Posture and Parkinson disease
This month the PWR! Virtual Experience theme is Posture and it is a great excuse to PWR! Up with some antigravity core strengthening! As a newborn, you already did the hard work of developing your postural muscles as you struggled to hold your head up in “tummy time” or to scoot, roll, sit, or stand to get to favorite toys! Unfortunately, our lifestyle (e.g., injuries, bad habits, diet, stress) can take a toll on our musculoskeletal health. And, for PWP, worsening of posture is one of those “axial” symptoms that doesn’t respond robustly or at all to medications or deep brain stimulation.
To understand more about how PD-related posture changes affect YOU and what rehabilitation and exercise interventions may help - read Part 1.
To find a detailed explanation of posture and a summary of the pathophysiological mechanisms that contribute to postural changes in normal aging and PD please read Part 2.
The changes Parkinson's has on posture. Part 1
Here is a list of the many different ways that PD-related posture changes affect YOU
1. Interferes with the control of automatic postures and movements, requiring that more of your attentional resources be directed to self-monitor and correct for those missing automatic reminders to PWR! Up. This shifting of attentional resources towards maintaining optimal posture may reduce your ability to use those resources when you want to participate in everyday activities in complex environments that require multi-tasking and quick decision-making. This can lead to falls or injuries.
2. Interferes with sensory integration processing necessary for good body awareness and accurate perception of verticality.
3. Reduces balance (reactive stepping to side and back, and anticipatory trunk righting responses)
4. Decreases the efficiency of everyday movements which may contribute to fatigue and pain
5. Alters gait biomechanics (floor clearance, step length, turning, changing direction in small areas)
6. Associated with depression and increased mortality
7. Reduces ability to take deep breaths, which can also affect your communication and swallowing and ability to exercise
What can you do to shorten that list?
With YOU in mind, we have integrated new posture research into our exercise programming this month to help you improve age-related or PD-related posture changes. By participating in the videos form this release, you will learn to improve your body awareness to self-monitor and then “reset” your posture throughout the day. You will then re-learn how to it feels to use your core muscle strength to maintain that better posture when sitting, standing or lying down or when moving overground or up and down!
Research suggests that you can improve your ability to: 1) achieve better posture and 2) maintain improved posture during balance challenges and mobility in complex settings. If you have pain, comorbidities that interfere with achieving good posture or if you want a personalized plan with goals, more feedback, adaptations, more challenge----visit one of our rehabilitation PD-specialists and get started now! You need to do something multiple times a day, let us show you how! Or sign up for a wellness consult and get some personal feedback as you exercise.
Here are some of the techniques that you will experience in the Posture themed classes.
Rehabilitation and exercise research
• Strengthen extensors and core musculature
• Increase body awareness (mental imagery, augment tactile and proprioception stimulation)
• Pelvic tilting exercises
• Trunk mobility stretching (active and hold; whole body anterior or posterior chain stretches)
• Postural education (avoid asymmetry, enhance alignment, posture techniques in sitting and standing at a wall and lying down, axial taping)
• Practice mindful good posture during everyday movements
• Respiratory coordination training
• Mental imagery (self-cue)
• Pilates, Yoga, Alexander technique
• Hydrotherapy
• Raised walking devices
• Anterior spinal hyperflexion brace to
• Low-slung backpack with weights
Other considerations
• DBS (not indicated, investigating novel targets)
• Botulinum toxin for identified dystonic muscles
• Spinal surgery to correct postural deformity as a last resort – complications may require revisions
Ready to get started? Not sure what to do?
Schedule an appointment with one of our PWR!Gym Therapists to assess your balance control and provide you with a personalized plan.
Working 1:1 with a physical therapist is the most efficient and effective way to “retrain” balance, group exercise is the most effective way to “sustain” the gains from therapy! Guess what? At the PWR!Gym, we can give you access to both – intensive bouts of PD-specialized rehabilitation and group exercise training for life.
Come join us at the PWR! Virtual Experience and live YOUR “Life in Balance.”
Our goal is to make sure you’re always empowered and informed.
We offer handouts, downloads, research updates, Wellness Series talks, retreats with knowledgeable speakers, in-person and virtual wellness consultations, and in-person physical therapy visits. We are here for our PWR! Members every step of the way.
We’re excited to have you join us!
