Understanding Physical Changes in Parkinson's Disease
- Lifespark
- 6 days ago
- 10 min read
Updated: 14 minutes ago
Introduction
What is the link between breathing difficulties and Parkinson's? When most people think of Parkinson’s disease, they picture shaking hands, stiff muscles, or moving slowly. While those are common signs, Parkinson’s also causes changes in posture, muscles, and bones that can affect daily life in surprising ways. Understanding these physical changes can help patients, families, and caregivers spot problems early and preserve quality of life.
This blog helps you understand:
How to recognize early signs and why it is important to do so?
Preventative and practical tips that support daily life.
How patients and caregivers can come together with a shared understanding
Why do physical changes happen in Parkinson’s?
Parkinson’s affects both the nervous system (the brain and nerves) and the musculoskeletal system (muscles, bones, joints). Over time, stiff muscles, abnormal contractions (called dystonia), and loss of flexibility can lead to changes in posture and bone alignment1. These alterations may cause pain, trouble walking, breathing or swallowing issues and higher risk of falls. What is important to know is that these can be spotted early and treated
Why do some people develop severe postural deformities?
Not everyone with Parkinson’s gets serious posture problems. Sometimes they appear suddenly after changes in medication or surgery, but more often they develop gradually. The reasons why some people with Parkinson’s disease experience severe postural problems are poorly understood. People who have a history of back problems or injuries appear to be at higher risk but other than that it is very difficult to determine who may be affected7.
In a few instances, administering certain medications including antipsychotics or anti-Parkinson’s medications, or surgical therapies such as deep brain stimulation, can trigger the sudden appearance, or worsening, of postural problems. In these cases, simply adjusting medication or the intensity of stimulation being delivered is often enough to reverse or ease the problems. However, the majority of people develop postural problems gradually and there is no clear, single cause. Research suggests that there may be several intricately linked factors at play. These may involve:
Changes in muscle tone with either some muscles becoming hyperactive other muscles becoming weakened, or a combination of both. For some, if these changes cause the muscles supporting the trunk and spine to become imbalanced it may lead in the development of severe postural changes.
Problems sensing body position (proprioception) Proprioception is the sense that allows us to perceive the position and movement of our bodies. Body schema perception enables us to orient and adapt our vertical position based on sensory information.
A few studies suggest that Parkinson’s may interfere with how the brain interprets the messages it receives from muscles and joints about the body’s position. This may result in people no longer feeling that they are leaning or bending, leading to changes in muscle tone.
Cognitive changes that affect balance and coordination A growing number of behavioral studies have explored the relationship between cognition and motor skills. Cognitive regulation of postural control involves the dynamic interplay between cognitive processes and the neural circuits responsible for maintaining equilibrium in an upright stance. The cognitive decline associated with PD exacerbates postural control difficulties and further increases risk of falls 8.
We simply do not have enough understanding about the underlying cause of postural problems. With both muscular changes and brain changes, it can be quite challenging to know whether they are causing the problems or are actually an effect or reaction to the original cause. Either way, it’s likely that a number of factors are at play, and that these may be different from person to person.
How is skeletal muscle health affected in Parkinsonian syndromes:
While stiff muscles are common in Parkinson's — muscles can also weaken and waste away (a process called sarcopenia). 41–65% of people with Parkinson’s experience significant weight loss over time. This isn’t just due to reduced appetite, it is also because of this muscle loss. Muscle weakness makes everyday activities like standing up, walking, or even eating more difficult. Many patients describe fatigue as one of their earliest and most troubling symptoms, sometimes even before diagnosis. These muscle changes are a big reason why everyday life becomes harder over time.
How Postural and Muscle Changes Affect Everyday Life
Physical changes in Parkinson’s don’t just affect appearance—they interfere with daily independence and quality of life.
Mobility & Walking: Stooped posture, leaning (Pisa syndrome), or forward bending (camptocormia) can make walking tiring and unstable, increasing the risk of falls.
Self-Care: Hand and foot deformities, along with muscle weakness, make simple tasks like buttoning a shirt, tying shoelaces, or cutting food more difficult.
