Why Do Parkinson’s Patients Fall Backwards? Understanding Postural Instability

Falling backwards is a common and particularly challenging issue for people living with Parkinson’s disease. This condition can significantly affect mobility and safety.

In this article, we will explore the reasons behind why people with Parkinson’s might experience these backward falls. We will also offer some insights for patients, families, and caregivers seeking to understand and manage this aspect of the disease.

Why do Parkinson's patients fall backwards?

Parkinson’s disease is primarily known for its effect on motor functions. This is due to a decrease in dopamine. Dopamine is a chemical produced in the brain that helps control movement and coordination. This decrease in dopamine results in a variety of movement-related symptoms that progressively worsen over time. As the disease progresses, patients often experience a gradual loss of automatic movements, which can severely impact daily activities and quality of life.

One of the most significant challenges faced by individuals with Parkinson’s is maintaining balance and posture. This difficulty stems from the body’s reduced ability to regulate and control movements. The loss of dopamine affects the basal ganglia, a group of structures in the brain that are crucial for initiating coordinated movements. Without sufficient dopamine, the basal ganglia cannot function properly, leading to delayed and uncoordinated movement responses. This impairment manifests in several ways, key among them being postural instability.

Postural instability refers to a reduced ability to maintain a stable and upright position when standing or walking. It makes Parkinson’s patients particularly vulnerable to falls, as they are less able to adjust their body’s position in response to changes in balance. This instability is most pronounced when a patient is jostled or bumped, or when attempting to turn around or reach for an object. The inability to make quick, corrective movements to regain balance often results in a backward fall, which is dangerous and can lead to serious injuries.

Moreover, postural instability in Parkinson’s disease is not always responsive to medications that typically help other symptoms such as tremors or stiffness. This makes managing balance issues particularly challenging and underscores the importance of comprehensive treatment approaches, including physical therapy and occupational therapy, to help strengthen the body and improve coordination.

By understanding how Parkinson’s disease impacts motor functions and leads to issues like postural instability, patients and caregivers can better address these challenges through targeted strategies that enhance stability and safety.

The effect of muscle rigidity and bradykinesia

Muscle rigidity and bradykinesia (slowness of movement) are hallmark symptoms of Parkinson’s disease. Rigidity can limit the movement of joints, making it difficult for patients to shift their weight quickly enough to maintain balance. Bradykinesia also contributes to the difficulty in performing quick corrective movements. Together, these symptoms make it harder to recover from a stumble or shift position effectively, increasing the risk of falling backwards.

The rigidity in Parkinson’s disease often leads to a characteristic stiffness throughout the body. This stiffness can be particularly limiting when a person attempts to initiate movement or respond to a sudden loss of balance. For instance, if a Parkinson’s patient starts to tip backwards, the normal instinct would be to quickly step backwards to catch oneself. However, due to rigidity and slowed reaction times, this corrective step may either be too slow or too small, failing to prevent a fall.

Furthermore, bradykinesia affects virtually all movements, including the automatic adjustments that are usually made unconsciously to maintain posture and balance. This slowness can delay not just major corrective actions, like stepping back fast enough, but also smaller, necessary adjustments that help a person stand steadily. Over time, as these symptoms progress, the patient may require assistance for walking or even standing, as the risk of falling increases significantly.

Additionally, these physical limitations can lead to increased fatigue because even simple movements require more effort. Fatigue, in turn, can exacerbate both muscle rigidity and bradykinesia, creating a cycle that further impairs mobility. The combination of tiredness and slow, stiff movements means that the patient’s ability to manage daily activities diminishes, and the likelihood of falls, particularly backward falls, becomes more common.

By understanding the profound impact of muscle rigidity and bradykinesia on balance and movement, patients, caregivers, and healthcare providers can better focus their efforts on interventions that may alleviate these symptoms, such as customized exercise programs, physiotherapy, and suitable medication adjustments. This complete approach is crucial for helping to improve mobility and prevent falls in individuals living with Parkinson’s disease.

Strategies to prevent backward falls

While it’s challenging to completely eliminate the risk of falling in Parkinson’s patients, there are strategies that can help reduce the likelihood and severity of falls:

Physical therapy: Engaging in targeted exercises designed by a physical therapist can strengthen muscles, enhance flexibility, and improve balance. Regular sessions can help patients learn specific techniques to manage their body’s response to balance challenges, which is crucial in preventing falls. These exercises might include activities like tai chi or Pilates, which are known for improving core strength and coordination.

Related post: Exercise – Is it Useful in Parkinson’s Disease?

Home safety modifications: Making simple changes in the home can significantly reduce the risk of trips and falls. Removing area rugs, securing loose carpets, and clearing walkways of clutter are essential steps. Installing grab bars in bathrooms and along hallways, as well as ensuring adequate lighting in all areas of the home, especially at night, can prevent accidents. Considerations such as non-slip mats in the bathroom and handrails on both sides of stairways can also make a big difference.

Proper footwear: The choice of footwear can greatly influence a person’s stability. Wearing shoes with good support and non-slip soles is essential. It’s also important that shoes fit properly and do not have thick soles, which can make it hard to feel the ground beneath. Slip-on shoes can also pose a risk because they may come off easily or cause trips if they do not fit snugly.

Regular medication review: Parkinson’s symptoms can fluctuate, often requiring adjustments in medication. Consulting regularly with healthcare providers to ensure medications are effectively managing symptoms is crucial. Proper medication management can maintain better overall control of motor symptoms, which in turn reduces the risk of falling.

Assistive devices: For those with significant balance issues, assistive devices such as walkers or canes designed specifically for stability can be helpful. It’s important that these devices are professionally assessed and fitted to suit the individual’s specific height and weight to ensure they provide the maximum benefit.

Related post: The 3 Best Walking Aids for Parkinson’s Patients

Education and awareness: Educating patients and caregivers about the risks and prevention strategies for falls is also vital. Understanding the specific situations that increase the risk of falling and how to avoid these scenarios can empower patients and their families to take proactive steps in fall prevention.

By incorporating these strategies, individuals with Parkinson’s can significantly reduce the risk of backward falls, enhancing their ability to live more safely and independently. This proactive approach not only helps in managing the physical aspects of the disease but also boosts confidence and improves overall quality of life.


Falling backwards is a significant risk for those with Parkinson’s disease, primarily due to impaired postural reflexes, muscle rigidity, and bradykinesia. By understanding the underlying causes, patients and their caregivers can better prepare and implement strategies to mitigate this risk. Regular consultations with healthcare professionals, combined with physical therapy and safety modifications at home, are critical steps in managing the challenges of Parkinson’s disease and improving quality of life.

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