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Posture and Parkinson's

Updated: Jul 25

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Introduction

Parkinson’s disease (PD) is a condition that affects the nervous system and disrupts the brain’s ability to automatically control movements. As a result, posture can change over time without those natural reminders to stay upright. These changes can involve rounded or slouched shoulders, a reduced curve in the lower back, or a forward tilt of the head or entire body, which may cause a hunched-over appearance.  


Postural changes can happen due to a variety of factors, including:

  • Muscle stiffness or rigidity  

  • “Off” periods, when your medication isn’t providing its usual level of relief

  • Remaining in one position for a long time 

  • Focusing on another task, such as walking or using a computer



How can poor posture affect you? 

  • Neck or back pain can arise when the spine's natural curves are out of alignment.

  • A stooped posture can make it harder to take deep breaths, which may affect your ability to speak clearly and project your voice. A stooped posture also reduces eye contact. When paired with other Parkinson’s symptoms—such as a softer voice or reduced facial expression—this can greatly affect how well you're able to communicate with others.

  • Difficulty swallowing 

  • Postural changes can reduce flexibility, making simple daily movements—like raising your arms to dress or rising from a chair—more challenging.

  • Additionally, poor posture can throw off your balance, which may raise the chance of falling.


Early detection/ symptoms for developing stooped posture


Reduced flexibility

 In early PD, increased kyphotic and lordotic angles, along with reduced spinal mobility, reflect axial rigidity and muscle weakness. These changes contribute to a stooped posture, even in the absence of significant disease progression.


Muscle Stiffness or Rigidity

Muscle rigidity, particularly in the axial muscles, contributes to reduced spinal flexibility and postural abnormalities in PD. This stiffness can lead to a forward-leaning posture as individuals attempt to maintain balance.


Decreased Arm Swing

Reduced arm swing is an early motor sign in PD, often observed asymmetrically. This decrease is linked to bradykinesia and rigidity, affecting overall gait and contributing to a stooped posture.


Difficulty in Maintaining Upright Posture

Loss of postural reflexes in PD patients impairs the ability to maintain an upright stance. This dysfunction contributes to the development of a stooped posture, especially in advanced stages of the disease.


Difficulty maintaining vertical head and trunk orientation without vision

Early Detection Symptom

Focus Area

Recommended Exercises

Progression/Notes

Reduced Flexibility

Neck & Head Posture Awareness

- Chin Tuck




 -Trapezius 

 Stretching 



Increase sets to 3/day

Practice during screen time or reading


Increase hold time up to 30 secs


Thoracic Mobility & Extension



- Thoracic Extension

Gradually increase range

Hold extended position longer

Muscle Stiffness or Rigidity

Shoulder & Upper Back Alignment

- Scapular Retraction

- Shoulder Rolls

Add light resistance bands

Do shoulder rolls hourly during sedentary periods


Hip Flexor Flexibility

- Hip Flexor Stretch





-Deep 

breathing 






Increase hold to 45 seconds

Repeat multiple times daily



Practice will doing exercises

Decreased Arm Swing

Shoulder & Upper Back Alignment

- Scapular Retraction

- Shoulder Rolls

Add light resistance bands

Emphasize conscious arm swing during walking

Difficulty Maintaining Upright Posture

Core & Lower Back Strength

- Pelvic Bridges

Hold bridge for 10 seconds

Add reps or light weights


Lower Body Strength & Stability

- Squats

Increase squat depth gradually

Use chair/wall support if needed

Difficulty Maintaining Vertical Orientation Without Vision

Neck & Head Posture Awareness

- Chin Tuck

Practice in varied environments

Progress by reducing visual cues


Breathing & Posture Reset

- Deep Breathing

Practice before walking or transitions

Combine with chin tucks or shoulder rolls



Vision Training




Upward Vision Exercise: Sit/stand tall and slowly shift gaze upwards without moving the head. Hold for 5-10 seconds. Repeat 10x.


Gradually increase gaze range

Combine with head posture correction exercises


How to help correct your posture


Stretching

The forward-leaning posture often seen in Parkinson’s disease can reduce flexibility in the front of the body, especially in the chest, shoulders, and neck. Doing stretches that target these areas—particularly those that open up the chest, neck, and upper back—can help improve posture and counteract the forward bend.


Strengthening

When the muscles at the front of the body lose flexibility, the opposing muscles in the back can become overstretched and weakened. This makes it harder for them to support a straight, upright posture. This, in turn, leads to weakness. Strengthening the muscles in your back can help you maintain an upright posture for longer periods of time.


Here are some exercises you can do at home to help correct your posture


Chin Tuck

The purpose of a chin tuck is to reduce forward head posture. To do this exercise, sit up as straight as you can. Then gently move your head and neck backward and slightly upward, aiming to bring your ears in line with your shoulders. Tuck your chin in towards your body. This tends to make the unpleasant “double chin”, but it also means you have successfully performed a chin tuck! Repeat 10-20 times daily. 


Scapular Retraction

Scapular retraction helps reduce shoulder rounding. To do this exercise, sit up as straight as possible. Bend your elbows at your side. Draw your elbows backward behind your body, as if you’re performing a rowing motion. Keep your shoulders down away from your ears. As you move your arms back, focus on gently squeezing your shoulder blades together. Repeat 10-20 times daily. 


Thoracic Expansion/ Extension

The goal of thoracic expansion is to decrease rounding of the upper back, known as “increased kyphosis”. To do this exercise, sit in a chair with a low backrest that supports the middle of your spine. Place your hands behind your head and spread your elbows wide apart. Lean up and back over the chair. Finally, gently tilt your head upward, looking toward the ceiling. Take a deep breath in! Exhale and repeat 5-10 times daily.


