While not everyone will experience freezing, it is a common symptom of Parkinson’s, particularly in the middle to late stages. Suddenly losing the ability to move for a few seconds or minutes can be upsetting, but the more you understand freezing, the easier it is to navigate through.
Here we talk about what freezing with Parkinson’s actually is, why it occurs and the range of treatments available to help. Physiotherapist (and President of Parkinson’s Europe) Josefa Domingos – who has spent decades specialising in physiotherapy for Parkinson’s – has approved the following advice.
See our article on tips to help with Parkinson’s and freezing
What is freezing with Parkinson’s?
Freezing can be a common symptom of Parkinson’s. It is sometimes described by people with Parkinson’s as feeling like your feet are ‘glued’ to the ground. This can last for a few seconds or minutes. When freezing occurs, your feet will feel ‘frozen’ or stuck to the ground, although the top half of your body will still be mobile.
It happens suddenly, mainly when turning, walking or taking the first step after stopping. This last one is called ‘start hesitation’, which is when you find it difficult to initiate a movement. This might happen, for example, when you try to step forward just after getting up or when you start getting out of bed. It can also occur in speech or writing.
Why do people with Parkinson’s freeze?
Not everyone with Parkinson’s will experience freezing, and some people are more prone to this symptom than others. It tends to occur more frequently as Parkinson’s progresses. It also seems to be more prevalent in those whose initial symptoms include gait problems, and less prevalent in people who initially present with tremor.
There does appear to be a link to long-term use of levodopa, although freezing can also be experienced by people who do not take the drug, so it is not simply a side effect of medication.
The exact cause of freezing is still unclear, but it is thought to occur when there is an interruption to a familiar or automatic sequence of movements.
Freezing when walking
During walking, freezing is mainly observed when:
- your medication is ‘wearing off’ and no longer controlling symptoms as well
- you are turning or changing direction, especially in a small space
- you are walking towards doorways, chairs or around obstacles
- you are distracted by another task when you are walking
- you are in places that are crowded, cluttered or have highly patterned flooring
- the ‘flow’ of your walking is interrupted by an object, by someone talking, or if you begin to concentrate on something else. All of these will stop you from being able to keep a rhythm going
- you are in a group situation or in conversation
Is freezing related to the intake of dopaminergic medication?
Some people with Parkinson’s have ‘on’ and ‘off’ periods. This is when they switch from being able to move when their medication level is higher (on) to being unable to move without difficulty when their medication level is low (off).
Many people notice that freezing is worse when their medication level is low, when they are ‘off’. But freezing is not the same as being ‘on’ or ‘off’.
Treatment and management of freezing
There are lots of things you can do to help yourself, as well as lots of support available from experienced professionals.
Medication
The most important factor in treating freezing is establishing whether or not it responds to standard Parkinson’s medication. Freezing that occurs during ‘off’ periods, when medication is not working well, often responds well to adjustments in the timing and dosage of drugs. Always discuss any changes to medication with your doctor, or Parkinson’s nurse if you have one.
Freezing that is not related to ‘off’ periods is rare – less than 5% of cases – and doesn’t generally respond well to standard medication or adjustments to timing and dosage. In this case, for some people reducing the amount of dopamine medication you take may make freezing less likely during ‘on’ periods.
Physiotherapy or occupational therapy
A physiotherapist or occupational therapist can teach techniques to avoid freezing and recommend compensations strategies to deal with it if it happens. They will work with you, assessing your home and daily routine, to recommend any changes that might help you avoid freezing, or suggest ways to overcome it if an episode occurs. A therapist can also advise on techniques to reduce anxiety, which may trigger your freezing episodes.
They can even advise on things like the best footwear to minimise freezing and suitable walking aids – some are not recommended for people with Parkinson’s and can increase the likelihood of freezing.
Parkinson’s can affect your posture and balance. A physiotherapist can also show techniques and exercises to help with these and reduce your risk of falling forward if you freeze.
Exercise
Regular exercise is very important for people with Parkinson’s. Talk to your physiotherapist, who can suggest the best form of exercise for you. There is strong evidence to show supervised treadmill training, aqua therapy and dance can improve freezing.
Surgery
If other interventions do not help, deep brain stimulation (DBS) surgery can be effective in treating freezing episodes in some, but not all, people with Parkinson’s.
Find out more about freezing in Parkinson’s
Acknowledgements: We would like to thank Dr Jorik Nonnekes (Radboud University Nijmegen Medical Centre, The Netherlands) for his help in reviewing this information; Parkinson’s UK for permission to use this source in compiling this information, and Josefa Domingos for reviewing this article.