References
1. Abraham A, Duncan RP, Earhart GM. The Role of Mental Imagery in Parkinson’s Disease Rehabilitation. Brain Sci. 2021;11(2):185. doi:10.3390/brainsci11020185
2. Ashour R, Jankovic J. Joint and skeletal deformities in Parkinson’s disease, multiple system atrophy, and progressive supranuclear palsy. Mov Disord 2006;21:1856-63
3. Bansal S, Katzman WB, Giangregorio LM. Exercise for improving age-related hyperkyphotic posture: A systematic review. Arch Phys Med Rehabil. 2014;95(1):129-140. doi:10.1016/j.apmr.2013.06.022
4. Capecci M, Serpicelli C, Fiorentini L, et al. Postural rehabilitation and kinesio taping for axial postural disorders in Parkinson’s disease. Arch Phys Med Rehabil. 2014;95(6):1067-1075. doi:10.1016/j.apmr.2014.01.020
5. Debû B, De Oliveira Godeiro C, Lino JC, Moro E. Managing Gait, Balance, and Posture in Parkinson’s Disease. Curr Neurol Neurosci reports. 2018;18(23). doi:10.1007/s11910-018-0828-4
6. Doherty KM, van de Warrenburg BP, Peralta MC, et al. Postural deformities in Parkinson’s disease. Lancet Neurol. 2011;10(6):538-549. doi:10.1016/S1474-4422(11)70067-9
7. Forsyth AL, Paul SS, Allen NE, Sherrington C, Fung VSC, Canning CG. Flexed truncal posture in Parkinson disease: Measurement reliability and relationship with physical and cognitive impairments, mobility, and balance. J Neurol Phys Ther. 2017;41(2):107-113. doi:10.1097/NPT.0000000000000171
8. Gandolfi M, Tinazzi M, Magrinelli F, et al. Four-week trunk-specific exercise program decreases forward trunk flexion in Parkinson’s disease: A single-blinded, randomized controlled trial. Parkinsonism Relat Disord. 2019;64. doi:10.1016/j.parkreldis.2019.05.006
9. Grasso R, Zago M, Lacquaniti F. Interactions between posture and locomotion: Motor patterns in humans walking with bent posture versus erect posture. J Neurophysiol. 2000;83(1):288-300. doi:10.1152/jn.2000.83.1.288
10. Jankovic J. Camptocormia, head drop and other bent spine syndromes: heterogeneous etiology and pathogenesis of Parkinsonian deformities. Mov Disord. 2010;25(5):527-528. doi:10.1002/mds.23139
11. Lee KH, Kim JM, Kim HS. Back extensor strengthening exercise and backpack wearing treatment for camptocormia in Parkinson’s disease: A retrospective pilot study. Ann Rehabil Med. 2017;41(4):677-685. doi:10.5535/arm.2017.41.4.677
12. Margraf NG, Wrede A, Rohr A, et al. Camptocormia in idiopathic Parkinson’s disease: A focal myopathy of the paravertebral muscles. Mov Disord. 2010;25(5):542-551. doi:10.1002/mds.22780
13. Mori L, Putzolu M, Bonassi G, et al. Haptic perception of verticality correlates with postural and balance deficits in patients with Parkinson’s disease. Park Relat Disord. 2019;66:45-50. doi:10.1016/J.PARKRELDIS.2019.06.026
14. Muthukrishnan N, Abbas JJ, Shill HA, Krishnamurthi N, Edu JA. Cueing Paradigms to Improve Gait and Posture in Parkinson’s Disease: A Narrative Review. Sensors. 2019;19:5468. doi:10.3390/s19245468
15. Okada Y. Galvanic Vestibular Stimulation for Camptocormia in Parkinson’s Disease: A Case Report. J Nov Physiother. 2012;01(S1):1-4. doi:10.4172/2165-7025.S1-001
16. Okada Y. Rehabilitation for Postural Deformities in Parkinson’s Disease: An Update and Novel Findings. J Nov Physiother. 2014;04(05). doi:10.4172/2165-7025.1000233
17. Spuler S, Krug H, Klein C, et al. Myopathy causing camptocormia in idiopathic Parkinson’s disease: A multidisciplinary approach. Mov Disord. 2010;25(5):552-599. doi:10.1002/mds.22913
18. Ye BK, Kim H-S, Kim YW. Correction of Camptocormia Using a Cruciform Anterior Spinal Hyperextension Brace and Back Extensor Strengthening Exercise in a Patient With Parkinson Disease. Ann Rehabil Med. 2015;39(1):128. doi:10.5535/arm.2015.39.1.128
Dr. Becky Farley About the Author
If you ask her, Dr. Becky Farley will tell you that working with her first client with Parkinson’s almost 20 years ago changed her life and her career, and since then she hasn't stopped changing lives of those living with Parkinson's, in Arizona and the rest of the world. In 2010, she established the PWR!Gym in Tucson and has been offering people with Parkinson disease the PD-specific physical therapy, group exercise, and social engagement they need to get better and stay better. Globally, Dr. Farley supports PWR!’s mission of making cutting-edge PD-specific "exercise as medicine” available to the 10 million people living with PD worldwide, by training healthcare and fitness professionals in the PWR!Moves and the PWR!4Life model (and she’s trained over 6000 professionals since she started in 2010!).
When she’s home in Arizona, you’ll find Becky working on PD-specific exercise at the PWR!Gym as well as leading our annual exercise intensive PWR! Retreats. When she’s on the road, she’s either teaching our PWR!Moves workshops or giving talks at conferences, community organizations, and healthcare networks across the US and world.
When she isn’t working, you can find her working out, walking the dog, and gardening. To learn even more about Dr. Farley, visit our team page.
You can find Dr. Farley at:
How do you work through gait issues one never had till dbs?
Hello Don,
That is a difficult issue to tackle! What we would recommend is finding a Physical Therapist in your local area that has experience treating patients who have experience working with people with Parkinson’s, and specifically freezing of gait. The DBS can absolutely change how you walk. I will suggest you visit our Professional Directory below, as it will let you search for all PWR!Moves certified professionals in your local area. If you want general training and suggestions, then you could call the PWR!Gym and schedule a wellness consultation with an exercise specialist so that you can figure out a plan of attack to improve your symptoms.
https://www.pwr4life.org/professional-directory/