Shoulder rolls

Sit or stand up straight with arms relaxed by your sides. Slowly roll your shoulders towards your ears, then back and down in a circular motion. Repeat 10 times, then switch directions (moving forward) for 10 more reps. This eases shoulder stiffness and reminds your body to sit or stand upright. 


Hip flexor stretches

This stretch aims to counteract the forward-flexed posture. To perform this exercise, lie down on your back on a firm bed or mat. Bring your right knee toward your chest, holding it gently with both hands. Let your left leg stay extended and relaxed on the bed. As you hug the right knee, you’ll feel a stretch in the front of the left hip. Hold this position for 20–30 seconds, breathing normally. Slowly release and switch legs. 

Pelvic Bridges

The goal of pelvic bridges is to strengthen the core, glutes & lower back muscles that support and maintain the upright posture. To do this exercise, lie on your back with your knees bent and your feet flat on the floor, keeping them about hip-width apart. Slowly lift your hips off the ground until your body forms a straight line from shoulders to knees. Hold for a few seconds, then slowly lower down. Repeat 10–15 times. 


Squats

The goal of performing squats is to build stability, support upright standing, and reduce stooping. To perform this exercise, stand with feet shoulder-width apart. If needed, use a chair or a wall for extra support and stability during the exercise. Slowly bend your knees and push your hips back as if you’re going to sit on a chair. Keep your back straight and knees behind your toes. Go down as far as comfortable, then return to standing. Repeat 10 times.


Deep breathing

The goal of deep breathing exercises is to improve chest expansion and promote upright posture. To perform this exercise, sit on a chair with feet flat and back straight but relaxed. Place one hand on your chest and the other on your belly to help you feel your breathing. Inhale deeply through your nose for four counts: 1-2-3-4, and feel the belly rise. Exhale slowly through pursed lip (mimicking blowing a candle) for four counts- belly falls. Repeat 10 times. 


Tips for Adding Posture Exercises to Your Daily Routine

Including posture exercises in your daily routine can help improve mobility and reduce the risk of falls for individuals living with Parkinson’s. These are few proven ways to get started:


Start Slowly

For those living with Parkinson’s, it’s a good idea to ease into exercise with simple, low-intensity movements. As your comfort level improves, you can gradually build up both how long and how hard you work out. Be sure to stay in tune with how your body feels—some discomfort is normal, but pushing too far can do more harm than good.


Be Consistent

Consistency is essential for posture exercises. Individuals with Parkinson’s should try to practice them regularly—even just a few minutes each day can make a meaningful difference.


Use Proper Form

Maintaining proper form is crucial when doing posture exercises. People with Parkinson’s are encouraged to work with a physical therapist or exercise specialist to make sure they’re using the correct technique and getting the most benefit safely.


Whom to Consult When Stooped Posture Becomes a Problem in Parkinson’s Disease?


  • Neurologist or Movement Disorder Specialist:

  • Physiotherapist (Neuro-Physiotherapist)

  • Orthopaedic- if you experience chronic back pain or stiffness.

  • Speech Therapist: As posture worsens, it can affect breathing, swallowing and voice projection. 


Posture Rehabilitation Protocol

Day 

Warm-Up / Mobility 

Posture Exercises 

Strength / Stability 

Breathing / Reset 

Progression Guidelines

Day 1  Neck, Shoulders, Thoracic 

Shoulder Rolls (10x forward/backward) 

Chin Tuck (2–3×10–20) - Scapular Retraction (2×15) 

– 

Deep Breathing (10x) 

Increase reps/sets. Add resistance bands, longer holds.

Day 2  Upper Back & Core 

Shoulder Rolls (Hourly if sedentary) 

Scapular Retraction (2–3×15 reps) Chin Tuck (1–2 sets) 

Pelvic Bridges (2×10–15, hold 5–10 sec) 

Deep Breathing (10x) 

Gradually increase range. Hold position longer


Day 3 Thoracic & Hips 

Shoulder Rolls & Thoracic Mobility Prep 

Thoracic Extension (2×5–10 reps)  Hip Flexor Stretch (3×30 sec/leg) 

Squats (2×10 reps, shallow to moderate depth) 

Deep Breathing (Before/After activity) 

Gradually increase range. Hold position longer

Day 4  Lower Body & Core 

Shoulder Rolls & Light Marching 

Chin Tuck (1–2 sets) Hip Flexor Stretch (3×45 sec/leg) 

Pelvic Bridges (3×10–15) Squats (2×10) 

Deep Breathing (10x, with posture awareness) 

Repeat multiple times daily. Add reps or light weights



Day 5  Full-Body Activation 

Shoulder Rolls (10x) 

Thoracic Extension (2×5–10) Chin Tuck (1–2 sets) 

Squats (2×10) Pelvic Bridges (2–3×10–15) 

Deep Breathing (10x) 

Use chair/wall support if needed for squat.


Day 6  Lower Body Strength 

Hip Flexor Stretch (2×30–45 sec/leg) 

Scapular Retraction (2×15)  Chin Tuck (1×15) 

Squats (3×10) Pelvic Bridges (2×15) 

Deep Breathing & Shoulder Rolls 

Add light resistance bands


Day 7 Posture & Breathing Reset 

Shoulder Rolls (10x) Hip Flexor Stretch (2×30 sec) 

Chin Tuck (1–2×15)  Thoracic Extension (1–2×5–10) 

– 

Deep Breathing (10x, combine with other drills) 

Practice before walking or transitions. Combine with chin tucks or shoulder rolls


References



 
 
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