Eating & Swallowing: Weakness in chewing and throat muscles can cause swallowing difficulties (dysphagia), affecting nutrition and leading to weight loss.
Pain & Fatigue: Stiff muscles and abnormal posture often cause back pain, shoulder discomfort, and chronic fatigue.
Social Participation: Visible deformities, fear of falling, or physical dependence can reduce confidence, leading some to avoid social activities.
Common Postural and Bone Changes (Watch for these risks)
Individuals with parkinsonism, which includes Parkinson's disease (PD), multiple system atrophy (MSA), and progressive supranuclear palsy (PSP), may develop certain posture problems. Some common issues are:
Striatal limb
The hand or foot bends or curls in unusual ways, often causing cramps, toe dragging, or tripping. Foot abnormalities are more frequent in PD patients. These are more common in advanced PD and in individuals with early onset or younger people2.
Early Signs Of Developing Striatal Hand or Foot
Stiffness in fingers in morning
Reduced arm swing
Unconscious tucking of thumb, especially while walking
Involuntary curling of toes
Foot turning inside
Foot cramps
Toe drag or tripping that usually starts appearing as medication wears off and then progresses to fixed contractures
How To Manage Striatal Hand Or Foot
Hand stretching
Splinting
Strengthening using elastic band
Putty exercises
Tabletop finger lifts
Task specific training
Functional hand re-training
Stretching of plantar flexors
Orthoses or show modifications
Marble pickup with toes
Heel raises
Ankle inversion/version with band
Gait drills - heel toe walking, spot marching
Camptocormia
Bending forward at the waist when standing or walking. The majority of the PD patients with camptocormia exhibit both rigidity and dystonia3,4.
Early Signs Of Developing Camptocormia
Abnormal forward bending while standing (check in a mirror)
Lower back pain and fatigue
Increase in aspiration (food or water accidently going in the wind pipe)
How To Manage Camptocormia
Back extensor stretching & core extensor strengthening
Spinal mobility exercises- superman exercise, trunk rotations, standing back extension over stability ball, wall standing drill
Breathing and trunk extension
Aquatic therapy to upright posture
Orthoses for support
Antecollis
The head and neck droop forward. Sometimes this makes swallowing and breathing harder. It was once considered a “red flag” for multiple system atrophy (MSA), but it can also appear in Parkinson’s disease - even in those who respond to medication.
Early Signs Of Developing Antecollis
Involuntary neck pulling or head jerking
Head fixed in forward flexed position
Pain behind the neck
Swallowing issues (dysphagia)
How To Manage Antecollis
Back extensor stretching & core extensor strengthening
Cervical stretching and strengthening exercises
Spinal mobility exercises- superman exercise, trunk rotations, standing back extension over stability ball, wall standing drill
Breathing and trunk extension
Aquatic therapy to upright posture
Orthoses for support
Pisa syndrome
Also called pleurothotonus, Pisa syndrome is when an individual seems to be leaning noticeably to one side, often with dropping of the head. Early Signs of Developing Pisa Syndrome
Low back pain or hip pain on only one side of the body
Palpable stiffness on one side
Worsening tilt later in the day due to medication wearing -off
Fatigue
Falls more frequent to one side
How To Manage Pisa Syndrome
Strengthening and stretching
Feedback using visual mirrors and tactile feedback using stretching tape
Balance training
Side plank
Functional reach exercises
Nordic walking
Scoliosis
A sideways curve of the spine, more common in Parkinson’s than in the general population
Early Signs Of Developing Scoliosis
Trunk deviation to one side
One shoulder appears higher or lower than the other
Uneven waistline
Reduced spinal mobility or reduced ability of move in one direction than the other
How To Manage Scoliosis
Stretching and core strengthening – cat camel stretch
Spinal mobility exercises - side lying trunk lifts, theraband rotations
Breathing exercises - schroth based breathing, incentive spirometry, diaphragmatic breathing
Postural braces
How are these physical changes treated?
Treating postural problems is complex but there are ways to both alleviate the pain that many people experience and to try and correct the postural problems themselves.
