The term gait refers to the human steady state of walking. Although most of us don’t have to concentrate on walking from one room to another, this task is actually very complex for our balance control system as it requires the integration of multiple sensory input arising from the somatosensory, vestibular, and visual systems. It also necessitates the coordination of multiple skeletal muscles and involves executive (brain-driven) functions. Because of this, individuals with sensory, motor, and/or cognitive deficits—like patients with Parkinson’s disease—may develop a gait disorder.

Parkinson’s Disease is a common progressive neurodegenerative condition characterized by various motor and non-motor symptoms that impact a patient’s quality of life. The primary clinical signs of the disease include a resting tremor, bradykinesia (moving slowly), rigidity and postural instability. Secondary motor symptoms include a flexed or bent-forward posture and freezing of gait. As motor dysfunction progresses, this often leads to difficulties in coping with daily locomotor tasks such as gait initiation, walking, obstacle crossing, and/or moving around a more confined space like a home—which can increase the risk for serious fall and injury.

When we think of manual therapies provided by doctors of chiropractic, we often do so from a pain relief perspective. However, manual therapies also stimulate several biomechanical, neurophysiological and psychological changes that result in improved motor control. For example, several studies have shown that manual therapies can have short-term positive effects on athletic performance. Until recently, few researchers have come at this from the opposite direction to see if patients with motor impairments can benefit from manual therapies.

In a systematic review published in January 2024, researchers looked at findings from three studies on the application of manual therapies in patients with Parkinson’s disease. They found that mobilization and manipulative therapies applied to the cervical, thoracic, and lumbar spine, shoulder girdle, sacroiliac joint, hip bones, leg musculature, and ankles may result in significant improvements in dynamic gait tasks like walking on a level surface, changing gait speed, turning the head in a horizontal and vertical direction while walking, rapid directional changes, stepping over and around an obstacle, and stair climbing.  However, due to the limited research on the topic, the authors of the review were unable to draw firm conclusions and noted that further research is needed to explore the topic.

Because the number of Parkinson’s cases is expected to double in the next two decades, it’s a certainty there will be an increased need for therapies to help patients maintain their independence. It seems likely that chiropractors may eventually find themselves as valuable partners in managing patients with Parkinson’s disease.