Walking tall and Parkinson's

How can people with Parkinson’s walk more confidently? Physiotherapist Bhanu Ramaswamy gives her advice – and explains the wonders of how we walk.

Next time you’re out and about, take a moment to watch how people around you walk. Some might take longer strides, others might bob their heads. But there’s a definite pattern to how people move around.

Although it looks simple, walking is anything but. There’s a lot of work going on between the brain and the body to execute the movements in sequence. Every part of the body, from the feet to the head, works together to make walking happen.

How we walk

The toes push the leg off the ground, which then moves forward until the heel hits the ground to take a step. The ankle and hip joints, plus leg, buttock and lower back muscles, all need to be flexible and strong. The torso needs to work too – twisting, creating an arm swing to help with balance. Strong back, stomach and chest muscles are key, as well as flexible shoulders. The head and neck also play a part, moving as you walk so you can look around to see what’s coming.

The brain automatically plans where and how you’re going to walk, subconsciously noting if there are steps coming up or a slope. The body has to be flexible and strong enough to manage the movements. It also has to be free of pain, which can switch off some muscles and cause others to tense protectively.

Here are some common problems people with Parkinson’s face when walking, and advice for dealing with them.

Coping with bradykinesia

Bradykinesia – which means slowness and a reduced range of movement – is common in people with Parkinson’s. It can make your steps shorter so it takes more time and effort to get somewhere.

To help, try working out how many large steps it should take you to get from your living room chair into the kitchen. Count your steps aloud as you walk there, and repeat as you walk back, trying to hit your target.

If you’re out walking, choose a marker (for example, if you’re in a park, use the next tree you see) and really push yourself to walk with larger strides and at a faster pace for that distance. Gradually increase the pace of the whole walk over time.

Or, if you’re weaker on one side of your body, try saying to yourself ‘big step’ or ‘heel down’ when you take a step on your weaker leg, so you can make your stride lengths equal.

Coping with rigidity

Rigidity (tension in the muscles) causes your body to stiffen, especially on your weaker ‘Parkinson’s side’. It can lead to a forward stoop of your body from the hips. This can affect how your feet take off and land on the floor, and mean that the top of your body is leading your walking – making you less in control of your movement. It can also mean your arms don’t swing in the same way, and cause hip, knee and lower back pain.

Stretching up tall, twisting your body from side to side, and then standing and swinging a leg backwards and forwards are good ways to loosen up before a walk.

Coping with freezing

Usually when someone walks, their body automatically takes its weight over to one side so the opposite leg is free to lift off the floor and step forward. However, people with Parkinson’s can find this doesn’t happen – leading to freezing.

Standing back with your weight as much on your heels as the rest of your foot, then rocking your body from side to side, can help retrigger a good stepping motion. 

If these tips don’t help, ask your doctor to refer you to a physiotherapist. They’ll be able to suggest strategies to improve your walking, making it more efficient and safer.