Exercise (Move it or lose it): Exercise can make the greatest impact on the course of your disease. “Movement especially exercises that encourage balance and reciprocal patterns can slow progression of the disease. Exercise and physical therapy are a very important avenue for improving postural problems and should be undertaken as early as possible. Targeted programs like dance, tai-chi, pilates can improve posture, strength, and balance. Another helpful approach is the use of cueing strategies. These are external signals—such as rhythmic music or a metronome (auditory cues), floor markers or laser lines (visual cues), or vibration and touch (tactile cues)—that provide the brain with an extra reference point for movement. Cueing can help people walk more smoothly, overcome freezing episodes, and maintain better posture.
Caregiver’s support: Caregivers play a key role in monitoring small changes, encouraging activity and keeping routines consistent.
Antiparkinsonian drugs: Postural and striatal deformities are often considered hallmarks of advanced PD, but in some cases, they may appear even in early stages. Certain medications like DOPA agonists are best avoided11, while carefully adjusting Parkinson’s medication may be helpful if the postural problems worsen when drugs start wearing off, but this doesn’t work for everyone.
Camptocormia generally does not respond to Levodopa, and only rare cases of antecollis have shown benefit. Postural deformities such as Pisa syndrome, scoliosis, or striatal deformities may improve with medications like anticholinergics, baclofen, or benzodiazepines, useful in easing hand and foot dystonia3
Surgery: There is now also a growing body of evidence that deep brain stimulation (DBS) may be beneficial. Postural changes is improved due to improvement in dystonia and rigidity of paraspinal muscles12. But it appears that surgical approaches need to be used early, within 2 years of the onset of severe postural changes, to have these benefits.
Lifestyle: Living with Parkinson’s doesn’t mean slowing down—it means being smart about how you take care of your body. Simple lifestyle choices can help you manage symptoms and may even slow the progression of the disease. Diet modifications and a focus on exercise can help improve mobility, balance and enhance your overall quality of life.
Stay active daily — “move it or lose it” is especially true in Parkinson’s.
Use proper footwear to reduce falls.
Use mirrors to check posture and correct leaning.
Eat well to maintain muscle strength.
Table II : Do’s & Don’ts for people with Parkinsons:
Do's ✅ | Don'ts ❌ |
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Caregiver’s guide: Detecting and managing physical changes in Parkinson’s
PD is a complex motor disorder, meaning many features of the disease change over time. While no two people experience the disease the same way, there are number of early signs/ symptoms caregivers can look out to help them prepare for the changes likely to occur during early, mid, and advanced stage.
The more educated and prepared you are as a caregiver, the more successful you will be at overcoming the various challenges associated with your loved one’s disease.
Major Red flags to look out for:
Red flags | What you may notice | Caregiver tips |
| Coughing or Choking while eating, drooling | Encourage upright posture while eating, small bites, and consult a speech therapist. |
| Chin dropping forward | Gentle reminders to correct posture, physiotherapy-based stretching and strengthening.
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| Frequent stumbling, loss of balance during turns, difficulty rising from a chair. | Make the home fall-proof (grab bars, clutter-free spaces) and involve a physiotherapist for balance training. |
| Softer, slurred, or monotone speech, difficulty being heard. | Encourage voice exercises, consult speech therapy |
| Loose clothing, reduced appetite, difficulty finishing meals. | Small frequent meals, nutrient-rich snacks, consult dietitian.
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| Rapid decline in walking endurance, extreme tiredness after minimal effort. | Keep a symptom diary, review with healthcare provider. |
Finding and building a Parkinson’s support system
Some changes in Parkinson’s need quick attention—like sudden worsening of symptoms, frequent falls, swallowing problems, or new pain. Spotting these early helps prevent complications and keeps you safer.
You don’t have to face this journey alone. Teaming up with healthcare professionals can make daily life easier and improve quality of life:
Neurologists: Specifically, movement disorder specialists, who diagnose and oversee the medical management of Parkinson’s disease.
Physical therapists: Experts in movement science who help patients maintain and improve mobility, balance, strength, and coordination through tailored exercise programs. In Parkinson's, a neuro-physiotherapist is more relevant
Occupational therapists: Assist patients with everyday tasks, providing strategies and adaptations for maintaining independence at home and in daily life.
