Management of Your Parkinson's

Read Me First[edit | edit source]

This information is not intended to replace your healthcare professional. Please make sure you seek medical advice if you are experiencing any symptoms of Parkinson's.

Disclaimer[edit | edit source]

The content on or accessible through Physiopedia is for informational purposes only. Physiopedia is not a substitute for professional advice or expert medical services.

What is Parkinson's?[edit | edit source]

Parkinson's is a progressive neurodegenerative disorder of the central nervous system. It is the most common disorder of the basal ganglia and the second most common neurodegenerative condition worldwide, after Alzheimer's. The main area of basal ganglia dysfunction appears to stem from the loss of dopamine-producing cells in the substantia nigra, causing difficulty in the initiation of movement.

There are approximately 6.3 million with Parkinson's worldwide. Global diagnosis ranges from 12 to 230 per 100,000 per year. It is more regularly diagnosed in the elderly, affecting around 1% of people over 65 years of age. It can affect both males and females, but is slightly more common in males.

Causes[edit | edit source]

PD Basal Ganglia etc.png

Parkinson's is caused by a loss of nerve cells in the substantia nigra, which is an area in the brain. Nerve cells in the substantia nigra are responsible for producing a chemical called dopamine. Dopamine acts as a messenger between the areas of the brain and nervous system that helps co-ordinate and control body movements. The volume of dopamine in the brain can decrease if these cells die or become damaged. This means the part of the brain controlling movement cannot work as well as normal, causing movements to become slow and abnormal. The loss of nerve cells is a slow process. The symptoms of Parkinson's usually only start to develop when around 80% of the nerve cells in the substantia nigra have been lost.

The exact reason why this occurs is currently unknown. However, researchers strongly believe that it is a combination of age, environmental factors and genetics that cause the dopamine-producing nerve cells to degenerate.

Prevention[edit | edit source]

Unfortunately, as the specific causes are unknown, there is not enough evidence for a proven prevention currently.

Symptoms[edit | edit source]

People with Parkinson's present with a range of symptoms affecting function, activity, participation and quality of life. Symptoms can differ from person to person and in the same person over time.

Key motor symptoms of Parkinson's are:

  • Slowness at initiation of and during movement (Bradykinesia) - may be demonstrated through difficulty with planning, initiating, executing and performing sequential and simultaneous tasks, loss of fine motor control.
  • Reduced movement amplitude (Hypokinesia) - typically observed in facial expression, arm swing during walking, writing, but can be present in any movement.
  • Rigidity
  • Tremor - usually becoming inhibited when initiating movement
  • Postural instability or "stooped posture" - this not seen at diagnosis but later on in the course of the disease. This can cause balance deficits and create a risk of falls.
  • Shuffling walking pattern - short and close steps
  • Freezing whilst walking - reduced ability to prepare and sustain movement

Non-motor symptoms:

Parkinson disease symtpoms.png

Diagnosis[edit | edit source]

No tests can conclusively show that you have Parkinson's. The diagnosis of Parkinson's is commonly based on motor symptoms such as muscle stiffness (rigidity), tremor at rest and slowness of movement. Other symptoms such as depression, falls and sleep disturbances aid the diagnostic decision-making process.

If your doctor does suspect Parkinson's, you will be referred to a specialist. This will either be a neurologist - specialising in brain and nervous system, or a geriatrician - specialising in conditions affecting elderly people.

Being informed that you have Parkinson's can be overwhelming and an emotional experience. It is important to feel supported by a care team and your family during this time. There are a number of support groups and charities that should provide some additional information and support. There are some listed at the bottom of this page.

Management[edit | edit source]

Discovering the right medications, complementary therapies, support and ways to stay independent can enhance your quality of life with Parkinson’s. Unfortunately, currently there is no cure for Parkinson's, but there are medications available that can help you manage your symptoms. Dopaminergic medications that increase the dopamine availability in the brain are the most common drug therapies. These medications increase or substitute for dopamine and may help you with issues such as your tremor, walking or other movements. The most commonly used medication is Levodopa.

Exercise[edit | edit source]

The role of your Physiotherapist is to enable you to be active, engaged and participating socially, therefore enhancing your quality of life. Treatment, as always, should be tailored to the needs of the individual. You will be helped to make informed decisions about your care, and also involve family and carers if you choose to. You may work with other healthcare professionals such as Specialist Nurses, Occupational Therapists and Speech and Language Therapists. There is good evidence that Physiotherapy can help maintain and improve balance, strength and gait.

Below are some exercises that you may see within your exercise programme.

Squats are a great exercise for building strength in the legs, which can be important for tasks such as standing up from a chair. You can also make these harder or easier, using a chair behind you or flat surface in front of you for support. Strengthening the muscles in your legs can also improve balance. Try 3 sets of 5 to begin with.


Exercising the muscles in your arms is another fantastic way of building some strength. This can be helpful for tasks such as carrying shopping or opening jars of food. Try some bicep curls, you can do this seated or standing. Try 3 sets of 10 to begin with.


Walking and/or cueing can be a great exercise for improving balance and gait, in turn reducing the risk of falls. Cueing has been found to improve walking speed, step length and also reduce "freezing" whilst walking.


Self-Management[edit | edit source]

It is really important to maintain general health and wellbeing. This means consuming a balanced diet with enough vitamins and nutrients - consisting of fruit & vegetables, plenty of fluids and making sure you have enough protein.

Remember that sleep is also important for wellbeing. If you are currently struggling with sleep, then please seek advice from your healthcare professional.

Medication is also important for people with Parkinson's. Take this at the times prescribed by your doctor. You will be involved in the decision-making process with this. If you need any extra support or information then seek advice from your doctor.

More Information and Support[edit | edit source]

For more information on Parkinson's click here.

There is further support and information on the management of Parkinson's below:

Parkinson's Foundation

NHS - Parkinson's Management

Parkinson's 101 - The Michael J. Fox Foundation

Parkinson's Care and Support

References[edit | edit source]

  1. Rehab My Patient. Full Squat. Available from: [last accessed 17/3/2022]
  2. Rehab My Patient. Senior: How to do a Bicep Curl with Dumbbell Sitting. Available from: [last accessed 17/3/2022]
  3. The Lancet. Freezing of Gait. Available from: [last accessed 17/3/2022]