Walk tall

My head is in a good place at the moment. Unfortunately, it rests on my neck and shoulders, which are not.

Let’s look first at my reasons to be cheerful:

• I’m back doing the things I love (running, making music) with the people I love (Eden Runners, Penrith Town Band).
• Every time I post my exploits on social media I get a huge wave of likes from you, my lovely friends and followers. So loud is the applause sometimes that you’d think I’d completed the Camino de Santiago barefoot and backwards on hot coals, and not just shuffled round the 5km Parkrun.
• I’m not in pain – somehow a walking holiday in Scotland where I ate fish every day has (touch wood) seen off my sciatica.
• I’m in a research trial on the benefits of improvisation for people with Parkinson’s. I can’t say too much about this at the moment as I don’t want to jinx the results. What I will say is that two hours a week of verbal jamming with some lovely folk from the other side of the pond looks set to to become my talking therapy of choice.
• I’m 5ft 8ins but I feel about 6ft 6ins right now. I feel like this:

So it was a shock to see video footage of me marching with the band last weekend, because I look like this:

Who IS this terrified garden gnome staring resolutely at the ground, trying to parp out a few correct notes while not tripping over the speed bumps in Middlegate? I don’t recognise her.

When I blogged last time about the problem of leaning (Every which way but loose) I was writing in the past tense as though my problem had gone away. Clearly it hasn’t. Why? And what can I do about it?

Call the expert

Over to you, Vicky Knight, neurophysiotherapist at  LV Rehab based in Chichester. An accredited PD Warrior practitioner, Vicky often sees people with Parkinson’s who have started to stray from the vertical. She says:

“The changes that occur in posture as a result of Parkinson’s result from a reduction in postural drive from the brain. This postural drive enables you to maintain an upright position automatically. When the muscles do not receive the required neurological input, gravity will take over. The muscles that make you slump forward may start to become stronger than the posterior muscles that help to hold you up. If you do nothing about your posture, it is unlikely to improve and may well get worse. Be proactive! Do what you can to slow or reduce postural changes.”

Wake-up call

I thought I was doing my best, but then I do also spend a lot of time either hunched over my keyboard or on the rowing machine. I’ve evened up left and right, now it’s time to even up back and front. I’m happy for a wake-up call! Here, Vicky suggests some exercises to revisit.

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Stretch

Spend time each day stretching out muscles at the front of your body.

• Lift your head
• Open your chest
• Squeeze your shoulder blades
• Lean back

Hold a stretch for at least 20­–30 seconds and repeat 2–3 times at least 2–3 times a day to feel the benefit

Strengthen

Aim to strengthen the posterior back muscles and side muscles that help you to stand upright. Don’t worry about working with heavy weights. Focus on the quality of each exercise and ensure you are moving through the maximal range available.

Your postural muscles need to work for long periods, so they need an element of endurance. So go for lower weights/resistance and higher number of repetitions. You are not looking to be the next Hulk Hogan!

Take a Theraband (yellow or red) and stretch it across your chest, keeping your arms below shoulder height. People with Parkinson’s will stop when their arms get to 90 degrees at best, but most in my experience (unless they have a shoulder pathology such as a rotator cuff tear) can get past that point and they just need reminding what that feels like. 

If you stop before that point, then anterior muscles such as your pectorals will just get stronger. Reduce the resistance of the band at first and move through the full range. This will help you activate posterior muscles around the shoulder blades and mid back, bringing you more upright.

Swim

This is just from my clinical experience, and it has been remarkable to see how straight I can get someone in water who on land really is like the leaning tower of Pisa. The water is a great medium for allowing muscles to relax and I find PwP can move or walk more easily.

You don’t have to be a good swimmer, you can just relax in water on your back with noodles (foam tubes) to support you. Walk or stand in the water and reach arms above your head and side stretch. Lie on your back and just kick your legs. If you like swimming then use it as a form of exercise, it is great for co-ordination of arms and legs.  If you are worried about your legs sinking, think about buying an abdominal belt to aid flotation, or use a noodle under your hips and arms.

Support

There are items on the market to help postural feedback. The Upright Go is one example which sells at a reasonable price.

Stop

I am a big advocate for high intensity exercise for Parkinson’s to slow progression. But you do also need plenty of rest and recovery. Your muscles and the nervous system fatigue, so allow yourself time to reboot. You will then get more out of what you do every day.

Optimise your meds

In the last article Ali gave a vital clue. She mentioned her posture getting worse when her medication was wearing off. Optimising your medication will ensure you get the most out of any exercise you do to help reduce the changes caused by Parkinson’s.

Talk to an expert

I recommend you seek advice from a neurophysiotherapist or exercise specialist who has experience of working with people with Parkinson’s to ensure a strengthening programme is designed specifically for you.

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Thank you, Vicky! I think I am going to give the Upright Go a chance, although I shall probably call it Upstart Crow by mistake to honour my favourite Shakespeare sitcom.

Play > Walk tall > Val Doonican

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