If you’re reading this, there’s a good chance someone you love has been diagnosed with Parkinson’s disease. Perhaps you’ve noticed their walking has changed, or they’ve had a fall that shook everyone’s confidence. You might be searching late at night, trying to understand what help is available and whether physiotherapy is worth pursuing.
This article is written for you—the family member trying to make sense of it all. We’ll explain what physiotherapy can realistically help with, what it cannot fix, and how to access the right support. No exaggerated promises, just honest, evidence-based information.
What Parkinson’s Does to Movement
Parkinson’s disease affects the brain’s ability to produce dopamine, a chemical that helps control movement. This leads to specific changes that are quite different from normal ageing.
Bradykinesia is the gradual slowing of movement. You might notice your relative takes longer to get dressed, their handwriting has become smaller, or they seem to move in slow motion. This isn’t laziness or low mood—it’s a core feature of the condition.
Rigidity causes muscles to feel stiff and resistant to movement. Your relative might describe feeling “wooden” or find it harder to turn over in bed. This stiffness can also contribute to the stooped posture that often develops.
Postural instability affects balance, particularly when turning, reaching, or being nudged. This is why falls become more common as Parkinson’s progresses—the automatic balance reactions we all rely on become slower and less effective.
Freezing of gait is one of the most distressing symptoms for families to witness. The person suddenly becomes unable to move their feet, as if they’re glued to the floor. This often happens in doorways, when turning, or when approaching furniture. It can be frightening for everyone involved.
Understanding these specific movement problems matters because physiotherapy targets them directly. A physiotherapist with Parkinson’s experience won’t just prescribe generic strengthening exercises—they’ll work on the particular mechanisms causing difficulty.
What the Evidence Actually Shows
Research into physiotherapy for Parkinson’s disease has grown substantially over the past decade. Here’s what the evidence tells us.
The National Institute for Health and Care Excellence (NICE) recommends that people with Parkinson’s should be referred early to a physiotherapist with experience of the condition. This isn’t just for people who are struggling—early input for assessment, education, and advice about physical activity can help people stay active and maintain function for longer.
A large Cochrane review examining over 150 trials found that exercise and physiotherapy improve motor symptoms and quality of life across most types of intervention. The consistent message from research is that structured physical activity helps—though the specific type of exercise matters less than actually doing it regularly.
Balance and mobility outcomes reliably improve with targeted physiotherapy. Studies show that gait speed, walking capacity, and balance scores all respond well to treatment. Strength training also produces meaningful improvements, with benefits extending to mobility and daily function.
However, it’s important to be realistic about what the evidence shows regarding falls. While balance often improves with physiotherapy, this doesn’t always translate into fewer falls. Some studies show reduced falls in people with mild to moderate Parkinson’s, while others show no change—or in some cases, increased falls in people with advanced disease and severe freezing of gait. This may be because improved confidence leads to more activity and therefore more opportunities to fall.
Cueing strategies—using external prompts like rhythmic sounds, visual targets, or counting—can help with freezing and gait difficulties. Research confirms cueing works, but also shows that one cue doesn’t fit all. What helps one person may not help another, so finding the right approach requires individual experimentation.
The benefits of physiotherapy typically require ongoing engagement. This isn’t a condition where you attend a few sessions and are “fixed.” Maintaining improvements usually means continuing with exercises and strategies long-term.
What Physiotherapy Can Help With
Freezing of Gait
Freezing episodes can be addressed through cueing techniques—using rhythmic counting, stepping over visual targets on the floor, or listening to music with a steady beat. A physiotherapist can help identify which type of cue works best and practise strategies for common freezing situations like doorways and tight spaces. They can also advise on environmental changes that reduce freezing triggers.
Shuffling Walk and Reduced Stride Length
Parkinson’s often causes steps to become shorter and shuffling. Physiotherapy focuses on consciously thinking about taking bigger steps and lifting the feet higher. This amplitude training helps counteract the brain’s tendency to make movements smaller over time. Practising walking with attention to stride length, arm swing, and heel strike can improve gait quality.
Balance and Falls
Balance training for Parkinson’s goes beyond simple standing exercises. It includes practising weight shifts, turning safely, reaching tasks, and responding to unexpected balance challenges. A physiotherapist will assess where the balance problems occur and design exercises that target those specific difficulties. They’ll also review the home environment for hazards and suggest modifications.
Stiffness and Rigidity
Regular stretching and movement exercises help manage rigidity. Specific attention to trunk rotation, shoulder mobility, and hip flexibility can reduce the feeling of stiffness and make everyday movements easier. Maintaining range of motion also helps with tasks like turning in bed, getting dressed, and looking over your shoulder.
Transfers and Functional Tasks
Getting up from a chair, getting in and out of bed, and moving from sitting to standing are fundamental daily activities that often become difficult. A physiotherapist will observe how your relative performs these tasks and teach more efficient movement patterns. Sometimes small changes in technique make a significant difference to independence.
