Musculoskeletal Conditions and Parkinson's

Musculoskeletal conditions, those relating to the muscles and the bones of the skeleton, are common among people with Parkinson’s disease (PD), although they are frequently unnoticed and undertreated. Common musculoskeletal conditions in people with PD include:

• Frozen shoulder
• Low back pain
• Arthritis
• Osteoporosis¹

Frozen shoulder

Frozen shoulder is characterized by stiffness and pain in the shoulder joint. Some patients initially go to their doctor with complaints of frozen shoulder before they are diagnosed with PD, and in at least 8% of patients, frozen shoulder is the first symptom of the disease. Research has found that people with PD are six times more likely to experience shoulder pain compared to people without PD. Prolonged immobilization of the shoulder can cause atrophy of the joint capsule and can provoke tearing of the tendons. It’s believed that rigidity contributes to the development of frozen shoulder in people with PD. Treatment for frozen shoulder includes drug therapy, physical therapy, or surgery.^1,2

Low back pain

People with PD are more likely to experience low back pain than their healthy counterparts. The rigidity, prolonged stooped posture, and prevalence of osteoporosis in people with PD may contribute to the higher prevalence of low back pain in PD. There are some differences in back pain between men and women. At the onset of PD, women report more neck pain and low back pain than men do.¹

Arthritis

Arthritis is a joint disease that causes pain, swelling, and stiffness. Research data on the prevalence of arthritis in PD is conflicting. Some studies have found there is a connection, with people with PD having more arthritis and chronic low back pain than their healthy peers. Other studies have not found an association between arthritis pain and PD. Treatment for arthritis includes physical exercise, physical therapy, anti-inflammatory and pain medicines, or surgery.^1,3

Osteoporosis

Osteoporosis is a bone disease in which the body loses too much bone, makes too little bone, or both. In people with osteoporosis, the bones become weak and more susceptible to breaking in a fall. Osteoporosis is more common in people with PD than in people who don’t have PD. Osteoporosis is also more common in women, and the risk of developing osteoporosis increases with age. In PD, osteoporosis is related to disease severity. The lack of movement in people with PD leads to high bone turnover – the loss of bone tissue. Vitamin D deficiencies are also frequently seen in people with PD, and the lack of vitamin D also contributes to weaker bones. Many patients with PD experience weight loss, and low body mass index (BMI) is another factor in the development of osteoporosis. Treatment for osteoporosis includes medications (bisphosphonates), hormone therapies for some women, and calcium and vitamin D supplementation.^1,4

Musculoskeletal conditions and pain

Musculoskeletal problems cause significant pain and physical disability in the general population, and they are even more commonly experienced in people with PD. Estimates range from 40-85% of people with PD experiencing pain, and the most common pain is musculoskeletal pain. Most of the pain from musculoskeletal causes seems to be related to the rigidity and the loss of voluntary movement (akinesia) seen in PD. Musculoskeletal problems also greatly reduce the quality of life in people with PD. Physical therapy and exercise can help reduce the pain and improve range of motion.¹