Parkinson's disease: physiotherapy for walking, balance and freezing

The NHS describes Parkinson's disease as a condition in which parts of the brain become progressively damaged over many years, with a loss of nerve cells leading to reduced dopamine, which plays a vital role in regulating movement. The main symptoms are tremor, slow movement and stiff, inflexible muscles, and balance problems may increase the chance of a fall.

Parkinson's UK says people with Parkinson's may find problems with everyday movements such as walking, getting in and out of a chair or turning in bed. Posture can become more stooped, with the knees bent, heels off the ground and head forward, which Parkinson's UK says can make freezing and falls more likely. Walking usually happens automatically, but in Parkinson's the brain has to work harder to help you walk and may not always be able to give walking the attention it needs.

Parkinson's UK explains that freezing is when you suddenly cannot walk or step forward even if you want to, which can last a few seconds or sometimes 30 seconds or longer. People often describe feeling that their feet are glued to the ground. It is more likely when starting to walk or turning around.

Parkinson's UK lists situations where freezing is more likely, including walking through doorways, moving from one flooring to another, narrow or closed-in spaces, turning, being distracted, busy or crowded places, being in a rush and poor lighting. It says you may be more likely to freeze when anxious, stressed, tired, low or sleep-deprived, if you have been taking levodopa for many years, or if you miss doses or take medication late.

Freezing can happen in "on" or "off" periods. Parkinson's UK says levodopa can help relieve freezing for some people, but those who have taken it for longer may also be more likely to freeze. It advises speaking to your specialist or Parkinson's nurse and not suddenly stopping medication.

The NHS says a physiotherapist can work with you to relieve muscle stiffness and joint pain through movement and exercise, aiming to make moving easier and improve walking and flexibility. Parkinson's UK adds that physiotherapists who specialise in Parkinson's are experts at seeing small changes in how you move and can give advice before problems become harder to manage.

According to Parkinson's UK, physiotherapy can help you stay independent with actions like walking and sit-to-stand, prevent or manage falls with strength and balance training, ease pain, support breathing and posture, and keep you physically active. A physiotherapist can also teach ways to overcome freezing, and ways to get down to the floor safely and up again after a fall. For carers, they can advise on helping someone move safely.

• Practising heel-first walking and moving weight to one side before stepping forward.

• Learning cues, which are things you can do to restart a movement.

• Working on doing two things at once, such as carrying something while walking.

• Rehearsing strategies in the places at home where you usually freeze.

• Strength and balance training, with advice on turning and on footwear.

Parkinson's UK suggests ways to reduce the risk of falls when freezing: ask for help, avoid distractions by not walking and talking at the same time, plan routes in short stages, slow down when turning and take a half circle rather than pivoting, and choose supportive low-heeled shoes. In busy places it suggests stepping aside, touching something solid for balance and repeating a "pause, look, plan and walk" routine.

It also suggests keeping notes for appointments, because freezing often happens in everyday situations and can be hard to see in a clinic: when and where you freeze, what you were doing and anything that gets you moving again. An occupational therapist can advise on equipment and home changes, and Parkinson's UK says to check with an occupational therapist before buying aids.

Parkinson's UK says physical activity can be as important as getting the right dose of medication, and that being active for 2.5 hours a week can help manage symptoms. It lists creative dance, Pilates, yoga and tai chi as classes that can help with movement and mental wellbeing, and cycling, aerobics or Zumba for more vigorous activity.

The NHS says people with Parkinson's may need regular appointments with their specialist so that the condition can be monitored, and that supportive treatments such as physiotherapy and occupational therapy sit alongside medication. If you are unsure what level of activity is safe for you, ask your physiotherapist or specialist.

Parkinson's UK says physiotherapy is available on the NHS or privately. NHS physiotherapists work in the community, GP surgeries, care homes, hospitals and outpatient clinics, and can sometimes visit at home. Your specialist, Parkinson's nurse or GP can refer you, and in some areas you can self-refer, though there may be a waiting list. Some people choose to see a physiotherapist privately; if you do, look for one with experience of Parkinson's, and tell your specialist team what you are doing.