Parkinson's Induced Overuse Injury: Lower Back And Inner Thigh

[park_bear]

I noticed there have been quite a few posts here by people having back problems. Of course back problems are commonplace. Be that as it may, I have had troublesome stiffness in my lower back for some months, and I have been wondering why. I realized (yo duh) this is because I am bending forward at my waist. I figure it is not like I am the only Parkinson's patient to have done this. Sure enough, the medical community has taken notice. For example:

onlinelibrary.wiley.com/doi...

"Camptocormia is characterized by severe forward flexion of the thoracolumbar spine which increases while walking and disappears in the recumbent position. ...We describe for the first time eight patients with presumed idiopathic Parkinson's disease ... who developed camptocormia." So far so good, but it continues:

"The pathogenesis of this phenomenon is unknown but might represent either a rare type of dystonia or an extreme form of rigidity."

Heh. I wonder if they thought to ask the patients. I know that in my case I do this in response to difficulty moving my legs forward. Bending forward seems to help a bit, but not worth it at the cost of incurring back problems! So now I make a deliberate conscious effort to stand straight up when I walk. It seems to be slower that way but so be it.

The other issue initially seemed to be a knee problem on the unaffected leg. But when I poked and probed and felt around it became clear what was hurting were the insertions of the vastus medialis muscle around the inner (medial) side of my knee. It also became clear that the entire muscle was sore and unhappy. That is the area shown in red on the illustration. This was particularly apparent out hiking when moving the affected leg forward. I was not swinging my arm on the affected side, and experimented with deliberately swinging it. Lo and behold the affected leg moves forward a lot more easily when swinging the arm on that side backward! Conservation of momentum. My muscle on the unaffected side had become unhappy due to bearing an unaccustomed load. So now I make it a point to deliberately swing that arm.

[Cons10s]

Thank you this is very helpful. I noticed recently I sometimes lean forward when walking, but only in the evening, and assumed It was because I was just tired. Now I’ll consciously address this.

[Kevin51]

Agree there is a lot we can do to improve. We are all getting older so back pain is a part of the territory. It must be made worse with PD stiffness and rigidity. It is one of my major targets to improve my quality of life - exercise, stretching, pilates and correcting my walk (insoles help). Wish I could get to yoga classes again!

[park_bear in reply to Kevin51]

I do a yoga routine usually first thing in the morning when I get up. Don't have to get to a class to do it!

[Hikoi]

Iinteresting post park bear. I had lower back pain alot pre diagnosis. Thankfully the ache goes when I have levadopa. I also have a PD friend with bent spine syndrome (captocormia ) . It came on in just a few days. There is no way he could straighten his back now.

As to cause, this update also says it is due to axial dystonia which seems to be neurological rather than mechanical .

ncbi.nlm.nih.gov/pmc/articl...

“BSS in PD is a caricatured exaggeration of the usual bent back related to the axial dystonia which is a hallmark of Parkinsonism.”

[park_bear in reply to Hikoi]

Thanks for pointing those things out. In my case the forward lean has been purely voluntary. Heterogeneous causes for our heterogeneous conditions.

[Hikoi in reply to park_bear]

The ittle old bent over man is the well known picture of pd.

The forward lean of PD seems to be a universal phenomenon of Parkinsons which we all have to work on. I think of it as a balance mechanism our bodies have adopted. Dont know if thats true.

[ronn]

The "Parkinson's Shuffle" is easily learned and difficult to avoid or overcome. It is possible, however, to have some success in regaining a more upright posture using daily walks while concentrating on bending the knees and landing each step heel first, then rolling the foot forward onto the ball and toes. It may be advisable, at first, to use a walker for balance, but, in my case it was possible to graduate to a cane, then to an unassisted heel/toe stride.

This is easy. The hard part is maintaining the heel/toe gait and upright posture throughout the day. The posture problem can be minimized, on walks, by looking at items of interest which are above eye level. This forces you to walk erect. Hey, you Sufflers, try this. If, in your home you have a long hallway or similar opportunity, mount a mirror just above eye level at the far end. Then, when you walk toward the mirror you can see yourself just as you appear to others, either as a short, bent over, shuffling old person or as a tall, straight, confident, ,young appearing pwp, ready to take on the world.

[Wendyhalpin]

Very interesting read.

[aspergerian]

Possibly helpful:

library.open.oregonstate.ed...

[shij]

hello Park_bear,

It seemed this discussion has been stopped for 3 years already. I wonder if there is any new information.

I am 60 and had PD for 18 years. the last 5-6 yrs I have been dealing with " bending forward" or Comptocomia". The medication did not help much. I had DBS 6 month ago , however, My docotor and I are still searching fior the best setting to relief the problem. After the procedure many of the other PD symptoms were "smoothed" out but the forwared bending still bother me a lot.

[park_bear in reply to shij]

In my case of voluntary bending forward I have found that yoga with a variety of forward and backward bending stretches has been helpful.

I took a look at the literature. I found this study of various forms of physiotherapy to be of interest. They had some success – well worth a look in my opinion:

ncbi.nlm.nih.gov/pmc/articl...

This study:

mdsabstracts.org/abstract/d...

found an association with use of dopamine agonists.

Wish you the best in your quest!

[Parkie- in reply to park_bear]

That's good to know:

"found an association with use of dopamine agonists."

I noticed it using Neupro patch (rotigotine agonist)