Posture
The stooped posture common in Parkinson’s develops gradually and can affect breathing, balance, and confidence. Exercises targeting trunk strength and postural awareness help counteract this tendency. A physiotherapist can also advise on seating and positioning throughout the day.
What Physiotherapy Cannot Do
Being honest about limitations is just as important as explaining benefits. Physiotherapy cannot cure Parkinson’s disease or stop it from progressing. The underlying condition will continue to advance regardless of treatment.
Physiotherapy cannot guarantee that falls will be prevented. While balance and mobility may improve, falls can still occur—particularly as the disease advances or if cognitive changes develop. Managing falls risk is about reduction, not elimination.
The benefits of physiotherapy are generally less pronounced in advanced Parkinson’s disease, particularly when cognitive impairment is present. If your relative has difficulty remembering exercises or lacks awareness of their movement problems, standard physiotherapy approaches may need significant adaptation. This doesn’t mean physiotherapy is pointless at later stages, but expectations should be adjusted.
Improvement isn’t permanent. Without ongoing practice, the benefits gained from physiotherapy tend to decline. This is frustrating, but it reflects the progressive nature of the condition. Maintaining gains requires continued effort.
Finally, a single assessment won’t solve everything. Parkinson’s management is a long-term relationship, not a quick fix. Needs change over time, and physiotherapy input often needs to evolve as the condition progresses.
When to Seek Physiotherapy
Families often wonder when the “right time” is to involve a physiotherapist. The evidence supports early referral—even before significant problems develop.
At diagnosis is an appropriate time to see a physiotherapist with Parkinson’s experience. Even if mobility seems fine, this initial contact provides education about staying active, establishes a baseline assessment, and creates a relationship that can be built on later.
After a first fall is a common trigger point for families. A fall often comes as a shock—a concrete sign that things have changed. This is absolutely the right time to seek physiotherapy input for falls prevention strategies and balance training.
When you notice walking changes is another key moment. Perhaps the shuffling has become more pronounced, or turns have become unsteady. These changes indicate that targeted gait and balance work would be beneficial.
When medication “off” periods affect mobility suggests it’s worth coordinating physiotherapy with medication timing. Some people with Parkinson’s have clear fluctuations in their movement ability depending on when they took their tablets. A physiotherapist can advise on optimal timing for exercises and activities.
When confidence drops and activity reduces creates a vicious cycle. Less activity leads to deconditioning, which leads to greater difficulty, which leads to further activity reduction. Early intervention can help break this pattern before it becomes entrenched.
When cognitive changes emerge may require adapted approaches, but doesn’t mean physiotherapy should stop. It does mean that family involvement becomes more important in supporting exercises and strategies.
NHS Versus Private Physiotherapy
This is a practical question most families face, and it deserves an honest answer.
Through the NHS, physiotherapy for Parkinson’s is accessed via GP referral or sometimes through a Parkinson’s nurse. Waiting times vary considerably by area—in some places you might be seen within weeks, in others it could be several months. The NHS provision is free, but sessions may be limited in number, and you may not have choice over which physiotherapist you see or whether they have specific Parkinson’s expertise.
Private physiotherapy allows self-referral without needing a GP letter. Access is typically faster, and you can choose a physiotherapist with neurological experience. Sessions can continue for as long as needed, and timing can be flexible. The obvious downside is cost, which varies depending on location and whether treatment is at a clinic or at home.
The more important question than NHS versus private is whether the physiotherapist has genuine experience with Parkinson’s disease. A neurological physiotherapist who understands cueing techniques, freezing management, and the specific challenges of the condition will provide more targeted help than a generalist physiotherapist—regardless of whether they work in the NHS or privately.
If you’re considering private physiotherapy, it’s reasonable to ask about the therapist’s experience with Parkinson’s specifically, not just neurological conditions in general.
Why Home-Based Physiotherapy Works Well for Parkinson’s
There are good reasons why physiotherapy at home can be particularly effective for people with Parkinson’s disease.
Practising in the real environment matters. The stairs your relative actually climbs, the chair they actually sit in, the doorway where they actually freeze—these are the situations that need addressing. Practising transfers and movement strategies in the actual home context means the learning is immediately relevant and applicable.
Travel is exhausting. Getting to a clinic appointment requires considerable energy—getting ready, travelling, waiting, having the session, travelling home. For someone managing fatigue alongside mobility problems, this can be draining. Home visits preserve energy for the physiotherapy itself.
Family members can observe and learn. When physiotherapy happens at home, relatives can watch the exercises and strategies being taught. This makes it much easier to provide helpful prompts and encouragement between sessions. Many cueing techniques work better when a family member understands how to use them.
Home hazards can be identified directly. A physiotherapist visiting the home can spot trip risks, suggest furniture rearrangements, and recommend equipment in the actual environment where it matters.
For people who feel anxious about leaving the house or who have significant mobility limitations, home-based physiotherapy removes a major barrier to accessing help.
What Happens in a Physiotherapy Assessment
Understanding what to expect can reduce anxiety about the first appointment.
