Managing Walking Problems With Parkinson’s

Take it one step at a time, the old saying goes. But when you live with Parkinson's disease, that can be easier said than done. Parkinson's effects on your brain can make walking challenging on multiple fronts and put you at risk for freezing or falling. If you or a loved one live with Parkinson's disease and you are becoming increasingly concerned about walking, take a look at what our experts say causes this challenge and what you can do to keep moving safely and independently.

What Walking Problems Are Common With Parkinson's?

Parkinson's comes from the gradual loss of dopamine-producing neurons in the brain. "That makes it harder for your brain to send smooth, automatic signals that control walking," explains Nina Mosier, M.D., physician and founder of Power for Parkinson's, an Austin, TX-based organization offering free online and in-person fitness classes for people with Parkinson's.

As a result, walking becomes less automatic and more prone to challenges or disruptions. According to the Parkinson's Foundation, some common Parkinson's disease-related walking problems can include:

• Decreased balance and greater risk of falling
• Freezing up
• Less arm swing
• Slower pace
• Taking smaller steps or shuffling
• Trouble turning

Over time, these problems can cause people with Parkinson's disease to gradually take fewer steps throughout the day overall. That makes it harder to reach physical activity goals, which are a key part of managing Parkinson's disease, note researchers in Seminars in Neurology.

How Does Parkinson's Change Your Gait?

Gait is another word for walking pattern or the way that you walk. Because Parkinson's disease affects the dopamine signaling that helps your muscle work smoothly, it can cause changes in your gait.

"As dopamine is lost, steps often become smaller or slower, the feet may shuffle, and the arms may swing less," says neurologist Daniel Truong, M.D., medical director of the Truong Neuroscience Institute at MemorialCare Orange Coast Medical Center in Fountain Valley, CA, and editor in chief of the Journal of Clinical Parkinsonism and Related Disorders.

Gait changes tend to intensify as Parkinson's disease progresses. You might also notice that they get worse when you're trying to do multiple tasks at once, like walking and talking, per a paper published in BMC Geriatrics.

Why Do People With Parkinson's Freeze While Walking?

Around half of people with Parkinson's disease have brief freezing episodes when they walk, per the International Parkinson and Movement Disorder Society. Doctors call this freezing of gait, and it's best described as feeling like you stepped in a bucket of super glue, then tried to move your legs. "Someone with Parkinson's disease might feel like their feet are stuck to the floor even though they're trying to walk," Dr. Mosier says.

Experts don't fully understand what causes freezing, but it seems to happen more often in certain types of situations. According to the American Parkinson Disease Association, these can include things like:

• Feeling anxious or rushed (like trying to get to an elevator door before it closes)
• Preparing to take a step after you've been resting
• Trying to make a turn or navigating tight spaces (like stepping through a door frame or onto an escalator)
• When your medication is wearing off

Freezing of gait can be frustrating. But it can also be dangerous, since it worsens already unstable balance. "Because freezing usually strikes mid-step, when the body is already moving forward while the feet stay planted, it is a leading cause of falls," explains Adam Mednick, M.D., Ph.D., a board-certified neurologist in North Haven, CT.

What To Do During a Freezing Episode

Most freezing episodes only last a few seconds, but in some cases, they can go on for several minutes, according to a paper published in the Archives of Physical Medicine and Rehabilitation. There are strategies that can help you get moving again and reduce your risk of falling. "Parkinson's disrupts pathways in the nervous system that help with automatic or habitual movements, so the best way to restart walking is to consciously override it with a new pattern or cue," Dr. Mosier says.

These are a few simple ways you can do that, from the American Parkinson Disease Association:

• Do another movement, like raising your arm or touching your head, before taking a step forward.
• Count "1-2-3-go" and then take a step forward.
• March in place a few times, then take a step forward.
• Hum a song and time your next forward step with the beat of the music.
• Shift your weight from side to side before stepping forward.
• Picture an object on the ground in front of you and try to step over it.

One thing to avoid: Trying to fight the freeze by forcing yourself to move forward, which usually doesn't work. "Stopping to reset [tends to be more effective] than pushing through," says Dr. Mosier.

