Postural Instability and Balancing Issues

Reviewed by: HU Medical Review Board

One of the main symptoms of Parkinson's disease (PD) is balance problems. This symptom usually appears in the later stages of the disease. People with PD often have issues with their balance, which makes them unsteady when standing. This is known as postural instability.1

People who have postural instability may easily fall if they are bumped or touched. This increases the risk of falls, which can be disabling for some people with PD and lead to a decreased quality of life.1

Motor (movement) symptoms of PD can include problems with balance. Not all people with PD have this issue, though. The other primary motor symptoms of PD are:2

  • Tremor at rest, such as uncontrolled shaking in the arms or legs
  • Rigidity (stiffness) in limbs, neck, or shoulders
  • Slowness of movement or gradual loss of spontaneous movement (bradykinesia)

How do they appear in PD?

Some people with PD have mild symptoms, while others have more severe symptoms that get worse over time. Postural instability may show up while a person is doing different activities, like when:1

  • Standing up
  • Getting up from a chair or a seated position
  • Getting out of bed
  • Making sudden, quick movements or turning while walking

Signs that may indicate postural instability include stooped posture, small shuffling steps, and a tendency to lean forward when walking.2

Postural instability is often seen when a person is first diagnosed with PD, but it becomes more common and worse as the disease progresses. People with PD are more prone to falls if they cannot recover from changes in motion, leading to hospital stays or even death.1

Because of this, postural instability is one of the most troubling symptoms of PD when people lose their balance and have trouble moving around.1

What is the cause?

In PD, the brain's dopamine nerve cells (neurons) are damaged and destroyed. Dopamine is a chemical produced in one of the brain areas most affected by PD. Dopamine messages are involved in areas of the brain that make sure muscle movements are smooth and purposeful.3

Diagnosing balance problems

Postural instability in PD can be challenging to diagnose since symptoms overlap with many other conditions. However, your doctor will perform a variety of physical exams to assess balance issues.1

One exam your doctor will perform is called the "pull test." Standing behind you and with their back to a wall, your doctor will pull on your shoulders to try to make you fall backward. If you can stay upright with just 1 or 2 steps, the test is negative. If you need more than 2 steps or fall backward, the test is considered positive.4


At this time, there is no known cure for PD. There are also no treatments that can slow or stop the natural progression of the disease. Most people with PD are started on medicine to help manage their symptoms.1,5

Some drugs that affect dopamine can help improve postural instability in the early to mid stages of PD. However, their effectiveness decreases as the disease progresses.1,5

Many doctors will tell you that exercise is the best approach to treating postural instability and balancing issues. Exercise has been proven to improve balance and your walking pattern (gait). This can help to reduce your risk of falling.1

Basic tips for preventing falls include:1

  • Wear appropriate shoes with good traction and ankle support
  • Remove tripping hazards, like throw rugs and loose cords
  • Keep a clean and tidy home free from clutter
  • Install handrails and grab bars at home
  • Use assistive devices like walkers and canes as needed
  • Ensure proper lighting in your home

You can ask your doctor for an in-home occupational therapist safety assessment. You or your family members can use online printable checklists to make sure your living environment is safe. Talk to your doctor about ways to keep you safe and prevent falls while living with PD.1

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