Archive for October 26, 2011

Physical Therapy and Parkinson’s disease

By:  Aleacha Wallington, PT

Parkinson’s disease (PD) is a chronic progressive disease that affects the motor component of the central nervous system.  In simpler terms this means that the brain does not send correct signals to muscles for accurate body movements.  It is a movement disorder characterized by rigidity, tremor, and slowness of movement.  Other symptoms may include: shuffling while walking, lack of facial expression, small handwriting, excessive saliva, difficulty swallowing, difficulty speaking, frequent falls, and freezing.  The cause is unknown but there are possible links to genetic mutations and environmental exposure to toxins or viruses.  Recent studies have suggested that treatment should not only include medication but also exercise.  The medication for PD helps treat the symptoms by increasing the brain’s supply of dopamine.  Dopamine is the chemical or messenger in the brain that is decreased with PD.   A recent study by Dr. J Eric Ashlskog suggested that an intense exercise program can have positive modifying effects slowing the progression of the disease.  Physical therapists are uniquely qualified to design an exercise program for individuals with PD whether a person is newly diagnosed or has been diagnosed for years.

                Physical therapists can improve an individual’s confidence and function while promoting safety with daily functional activities.  Ideally, physical therapy should begin as soon as an individual is diagnosed, but gains can also be made in the later years of PD progression.    The early stages are the best time to begin a program that is specially tailored to improve or slow down the progression of movement symptoms.  The goal of therapy is to teach an exercise program that can be performed on a daily basis and become a lifelong routine. 

                A good exercise program for an individual with PD will be challenging and address functional limitations.  These functional limitations can be as simple as rolling over in bed or getting up out of chair and as challenging as playing golf or performing work activities.  Exercises should focus on several different factors including improving spinal mobility, balance, posture, strength, and speed of movements such as walking.  Physical therapy will also include education and evaluation for assistive devices and home modifications to prevent falls.  For an exercise program to have the most benefit it is important to think of it as a daily medication.  We do not want to miss a dose of medication because we know it will have negative effects.  Missing a dose of exercise is similar in that we will not see maximum benefits (and may not be able to slow the progression of PD) if it is not performed on a daily basis.

                Rehabilitation of individuals with PD is different than treatment of patients with other neurological diseases and it is important for these patients’ to see a therapist familiar with specialized PD treatment. 

                Aleacha Wallington, DPT is a licensed physical therapist at HPT Physical Therapy Specialists in Huntington, WV.  She specializes in treatment of patients with Parkinson’s disease and other neurological conditions.  She can be reached at 304-525-4445 or

Shoulder pain causes can be prevented or minimized by: John Oxley, PT

Surprisingly, between 18 and 31 percent of the adult population experience shoulder pain during any 30-day period. There are many causes of shoulder pain including rotator cuff tendonitis or tears, adhesive capsulitis, shoulder instability and osteoarthritis. If we can identify risk factors for these conditions, we can prevent or at the very least minimize the problem.

Some lifestyle risk factors for shoulder pain and more specifically rotator cuff issues include obesity, tobacco use, and type 1 diabetes mellitus. These risk factors are believed to contribute to rotator cuff tears because of the restriction of blood flow related to nicotine and diabetes. The rotator cuff tendon suffers from limited blood flow anyway making it more susceptible than other tendons to chronic injury and tearing. Other risk factors that make people susceptible to shoulder injury include working with arms above shoulder level; hand-arm vibration; repetitive movements; pushing and pulling; and carrying loads supported by the shoulder.

A proactive approach to shoulder health includes brief daily stretching, posture improvement, intermittent rest breaks from overhead activity, and early identification of shoulder dysfunction. Early identification is extremely important because shoulder problems can get significantly worse if ignored and depending on the condition can be irreparable if unchecked. Conversely, acute shoulder pain responds well to intervention and early treatment can decrease productivity loss dramatically.

There are some seasonal activities on the horizon that are a common complaint and source of pain for my patient population: Raking leaves, shoveling snow, putting up Christmas decorations/lights, and weight training associated with early new years resolutions are just a few. You cannot avoid these activities, but you can be smart while undertaking these “must dos” by doing the following:

Take frequent rest breaks to change body position.

Don’t try to finish it all at once.

Use a ladder for reaching places overhead. Be careful when using a ladder, because the injuries associated with falling off a ladder can be far worse than a little shoulder pain.

Early treatment is important when it comes to treating shoulder problems efficiently and effectively. This is especially true when it comes to suspected rotator cuff tears because ignoring the problem can have catastrophic repercussions in some instances. Adhesive capsulitis is another condition that the research has recently supported treating early to prevent further freezing or loss of motion.

If you simply know that your shoulder hurts and don’t really know why then you should have a physician or physical therapist evaluate you. Possible treatments include steroid injections, surgery, oral medications or physical therapy to address your pain or limitations in function. In conclusion, be aware of shoulder position during seasonal or work activities, a healthy lifestyle can positively effect your joint health, and don’t wait to address your problem because the earlier it is addressed typically the more successful we are with treatment.

If you have any questions, email John at