Speech therapists: Specialists who help manage speech and swallowing difficulties common in Parkinson's disease.
Dietitians: Certified nutrition experts who can guide dietary choices to improve energy levels, manage medication effectiveness, and maintain overall health.
Mental health professionals: Counselors or psychologists offer patients and caregivers emotional support, coping strategies, and mental health care.
Remember: Seeking help isn’t a sign of weakness; it’s a proactive step toward safety, confidence, and a better quality of life.
Note: This article is designed to share information and raise awareness about Parkinson’s. It should not replace medical advice. For personalized care, always consult a qualified healthcare professional.
Contact us for further enquiry if necessary.
Supplementary Materials:
The following materials serve as a practical guide, providing clear instructions on how to perform the exercises effectively.
Hand stretching exercise:
Hand strengthening exercise:
Claw hand exercise:
Cervical stretching and strengthening exercise:
Spinal mobility exercises:
References:
1. Pandey, S., & Garg, H. (2016). Postural & striatal deformities in Parkinson`s disease: Are these rare?. The Indian journal of medical research, 143(1), 11–17. https://doi.org/10.4103/0971-5916.178577
2. Jankovic, J., & Tintner, R. (2001). Dystonia and parkinsonism. Parkinsonism & related disorders, 8(2), 109–121. https://doi.org/10.1016/s1353-8020(01)00025-6
3. Doherty, K. M., van de Warrenburg, B. P., Peralta, M. C., Silveira-Moriyama, L., Azulay, J. P., Gershanik, O. S., & Bloem, B. R. (2011). Postural deformities in Parkinson's disease. The Lancet. Neurology, 10(6), 538–549. https://doi.org/10.1016/S1474-4422(11)70067-9
4. Azher, S. N., & Jankovic, J. (2005). Camptocormia: pathogenesis, classification, and response to therapy. Neurology, 65(3), 355–359. https://doi.org/10.1212/01.wnl.0000171857.09079.9f
5. Baik J. S. (2016). Understanding of skeletal deformities in Parkinson's disease. The Indian journal of medical research, 144(5), 650–652. https://doi.org/10.4103/ijmr.IJMR_1166_16
6. Villarejo, A., Camacho, A., García-Ramos, R., Moreno, T., Penas, M., Juntas, R., & Ruiz, J. (2003). Cholinergic-dopaminergic imbalance in Pisa syndrome. Clinical neuropharmacology, 26(3), 119–121. https://doi.org/10.1097/00002826-200305000-00004
8. Tait, P., Graham, L., Vitorio, R., Watermeyer, T., Timm, E. C., O'Keefe, J., Stuart, S., & Morris, R. (2025). Neuroimaging and cognitive correlates of postural control in Parkinson's disease: a systematic review. Journal of neuroengineering and rehabilitation, 22(1), 24. https://doi.org/10.1186/s12984-024-01539-y
9. Margraf, N. G., Rohr, A., Granert, O., Hampel, J., Drews, A., & Deuschl, G. (2015). MRI of lumbar trunk muscles in patients with Parkinson's disease and camptocormia. Journal of neurology, 262(7), 1655–1664. https://doi.org/10.1007/s00415-015-7726-3
10. Murphy, K. T., & Lynch, G. S. (2023). Impaired skeletal muscle health in Parkinsonian syndromes: clinical implications, mechanisms and potential treatments. Journal of cachexia, sarcopenia and muscle, 14(5), 1987–2002. https://doi.org/10.1002/jcsm.13312
11. Savica, R., Kumar, N., Ahlskog, J. E., Josephs, K. A., Matsumoto, J. Y., & McKeon, A. (2012). Parkinsonism and dropped head: dystonia, myopathy or both?. Parkinsonism & related disorders, 18(1), 30–34. https://doi.org/10.1016/j.parkreldis.2011.08.006
12. Umemura, A., Oka, Y., Ohkita, K., Yamawaki, T., & Yamada, K. (2010). Effect of subthalamic deep brain stimulation on postural abnormality in Parkinson disease. Journal of neurosurgery, 112(6), 1283–1288. https://doi.org/10.3171/2009.10.JNS09917
