ‘Physical activity, exercise, and physiotherapy in parkinson’s disease: Defining the concepts’, Movement Disorders Clinical Practice, 7(1), pp. 7–15. doi:10.1002/mdc3.12849.

Pang, M.Y. (2021) ‘Physiotherapy management of parkinson’s disease’, Journal of Physiotherapy, 67(3), pp. 163–176. doi:10.1016/j.jphys.2021.06.004.

Tomlinson CL, Herd CP, Clarke CE, Meek C, Patel S, Stowe R, Deane KHO, Shah L, Sackley CM, Wheatley K, Ives N. Physiotherapy for Parkinson’s disease: a comparison of techniques. Cochrane Database of Systematic Reviews 2014, Issue 6. Art. No.: CD002815. DOI: 10.1002/14651858.CD002815.pub2.