Parkinson’s disease is a progressive neurological condition that primarily affects movement, although it can also cause a wide range of non-motor symptoms. It is most commonly associated with tremor, stiffness, slowness of movement and changes in walking gait and balance.

What actually happens in the brain to cause these changes?

To understand Parkinson’s disease, it helps to know about an area of the brain called the basal ganglia.

The basal ganglia are a group of structures deep within the brain that play an important role in selecting, initiating and regulating movement. Rather than simply telling your muscles to move, they help your brain decide which movements to facilitate and which to suppress.

An illustration of a brain with a network of neurons and connections

One of the key structures involved is an area of the basal ganglia called the substantia nigra. In Parkinson’s disease, there is progressive loss of dopamine-producing nerve cells within this area of the brain. Dopamine is an important signalling molecule within the circuits connecting the substantia nigra with the basal ganglia, particularly the striatum. The basal ganglia contain interconnected pathways that help regulate movement, often described as the direct and indirect pathways.

In simplified terms, dopamine normally helps to:

  • Facilitate desired movements through the direct pathway
  • Inhibit unwanted movements through the indirect pathway

Dopamine therefore helps the brain to appropriately select, initiate and regulate movement. When dopamine-producing cells in the substantia nigra are lost, dopamine levels within these circuits decrease. The balance between the pathways changes, making it more difficult for the brain to initiate and regulate movement efficiently.

This contributes to some of the characteristic movement problems seen in Parkinson’s disease, including bradykinesia (slowness of movement), rigidity, reduced movement amplitude (giving a tendency towards smaller movements) and difficulty initiating movement.

What does this mean in terms of mobility?

There are a wide range of movement impairments associated with Parkinson’s disease. It isn’t simply that a person is moving slowly or is more hunched because they are weak. Parkinson’s affects the brain’s ability to initiate, regulate and scale movement effectively.

Someone with Parkinson’s may notice that:

  • Their steps have become shorter
  • Their arm swing has reduced
  • They take longer to get up from a chair
  • Their handwriting has become smaller
  • They can freeze during gait
  • Ordinary tasks take longer to complete
  • Their posture is more crouched or hunched
  • Turning is more difficult and requires lots of steps
  • Getting dressed takes longer
  • Movements feel less automatic

How can physiotherapy help Parkinson’s disease?

Physiotherapy cannot stop the underlying neurological changes associated with Parkinson’s disease, but it can help people maximise their movement, maintain physical function and develop strategies to overcome some of the difficulties caused by the condition.

A physiotherapist can assess walking, balance, transfers, posture, strength, flexibility and functional movement, and then develop an exercise and rehabilitation programme around the individual’s needs and goals.

There are many strategies that physiotherapists can use to strengthen neural connections in the brain, or stimulate other areas of the brain involved in movement.

Physiotherapy and exercise

Exercise is an important part of Parkinson’s management. A physiotherapist can prescribe an appropriate combination of:

  • Strength training
  • Cardiovascular exercise
  • Balance training
  • Gait training
  • Range of movement exercises to help improve posture
  • Large-amplitude movements
  • Flexibility exercises
  • Functional task-based learning and practice
  • Dual-task activities
  • Turning and movement strategies

Why early physiotherapy can be valuable

Parkinson’s disease changes over time, and physiotherapy can form an important part of ongoing management.

Rather than waiting until mobility has significantly deteriorated, early intervention can provide people with exercise habits, movement strategies and practical tools and strategies that they can continue to use as their symptoms change.

Parkinson’s disease is a complex neurological condition involving changes to dopamine-producing neurons and the movement circuits of the basal ganglia. These changes can make automatic movement, movement initiation and movement amplitude more difficult.

But understanding how Parkinson’s affects movement also helps us understand why certain physiotherapy strategies can work.