Musculoskeletal Pain in Parkinson’s Disease: Why It’s So Common

by Son’s Rehabilitation Medicine & Chiropractic Clinic in Seoul

Parkinson’s disease (PD) is not simply a disorder of tremor and slow movement. It is a neurodegenerative condition in which dysfunction of the brain’s motor control system directly affects the structure and function of the musculoskeletal system.

Clinical studies show that 45–60% of patients with Parkinson’s disease experience musculoskeletal pain, and low back pain is the most frequent complaint.
Unlike pain caused by mechanical injury to muscles or joints, this pain arises mainly from abnormal postural control and altered muscle tone due to central nervous system dysfunction.

Why the Spine Becomes Distorted and Back Pain Worsens

1. Abnormal Postural Reflexes and Muscle Tone Imbalance

Due to basal ganglia dysfunction, postural reflexes become weakened and muscular rigidity increases.
As a result, characteristic postural deformities appear, such as:

  • Stooped posture (forward flexion)

  • Pisa syndrome (lateral flexion)

  • Camptocormia (severe truncal flexion)

These postural changes produce asymmetric load distribution on the spine, overloading the lumbar ligaments, sacroiliac joints, and facet joints. Chronic myofascial tightness then develops, leading to persistent low back pain.

2. Micro-Injury and Muscle Fatigue Accumulation

When muscles remain constantly tense without proper contraction–relaxation cycles, microcirculatory restriction and lactic acid accumulation occur.
This stimulates pain receptors, resulting in chronic myofascial pain.
Thus, the problem is not simple weakness but a neurogenic imbalance of muscle tone regulation.

3. Spinal Deformity and Mechanical Overload

Forward-leaning and scoliosis-like deformities reduce lumbar lordosis and shift the body’s center of gravity forward.
Consequently, posterior spinal structures (facet joints, ligamentum flavum, etc.) become overstressed, producing pain even when MRI shows no structural damage.

Why Walking Becomes Abnormal

Typical gait features in Parkinson’s disease include:

  • Decreased stride length

  • Reduced arm swing

  • Forward-flexed trunk and anteriorly shifted center of mass

  • Freezing gait (sudden inability to step)

Dysfunction of Basal Ganglia Circuits

Loss of dopaminergic neurons leads to abnormal signaling within the basal ganglia–thalamus–cortex loop, impairing initiation and rhythmicity of movement.
As a result, automatic gait control is lost, and patients struggle with turns and transitions during walking.

Impaired Sensory–Motor Integration

Normal balance relies on integration of visual, vestibular, and proprioceptive inputs.
In PD, this integration is disrupted.
When upper cervical misalignment (C1–C2) coexists, the vestibulo-spinal reflex and postural reflexes become even more unstable, causing unsteady, twisted gait patterns.

The Vicious Cycle Between Back Pain and Gait Disturbance

  • Lumbar malalignment and pain → abnormal weight shift during walking

  • Abnormal gait → asymmetric loading on the spine and pelvis

  • Result → further aggravation of pain and postural imbalance

Breaking this cycle requires more than injections or local physical therapy.
Treatment should include upper cervical and pelvic alignment correction, myofascial release, and balance and gait retraining.

Conclusion

In Parkinson’s disease, lumbar deformity, low back pain, and gait disturbance are not due to simple muscle weakness but reflect a neuro–musculoskeletal integration disorder.

Pathophysiological chain:

  • Dopamine deficiency → abnormal postural reflexes

  • Asymmetric muscle tone → spinal and pelvic distortion

  • Myofascial and ligament micro-injury → chronic pain

  • Gait alteration → worsening postural imbalance

Therapeutic approach:

  1. Pain relief: PDRN therapy, myofascial release, neural injection, IMS

  2. Alignment restoration: Upper cervical & pelvic chiropractic correction

  3. Neuromuscular rehabilitation: Balance and gait retraining

An integrative approach addressing both neurological control and structural alignment is essential for improving pain, posture, and quality of life in patients with Parkinson’s disease.

👍Consultation and Appointment Information

Son PMR & Chiropractic Clinic( 2nd floor, 229-1 Gucheonmyun-Ro, Gangdongu, Seoul, South Korea) 

by  Dr Son MD & DC 
Contact: 02-482-8875 in Seoul( +82-2-482-8875)

chson@daum.net


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