How Physical Therapy Can Improve Walking

If you're experiencing walking challenges, working with a physical therapist who specializes in neurologic conditions like Parkinson's disease may help. In a randomized clinical trial published in the Archives of Physical Medicine and Rehabilitation, Parkinson's patients worked with physical therapists in regular balance and brisk-walking training sessions. By the end of the study, participants had major improvements in their walking capacity, balance, and gait function.

Broadly, physical therapy can help you retrain how you move. "It teaches strategies to walk with bigger, safer steps, improve balance and turning, and manage freezing, helping people stay mobile, independent, and safer from falls," Dr. Truong says.

Your physical therapist may give you exercises to improve your posture, balance, and strength; learn how to make turns more safely; or teach you cueing strategies to manage freezing, for instance. They can also help you decide whether you'd benefit from a mobility device like a cane or walker and show you how to use the device safely.

Can Medication Improve Parkinson's Walking Problems?

Medications like levodopa work by increasing levels of dopamine in the brain, which can improve your muscle signaling and coordination. That can improve certain walking problems like small or shuffling steps and low walking speed, concluded a recent meta-analysis published in Expert Review of Neurotherapeutics.

In some cases, new or worsening walking symptoms are a sign that it may be time to make changes to your medication plan. "Because freezing and shuffling often occur as a dose wears off, worsening gait can indicate that the timing, dose, or combination of medications needs adjustment," Dr. Mednick says. Always talk with your doctor before making changes to your Parkinson's disease medication regimen. In some cases, increasing your levodopa dose could make walking problems worse.

There are some Parkinson's-related walking problems that medication doesn't improve. "Balance problems and some forms of freezing often respond less consistently to medication," says Dr. Truong. Fortunately, there are other tools that can make a difference, like exercise.

Exercises That May Support Safer Walking

Regular physical activity is just as important as medication for managing Parkinson's disease, according to the Parkinson's Foundation. "Over and over again, I see people walk into class with a cane and then forget about it on the way out! Exercise helps no matter the stage of Parkinson's they're experiencing," says Dr. Mosier. It can improve your balance, posture, endurance, and flexibility, which in turn can reduce your risk for falls and freezing, the Parkinson's Foundation notes.

Activities that build leg strength and balance may be especially helpful. The Parkinson's Foundation recommends things like tai chi, dancing, boxing, and even agility boot camp classes geared towards people with Parkinson's disease. At-home workouts, including ones that you can do in a chair, can also make a difference.

That said, you don't need to commit to an intensive exercise program to see improvements. "Shorter sessions performed consistently may be easier than an ambitious program that the person is afraid to attempt. Practice balancing in a wall corner on one leg to improve stability," Dr. Truong says. If you have questions or concerns about getting started, a physical therapist can help you get on the right track.

When Can a Mobility Aid Help?

Mobility devices like canes, walkers, and rollators can make getting around easier for many people with Parkinson's disease. Rollators may be preferable to walkers in helping people with Parkinson's remain mobile, research shows. "The goal isn't simply to prevent falls, but also to help the person remain active and independent," says Dr. Truong.

While deciding when to use a mobility device is individualized, it's worth starting the conversation with your doctor when medications, physical therapy, or exercise aren't doing enough to control your freezing, recommends the American Parkinson Disease Association.

There's no one best mobility device for everyone with Parkinson's disease, since different types offer different levels of support. A physical therapist can help you figure out which type of device will work best for you and help ensure the specific device you pick out is adjusted correctly for your body.

How to Reduce Falls While Walking

Falls are a risk when you live with Parkinson's disease, but they don't have to be inevitable. You can stay steadier on your feet by putting certain practices into place. Here are some of Dr. Mosier's top tips:

• Take your medications on time to keep your symptoms as well-controlled as possible
• Consciously take big steps where you pick up your feet, rather than shuffling
• Try not to rush, especially towards chairs or doorways
• Turn in wide arcs using several steps instead of quickly pivoting
• Minimize distractions if walking while multitasking is difficult
• Keep walkways free of clutter (like cords or rugs)
• Wear supportive, low-heeled shoes
• Use a mobility aid if one is recommended

When to Contact Your Parkinson's Care Team

Let your doctor know if your Parkinson's disease is causing any new or worsening movement-related symptoms, Dr. Mednick says. Frequent stumbling, freezing, changes in balance, or falls all deserve attention. Addressing these issues sooner rather than later gives you a chance to adjust your treatment plan and reduce your chance for a serious fall or injury.

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