Physiotherapy and Parkinson’s
What is a physiotherapist?
A chartered physiotherapist is a highly trained professional who uses physical
interventions as part of a holistic regime, teaches self-management of a
condition, and promotes the maintenance of as much independence by an
individual as possible.
Just as doctors train further and specialise in different conditions, so do
physiotherapists. Some work specifically with neurological conditions, such
as Parkinson’s. People with Parkinson’s and their carers, can derive significant
benefits from even short-term or occasional contact with such physiotherapists.
An early referral is strongly recommended.
What can the physiotherapist do to help someone with Parkinson’s?
Physiotherapists are trained to provide an assessment to see how
Parkinson’s affects the individual. This can be done with newly diagnosed, as
well as those who have been diagnosed for some time. In the earlier stages,
the emphasis of treatment will be mainly focussed on understanding the
condition and how a person might keep up their own general levels of fitness
and maintain independence for themselves. In the later stages of the disease,
the emphasis will include a support network for the individual, involving the
family and carers as part of the treatment.
The assessment will indicate to the physiotherapist what combination of
education and intervention is required, some examples of which are listed:
• Teach techniques that help make some automatic movements easier.
For example, the activities of walking, sitting down and standing up are
some of the tasks that may become difficult as Parkinson’s progresses,
but can be improved by learning new ways of doing things.
• Help you to maintain independence in your daily life if you are having
difficulty with certain actions, such as getting up out of a chair or
turning in bed. The physiotherapist may visit your home and be able to
teach you a different way of doing the action, or could give advice on
aids and adaptations that might be of use. (In many places, it is the
occupational therapist that deals with this sort of problem.) The PDS
recommends that advice is sought first from a physiotherapist before
you buy any piece of equipment, as no two individuals with Parkinson’s
are quite alike, and what might benefit one person might be unsafe for
another. See the PDS information sheets, Equipment and Disability
Aids (FS59) and Occupational Therapy and Parkinson’s (FS97).
• Work on stiff muscles and joints to maintain a posture, keep your joints
flexible and help relieve the effects of rigidity that might occur. This will
help to make your actions more smooth and efficient. The
physiotherapist can also teach you and your carer to do this.
• Improve or maintain muscle strength by the use of general or specific
exercises, or by providing an exercise programme for you to follow in
the hospital, or at home. A physiotherapist may help to maintain your
level of fitness or advise you take up a sport, such as golf or swimming,
or a class like yoga or tai chi, where the additional benefits of relaxation
help to decrease stress that can worsen the symptoms of Parkinson’s.
• Help prevent or manage falls. The physiotherapist may work on specific
balance training and improving your confidence to decrease any fear of
falling, or teach techniques to help you get off the floor or call for help.
They work with an occupational therapist to look at ensuring your home
environment is as free from hazards as possible. See the PDS
information sheet, Falls and Parkinson’s (FS39).
• Provide pain relief, if you experience it, through methods such as
manual therapy, the use of heat, cold or some electrical equipment.
More and more therapists are being trained in complementary
techniques such as acupuncture, which can also be used to alleviate
• Maintain or improve effective breathing.The stiffness and weakening of
the chest muscles can sometimes lead to a chest infection, for which
the therapist might use positioning and other techniques to help clear
the phlegm. Breathing exercises can also enhance your respiratory
capacity and can help if you find your voice has become softer.
• Help to prevent circulatory problems through handling and positioning,
especially if your movement is severely restricted, hampering the effect
of the natural pumping mechanism of the muscles.
What advice can a physiotherapist
If you are a carer and help to move a person with Parkinson’s, it is vitally
important that you get advice from a physiotherapist. They will advise you on
care of your own body (most importantly your back), as well as prevention of
harm to the person for whom you are providing care. This can be whether you
do something as simple as lifting their legs into bed, or as involved as
standing a person who cannot walk, so that they can get to the toilet. If it
becomes necessary to have equipment in the house to help you with these
tasks, the physiotherapist or an occupational therapist can advise you on the
best place to put these.
How do I find a physiotherapist?
Referral to a physiotherapist is generally made through your GP, a consultant
doctor, or a Parkinson’s Disease Nurse Specialist. In some areas, you can refer
yourself at the local hospital or a Community Health Clinic, depending on the
type of service available in your area, and your need and your preference. You
might find you have to wait some time before you receive an appointment, as
most NHS physiotherapy departments have a waiting list.
Some PDS branches have group physiotherapy sessions. There are also a
growing number of private physiotherapists who run clinics and make home
visits. When you contact them, make sure that they have the skills to handle
with people with Parkinson’s, as not all physiotherapists do. The Physio First
website allows you to search for qualified neurological physiotherapists in your
Does the PDS have any information resources on physiotherapy and
Apart from this information sheet, the PDS publishes an exercise dvd and
booklet, Keeping Moving (V011 for the dvd and B074 for the booklet).
What information is available
The PDS publishes The Professionals Guide (B126) aimed at 8 of the
professionals who work closely with people with Parkinson’s and their families. It
outlines good practice for providing care as part of the multidisciplinary team.
Guidelines for Physiotherapy Practice in Parkinson’s disease have also been
produced by neurological rehabilitation and information management experts
with funding from the Parkinson’s Disease Society.
Clinical Practice Guidelines for Physical Therapy in Patients with Parkinson’s
Disease (2005) have been developed in the Netherlands and an English
translation should be available from the website of the Center for Evidence
Based Physiotherapy. Check this site for updates: www.fdg.unimaas.nl/epid