In a recent webinar with Dr. Jay Alberts, the Vice Chair of Innovations of the Neurological Institute at the Cleveland Clinic, we discussed freezing of gait (FOG) and postural instability, as well as some exercises and therapies that can be helpful for addressing them. But what about retropulsion? This is a question that came up during and after that webinar, so we wanted to address it.
If you have ever had trouble catching your balance, especially when you feel like you’re being pulled backward or when you must take a bunch of small steps to restore your balance, you have experienced retropulsion: the tendency to lose your balance by leaning backward.
Retropulsion can affect a number of activities of daily living, including getting out of a chair, turning around in a tight space, walking backward, or straightening up from being bent over. It is also a leading cause of falls for people with Parkinson’s. If you notice that you often lose your balance and fall backward, you should talk to your neurologist or physical therapist about retropulsion.
As a form of postural instability, retropulsion is caused by a combination of highly complicated factors. Researchers believe that the degeneration of dopaminergic neurons in people with Parkinson’s means that less dopamine is produced, leading to balance issues like retropulsion. Additionally, some people with Parkinson’s have comorbid white matter disease, which can also lead to unstable balance and difficulty recovering from backward stumbles. Degeneration of your cholinergic system, which is common with aging but pronounced in people with Parkinson’s, may also be involved. Finally, as we discussed during our webinar on postural instability, issues like dual tasking and anxiety can also make your retropulsion and likelihood of falling worse.
A common diagnostic tool that neurologists use to evaluate postural instability is called the retropulsion test. Your doctor will stand behind you and give a sudden, unexpected pull to your shoulder to see what your response is like. The more steps you take (and the smaller the steps), the more postural instability you may be experiencing. Your doctor can also use this test to look for other possible motor symptoms like freezing of gait. Unfortunately, a retropulsion test cannot effectively determine how likely you are to fall in the future, but the information about postural instability that it can provide will be very valuable for creating a treatment plan with your neurologist, physical therapist, and/or occupational therapist.
Talking to your physical or occupational therapist about strategies to address retropulsion can be helpful for reducing your chance of falling. Here are three exercises from the University of Florida Health and an occupational therapist you can do at home:
If retropulsion is a concern for you, or you have had falls due to it, consider working with a physical therapist in your area. They can help you build strength and body awareness to reduce your risk of falling.
You can search for a local Parkinson’s physical therapist here using the APTA’s “Find a PT” tool. Select “Neurology” under “Practice Focus” or “Find by Specialist”.
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