Walking difficulties in degenerative brain conditions
Shuffling, freezing gait and instability are common in Parkinson’s disease, and increase the risk of falls.
All of these walking difficulties may respond, at least in part, to medication timing, targeted physiotherapy and home safety changes. However, other conditions can cause similar problems and should be ruled out.
Key points
- Shuffling gait results from slowness (bradykinesia) and stiffness (rigidity), which make it difficult to move. This leads to shorter steps, dragging feet and reduced arm swing.
- Freezing of gait is a sudden, brief inability to step forward, most often when starting to walk, turn or pass through narrow spaces.
- Postural instability (impaired balance reflexes) typically develops later than tremor, slowness and stiffness, and increases the risk of falling as the disease progresses.
- Medication review, physiotherapy, cueing strategies, exercise and home safety changes can meaningfully:
- improve walking
- lower the risk of falls
- reduce freezing.
Next steps:
Shuffling when walking (gait)
Two common movement symptoms of Parkinson’s disease, slowness (bradykinesia) and stiffness (rigidity), can gradually affect your legs and trunk, changing the way you walk. Over time, this can lead to:
- a stooped, forward-leaning posture
- trouble taking your first steps when walking
- reduced arm swinging, often more noticeable on one side
- your steps becoming quicker and smaller the longer you walk, sometimes called ‘festination’, and your feet may drag.
Freezing of gait
Freezing of gait is when your feet suddenly feel ‘stuck’ to the floor, even when trying to walk. It tends to happen most often when you’re:
- feeling rushed or anxious
- going through a doorway
- starting to walk
- turning in a tight space
- walking in a crowded or cluttered area.
You might notice:
- a tremor in one leg during a freezing episode, sometimes described as ‘trembling in place’, before you’re able to move again
- episodes that ease once you use a helpful cue like stepping over a line or listening to a metronome
- growing anxiety about walking in situations that have triggered freezing before.
Falls and balance
Your body normally has automatic reflexes that help you maintain stability, for example, quickly adjusting your footing when you step off a curb.
In Parkinson’s disease, these reflexes can slow down or stop working properly over time, making it harder to correct your balance when you:
- stop suddenly
- turn
- walk on uneven ground.
This is one of the main movement-related symptoms of Parkinson’s, but it usually shows up later than the others. You might notice:
- feeling lightheaded or dizzy when standing up (this is sometimes called ‘orthostatic hypotension’, which can add to your risk of falling)
- feeling unsteady or losing your balance when turning, stopping or walking on uneven surfaces
- it’s harder to stay steady when your attention is split, for example, walking while talking or carrying something.
For some people, a walking aid or wheelchair eventually becomes helpful for staying safe.
None of these patterns are unique to Parkinson’s disease. Your specialist may consider conditions such as:
- anxiety or fear of falling, which can worsen freezing-like hesitancy independently
- atypical parkinsonian disorders
- drug-induced parkinsonism
- general deconditioning or frailty
- inner ear/vestibular disorders, vision problems, peripheral neuropathy or joint/muscle problems
- normal pressure hydrocephalus – small shuffling steps or difficulty starting to walk, often alongside urinary changes and slowed thinking
- vascular parkinsonism.
If balance problems, falls or freezing appear before other typical Parkinson’s features are established, this may suggest a different condition and should be flagged with your specialist.
A doctor will typically watch you walk, turn and stand up from a chair, assessing:
- arm swing
- balance
- posture
- step length.
A ‘pull test’ may be conducted. It involves the examiner firmly pulling you backwards by the shoulders to assess your postural reflexes. Taking more than one or two steps back, or needing to be caught, suggests impaired balance.
Specific manoeuvres like walking through a doorway or turning quickly can help reproduce freezing in a clinic. Your specialist will also:
- check whether symptoms such as freezing occur during medication ‘off’ periods
- review standing blood pressure
- look for features suggesting an alternative diagnosis.
When to consider specialist review
Any new or worsening walking, balance or dizziness problem should always be assessed rather than assumed to be Parkinson’s disease, as the underlying cause affects both prognosis and treatment.
When to seek urgent help
Seek urgent medical attention if you experience:
- a fall involving injury, head strike or loss of consciousness
- a sudden or rapidly worsening change in walking or balance
- any new confusion or dizziness accompanying the change
- loss of bladder or bowel control
- new leg weakness or numbness
- repeated unexplained falls in a short period.
These symptoms may indicate a separate acute problem needing prompt assessment.