Physical Therapy Tips to manage retropulsion

Retropulsion in Parkinson’s disease is the force that contributes to loss of balance in a backwards or posterior direction. Retropulsion occurs due to a worsening of postural stability and an associated loss of postural reflexes. You may be familiar with the “pull test” that your neurologist performs to check your stability. Your doctor will stand behind you and then give you a forceful tug at your shoulders. If you take more than two steps or no steps at all, you may demonstrate retropulsion.

Retropulsion is a big contributor to falls in Parkinson’s disease. Retropulsion can contribute to losing your balance backwards when you rise from a chair, walk backwards, reach above  or below into cabinets, and when you open doors.

A physical therapist can help decrease retropulsion with these functional activities with compensatory strategies. Here are two examples:

1) A goal of physical therapy for patients with retropulsion is to facilitate an anterior or forward weight shift to prevent losing your balance backwards when standing up from a seated position. Here is an exercise that helps to shift your weight forward. Start with a ball on the ground in front of you and between your legs. Reach down for the ball as you begin to stand.


To return to a seated position without “plopping” backwards, lead with your hips and return the ball to the ground.


2) A compensatory strategy we teach in therapy assists patients with reaching outside of their base of support. Retropulsion can occur when you reaching above or below your waist, such as with reaching into a cabinet. It is common to reach with your feet parallel, as shown in this first picture by Kaitlin Ochipinti a 3nd year DPT student from UF:


Our therapy tip to decrease retropulsion while reaching is to change your feet position to a more staggered stance, shown here:


With your feet in a staggered position, it is easier to shift your weight forwards and backwards.

For more information and helpful tips, check in with the physical therapy team and our rehabilitation department!

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