Postural Instability in Parkinson’s Disease

Impaired posture and subsequent balance issues are frequently observed among people suffering from Parkinson’s disease (PD). In most of the cases, the PD patient’s posture becomes stooped and he faces difficulty in standing up straight. As PD mainly affects the patient’s motor system, posture changes transpire without the brain’s automatic reminders to stand up straight. Other PD symptoms like muscle stiffness, too, can negatively affect posture.

With muscle stiffness, the posture becomes slouched and as a result, the head and chest are bent forward. This slouched posture can upset an individual’s balance and make him more prone to frequent falls. Poor posture can also make easy activities like walking and eating more difficult and can cause severe back, shoulder and neck pain.

What causes Postural Instability in Parkinson’s disease?

Almost all PD fighters eventually experience postural instability but the severity of balance impairments may vary. What triggers the postural imbalance in PD is still unknown, however, many scientists believe that this occurs due to muscle rigidity and changes in parts of the brain that control posture or dystonia. Since rigidity results in many biomechanical impairments, postural issues such as abnormally stooped (flexed) postural alignment and forward head pan out.

Alternatively, imbalance of bigger muscles overpowering the smaller muscles can cause a PD patient to bend over. The muscles (abdominal muscles, psoas major and minor and iliacus) that flex or bend the spine or hip may become hyperactive in PD, resulting in postural instability.

Options to treat Postural Instability in Parkinson’s disease

While certain medications can improve the muscle stiffness, they cannot improve posture related issues. Physical Therapy and Yoga interventions are commonly used to improve PD-led posture instability. Since poor posture can negatively impact swallowing function, a speech therapist can also help a PD fighter with improving posture during eating.

Physical Therapy

Many studies have pointed out that Physical Therapy can improve walking, balance, strength, and flexibility in PD, however, which approach of Physical Therapy is most effective is still unclear. Physical Therapy, focusing on motor control relearning, may help the patient overcome postural instability. Aerobic conditioning (swimming, walking, and cycling) has also been shown to improve endurance, strengthening of back extensor and abdominal muscles for a more upright posture.

Yoga

Yoga is a popular complementary therapy that can help PD patients improve posture and relax tight, painful muscles. Various research studies hint that Yoga improves balance (though one-leg postures) and reduce the fear of falling. Standing Yoga can support center-of-mass during walking and may improve the patient’s overall stability.

Stooped posture in PD can also be associated with short spinal flexors and weak spinal extensors. Improved shoulder and spinal flexibility support a more upright posture. Hence, Asanas such as Utkatasana (Chair Pose), modified Navasana (Boat Pose), or variations of Salabhasana (Locust) can be prescribed to strengthen the core and counter the rounding shoulders to reserve stooped posture.