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Parkinsons affects approximately 1 in 500 people in the UK. It is a progressive neurological disorder mainly affecting an area of the brain called the basal ganglia, the brain centres that are responsible for producing a chemical known as dopamine.


What is it?

Normally nerve cells in the part of the brain called the basal ganglia produce dopamine, a chemical messenger used to transmit nerve impulses from the brain to various parts if the body. In Parkinsons degeneration of these nerve cells means not enough dopamine is made and messages transmitted from the brain to the muscles become less efficient.



There are many different symptoms that can be exhibited but not all people demonstrate the same presentation. Examples of symptoms are:

  • Tremor – this begins usually in 1 hand and can be the first symptom for many people
  • Bradykinesia or slowness of movement – people with Parkinsons can have difficulty initiating movements or performing tasks
  • Stiffness or Rigidity in the muscles – this can lead to functional difficulties with everyday tasks
  • Impaired balance – this can lead to falls
  • Posture and gait issues – stooped posture, decreasing arm swing when walking , shuffling of gait, tripping over toes, freezing of gait
  • Fatigue
  • Micrographia or decreased size of writing
  • Mask like face
  • Sleep disturbance
  • Anxiety/depression
  • Bladder/bowel disturbance.


As there is currently no cure for Parkinsons, treatment involves medical management through the use of medications and therapy. In the early stages people may not be prescribed medication until their symptoms increase. Instead they choose exercise and diet to assist them in the management of their condition.

Common types of medication are:

  • Levodopa
  • Dopamine agonists
  • COMT inhibitors
  • MAO-B inhibitors
  • Glutamate agonists
  • Anticholinergics.


Physiotherapy intervention is based around postural education, movement re-education, self management, exercise and prevention of complications.

Exercise is beneficial to anybody of any age. This is true of people with neurological conditions. When you have been newly diagnosed with Parkinsons there are many questions and thoughts flying around your head. Thinking about physiotherapy may not be one of them, however you may well have been experiencing symptoms for a few years before diagnosis (Schrag et al, 2014) and some of the ones related to decreasing movement can be addressed by physiotherapy (Keus et al, 2014).

For example, the European Physiotherapy Guideline (Keus et al, 2014), the recommended guidance for physiotherapists to use in the UK, note that many people with Parkinsons develop secondary problems e.g. decreased endurance and fitness, due to a less active lifestyle when not sure of the sort of activity that would be best for them. This also leads to changes in the way muscles and joints work effectively, affecting posture and the ability to move easily. Physiotherapy can help with all these issues, educating an individual to monitor their Parkinsons themselves, and teaching a person to manage or minimise the secondary issues.

In addition to traditional physiotherapy, there is more recent evidence demonstrating the benefits of physical activity for people in the early stages of Parkinsons in maintaining function for a longer period of time (McConaghy 2014, Combs et al, 2011).

PD Warrior

PD Warrior (11) PDWarrior programme explained by Karen Hodgson – YouTube is an exercise philosophy that aims to slow your Parkinsons down. Developed in Australia in 2011 by two neurological physiotherapists Melissa McConaghy and Lynn Tullock, it has already helped thousands of people around the world.

PD Warrior is a ‘neuro-active’ programme (11) Introducing PD Warrior! | Live brave with Parkinsons – YouTube that is designed specifically for the person with Parkinsons. Medication helps with symptom relief and general exercise programs will keep you healthy, but neither of them slow the progression of your disease. The recent evidence demonstrates that the right kind of exercise programme is the only way to modify the course of your disease.

PD Warrior is designed for people are:

  • In the early stages of idiopathic Parkinsons
  • Reasonably fit and active
  • Motivated individuals.

PD Warrior aims to show you how exercise can be enjoyable but also to show you how to exercise for life so you are in peak physical and mental condition at every stage of the disease.

Hallamshire Physiotherapy is now a licensed facility with 6 accredited instructors and runs both face to face exercise classes as well as on line programmes every week.

There are no other facilities in the region offering this successful programme.

If you would like to:

  • Look, move and feel better
  • Find out how to start a neuroactive exercise
  • Build your confidence
  • Slow the progression of your Parkinsons.

Then, contact the clinic on 0114 2671223 to discuss any issues/costs. There is no referral required.

If you would like to find out more about PD Warrior please visit their website


Combs S et al (2011). Boxing training for patients with Parkinson’s disease: A Case series. Physical Therapy; 91; 132 – 142

Keus SHJ, Munneke M, Graziano M et al (2014). European Physiotherapy Guideline for Parkinson’s Disease. KNGF/ ParkinsonNet, the Netherlands

McConaghy M (2014). The new Parkinson’s treatment: Exercise is medicine. New South Wales, Publish-Me

Schrag A, Horsfall L, Walters K et al (2014). Prediagnostic presentations of Parkinson’s disease in primary care: a case-control study. The Lancet Neurology; 14 (1): 57 – 6

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