Why Does Balance Break With Parkinson’s?

Balance and postural control are some of the most challenging areas to deal with in Parkinson’s Disease. Dopaminergic treatments that are typically given for PD have not shown much benefit for the stooped posture and unsteady feeling that PD patients commonly experience. This suggests that other parts of the brain may be causing these balance problems, and that other forms of therapy may be required to improve balance and posture in PD patients.

The good news is that basic exercise programs that simply get the body moving have been shown to have lasting improvements in patients with PD. This includes things like Tai Chi, resistance training, and even boxing training have been shown to have positive lasting effects in people with early to moderate symptoms.

How does something as simple as exercise improve the symptoms of a brain disease like PD? How can we use some of these concepts to help patients with PD overcome plateaus in their improvement? That’s what I’ll try to answer today.

Proprioception: The Underdog of the Senses

It’s hard to appreciate just how complicated balance is until you start to lose it. The maintenance of posture and balance is so important and complex in the human body that some of the largest and fastest tracts in your spinal cord are dedicated to the use of your back muscles.

In order for balance to work properly, it requires the use of 3 super important sensory systems. This includes your vision from your eyes, the vestibular system from your inner ears, and your proprioceptive system from your skin and joints. Most of use can understand how important your vision and vesibular system are to your sense of balance so I won’t get into that much, but many people have no idea what proprioception is.

The 3 super systems that maintain your balance

Proprioception is a sense dictated by movement detected by your skin, muscles, and joints. If you were to close your eyes and raise your hand over your head, you can reach up with your other hand and touch that body part without looking at it. How does your body know? Because there are sensors in your skin and joints telling your brain where it is in space all of the time.

When it comes to balance, these same sensors that exist in your spine and in your ankles play an enormous role in keeping you upright, and it is the breakdown in this system that commonly leads to balance and posture problems in people with PD.

When Proprioception Breaks Down

Research has shown that patients with Parkinson’s Disease typically have a balance system that is overly reliant on vision and has mostly normal inner ear function. This implies that it is the proprioceptive system that breaks down leading to a heavier reliance on vision to compensate.

Why does this break down? Because the basal ganglia (the area of the brain affected by Parkinson’s) plays a really important role in your body’s joint position awareness. The basal ganglia is a really important relay station for proprioceptive information to get to the higher parts of the brain in the cortex. When the brain can’t integrate this proprioception, then it can’t provide feedback to the muscular system to make appropriate adjustments.

This can be problematic because in people without balance problems need proprioception to stay upright and balanced with stability. If you can’t make adjustments to your muscular system, especially in the dark, then your likelihood for falling increases dramatically with a little push from an unexpected source.

Teaching an Old Brain New Tricks

Proprioception is a big fancy word that sounds like it requires tools and advanced therapies, but in reality it is generated by simple movement. Every time your muscles contract or a joint moves, you are increasing proprioception into the brain!

That’s why exercise of all shapes and sizes tends to help patients with Parkinson’s Disease. 

In addition to standard exercise programs, patients with PD may benefit from therapies that help their brain better integrate sensory stimuli. This can include different types of proprioceptive therapies that include visual feedback training, eye movement training, and vestibular rehabilitation from a functional neurology perspective.

Plus the impact that a specifically targeted chiropractic adjustment has on the the proprioceptive system of the brain is becoming more well documented as a reason it can help people maintain better balance.

The right combination of therapies may help patients with PD improve posture, gait, and general difficulties with movement. While we can’t fix the area of the brain that is damaged, because the brain has the ability to change itself, we can teach different parts of the brain new tricks to help the brain better adapt to the environment.