The physiotherapist will want to observe how your relative moves—walking, turning, sitting down, standing up, reaching for objects. They’re looking at specific aspects of movement quality, not making judgements about ability. They may ask your relative to perform certain tasks while they watch, or time how long particular activities take.
Balance will be assessed through various standing positions, weight shifts, and possibly gentle challenges to stability. This helps identify where the balance problems occur so exercises can be targeted appropriately.
Strength and flexibility are usually assessed, particularly in the legs and trunk. This informs decisions about whether strengthening or stretching should be prioritised.
A discussion about goals and concerns is essential. What does your relative want to be able to do? What situations cause the most difficulty or worry? What matters to the family? Physiotherapy is most effective when it addresses the things that actually matter to the people involved.
If the assessment is at home, the physiotherapist will likely look at the environment—stairs, bathroom, bedroom, main living areas—to identify risks and opportunities.
There may be some trial of cueing strategies during the first session to see which approaches help with any freezing or gait difficulties.
The assessment concludes with a discussion of findings and a proposed plan. This might include an exercise programme, specific strategies to practise, equipment recommendations, or suggestions for environmental modifications. Follow-up arrangements will be made based on what’s needed.
Family members are usually welcome to be present and ask questions. The physiotherapist understands that Parkinson’s affects the whole family.
Exercises and Strategies You Might Learn
While every programme is individualised, there are common elements that frequently feature in Parkinson’s physiotherapy.
Amplitude training involves consciously making movements bigger than feels natural. People with Parkinson’s often underestimate how small their movements have become, so deliberately thinking “big steps” or “big arm movements” helps counteract this tendency. It feels exaggerated but usually looks normal to observers.
Cueing techniques provide external prompts to initiate or maintain movement. Auditory cues might include counting steps aloud, walking to music with a steady beat, or using a metronome app. Visual cues could be stepping over lines on the floor or targeting specific points to step towards. Some people respond better to tactile cues like tapping their own thigh to initiate steps. Finding what works requires experimentation.
Safe turning strategies address one of the highest-risk activities for falls. Taking wider turns, using more steps, and avoiding pivoting on one foot all reduce the risk of freezing or losing balance during turns.
Getting up from the floor is something many families worry about. A physiotherapist can teach a sequence for getting up safely after a fall, and practise this with your relative. Knowing there’s a plan reduces anxiety about what would happen if a fall occurred.
Balance exercises range from simple weight shifts to more challenging single-leg standing, reaching tasks, and reactive balance activities. The level is matched to ability and progressed as appropriate.
Strength exercises typically focus on the legs and trunk. Sit-to-stand practice is fundamental—it’s both a strengthening exercise and a functional task that matters for daily life. Step-ups, heel raises, and seated exercises may also feature depending on ability.
Stretching maintains flexibility, particularly in areas prone to tightness like the hip flexors, hamstrings, and trunk rotators.
Supporting Someone with Parkinson’s: Guidance for Families
If you’re a family member, the challenges you face deserve acknowledgement. Watching someone you love struggle with a progressive condition is emotionally demanding. The practical burden of supporting them adds another layer. Many family carers describe feeling overwhelmed, exhausted, or isolated.
You’re not alone in finding this difficult. Research consistently shows that family carers of people with Parkinson’s experience high levels of strain, particularly when falls are frequent or cognitive changes are present. Your feelings are a normal response to an abnormal situation.
One of the hardest balances is between safety and independence. It’s tempting to do everything for your relative to prevent falls or frustration. But over-restriction can accelerate physical decline—muscles weaken faster when not used, confidence drops when independence is removed. Try to find the middle ground where safety measures are in place but your relative still does what they can for themselves.
Learning the strategies taught by the physiotherapist helps you support your relative between sessions. If you understand how the cueing works, you can prompt appropriately. If you’ve seen the exercises, you can encourage practice. Your involvement significantly increases the likelihood of strategies being used consistently.
Coordinating activities with medication timing can make a real difference. Many people with Parkinson’s have predictable patterns of when they move better or worse relative to their medication schedule. Scheduling physiotherapy exercises, outings, or demanding tasks during “on” periods makes success more likely.
Looking after yourself is not selfish—it’s essential. Exhausted carers cannot provide good support. Seek help from family, friends, or formal services. Consider respite options. Connect with other carers who understand what you’re going through. Your wellbeing matters too.
An occupational therapist can also help with practical aspects of daily living—equipment, home adaptations, energy management, and strategies for everyday tasks. Sometimes a combined approach with both physiotherapy and occupational therapy addresses the full picture of challenges a family faces.
Finding the Right Support
Physiotherapy won’t cure Parkinson’s disease, but it can meaningfully help maintain mobility, independence, and quality of life. The evidence supports early involvement of a physiotherapist with Parkinson’s experience, with ongoing input adapted as needs change over time.
If you’re researching options for a relative, trust your instincts about what they need. Ask questions about experience and approach. Look for therapists who understand the specific challenges of Parkinson’s rather than offering generic rehabilitation.
And remember that you’re doing the right thing by seeking information and exploring what help is available. That care and attention matters more than you might realise.