How does posture change with Parkinson's?

• Bent Posture.  A tendency to bend or flex forward is the most common change in posture seen with Parkinson’s disease. There can also be a tendency to flex or bend to one side. It is not known why this occurs but may be due to many factors including muscle rigidity, brain changes that control posture or dystonia. Muscle rigidity (stiffness) and imbalance of bigger muscles overpowering the smaller muscles can cause you to bend over. The muscles that flex, or forward bend the spine or hip may become hyperactive. These muscles that flex your spine forward and limit hip mobility include: the abdominal muscles, psoas major and minor and iliacus muscles.
• Change in Awareness of Posture.  As with many motor symptoms, there can also be a change in postural awareness or your own perceptions of change. When this occurs, you may feel like your posture is straight but it is not. This is similar to what happens with speech (you feel like you are talking loud but your speech is actually soft). Standing straight may seem like an over correction and may sometimes make you feel like you are falling backwards.
• Camptocormia- a severe but uncommon problem. This is another severe but less common posture problem than can occur with Parkinson Disease. It is a severe bending of the thoracolumbar spine (middle of back) or lower back, which is seen during standing and walking and improves while lying flat. This may be severe enough that the upper back is parallel to the floor making it hard to look up or see what’s ahead. A patient with camptocormia is bent forward and possibly rotated to one side while standing, less bent while sitting and able to lie flat on a bed or floor.

Postural Change with Aging

Not all changes are caused by Parkinson's disease. Degenerative changes from arthritis increase with aging. Osteoporosis (thinning of the bones) can also  also cause changes such as compression or fracture of the vertebral bones causing both pain and flexed posture. 

• DEXA or bone density scan - Ask your doctor about ordering this test to see if you have osteoporosis or osteopenia.
• Calcium and vitamin D keep your bones strong. Be sure your get the calcium you need in your diet. Ask your doctor if a vitamin D level is appropriate.
• Weight bearing exercise (jumping) weight lifting helps you keep your bone mass 

How does postural change affect mobility?

With normal posture our weight is well centered over the middle of our feet making it much easier to balance. When our spine is bent forward, the head also comes forward and our center of mass shifts ahead of the feet. To keep from falling, the forward flexed person tends to bend his or her knees and hips. This leads to difficulty in taking big steps and requires more energy to walk. Falls are more likely to happen due to the reduced foot clearance or shuffling that occurs while walking with knees bent. Also forward slouching limits arm swing, can cause shoulder and neck problems, reduces the lung volume which can lead to shortness of breath and or softness of speech.

Benefits of a straighter spine include better balance, improved breathing and less energy expended for daily activities.

What are the treatments?

A good exercise program with a focus on increasing FLEXIBILITY in the stronger muscles, and STRENGTH in the smaller muscles in the spine and back of the shoulder will help to delay postural changes and help maintain a more upright stance.

• Stretching and flexibility of flexing muscles of the chest, shoulder, waist, hips, hamstrings and calves.
• Strengthening of back muscles, shoulder and other muscles that help keep spine erect.
• Postural awareness and proprioception exercises to increase person's awareness of body position in space.
• Yoga and Tai chi improve posture through strength, flexibity, and awareness

ENDURANCE and STAMINA is very important because our posture tends to worsen when we get tired.

• Swimming
• Walking with hiking poles
• Dancing 

How can I get started? 

A physical therapist can assist with improving your posture by instructing you in a comprehensive exercise program to increase your flexibility including spine motion, instruction in strengthening exercises and normalizing the strength/length of your muscles.

Monique L. Giroux, MD
Guest Blogger, Former Medical Director of NWPF