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What Are the Motor Symptoms of Parkinson’s?

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Parkinson’s affects parts of the brain that influence the speed, quality, fluency and ease of movement. Motor (or movement-related) symptoms are often the most visible elements of Parkinson’s. Many motor symptoms of Parkinson’s tend to respond well to Parkinson’s medications.

Motor symptoms of Parkinson’s occur because Parkinson’s damages dopamine‑producing neurons in the brain, leading to reduced dopamine levels that impair movement. Researchers estimate motor symptoms don’t actually develop in most people until around 60% of the dopamine-producing cells in the brain have stopped working normally.

In this article, we will discuss the motor symptoms of Parkinson’s so you can be proactive in the management of your symptoms.

Common motor symptoms of Parkinson’s include:

  • Tremor: a rhythmic shaking in your arms, legs, or chin. Most people with Parkinson’s who experience tremor that is worse when relaxing and resting have rest tremor. Some people also experience action tremor, which appears when they are moving or holding a their body in a specific position like when they are drinking out of a cup or raising their hand to get someone’s attention.
  • Rigidity: painful stiffness, often in the arms, legs, neck or back muscles.
  • Bradykinesia: slowed and smaller movements, especially with repetitive movements like opening and closing your hand (making a fist) or tapping your thumb and pointer-finger together. The small, cramped handwriting (called micrographia) that some people with Parkinson’s experience is another sign of bradykinesia. Typically, repeated movements–including those involved in writing–get smaller the longer the movement is repeated
  • Postural Instability: balance problems caused by a loss of reflexes that help you stay upright. This can cause challenges with general balance as well as walking (especially making a turn). Sometimes postural instability brings the tendency to fall backward, called retropulsion. Postural instability is typically not among the first symptoms of Parkinson’s. Early postural instability may be a sign of an atypical Parkinsonism (a group of conditions with symptoms similar to Parkinson’s) rather than Parkinson’s itself.

Other ways that these symptoms may appear include a decreased facial expression, decreased arm swing when walking, a feeling of heaviness or dragging of one side of the body, or cramping in certain muscles. Because speech and swallowing also rely on coordinated muscle movement, speech and swallowing can also become softer and more difficult as Parkinson’s progresses and swallowing can also be affected.

As Parkinson’s progresses, walking can change from shuffling steps to festination, a tendency toward smaller and faster steps that can tip you forward. Paradoxically, sometimes people with Parkinson’s will experience freezing of gait, feeling like your feet are glued to the floor, and have trouble starting to walk again once this happens. Freezing can occur when you first begin to walk, make a turn, or are in a tight and crowded space.

Learn more about how to evaluate your walking-related motor symptoms and how to manage them with our Gait, Balance, and Freezing Worksheet .

Other Movement Symptoms of Parkinson’s

  • Reduced manual dexterity, making everyday tasks like buttoning a shirt difficult
  • Severe muscle cramping
  • Pain without an obvious cause

Learn more about Parkinson’s symptoms with the NINDS Parkinson’s Disease – National Institute of Neurological Disorders and StrokeMedlinePlus: Parkinson’s Disease and Mayo Clinic: Parkinson’s Disease.

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Parkinson’s slows you down, but staying active, like riding my bike, keeps me limber and moving and improves my outlook. It’s really important not to give up on doing the things you like. —Robert

Management of Motor Symptoms

Medication For Motor Symptoms

With the exception of postural instability, most motor symptoms of Parkinson’s respond well to medications, especially in the early stages of Parkinson’s.

Even after the early stages of life with Parkinson’s, medications can be very effective, especially when you and your care team monitor changes you experience over time and adjust your medication regimen.

Medications for motor symptoms include:

  • Dopaminergic medications
    • Dopaminergic medications, including carbidopa-levodopa and dopamine agonists replace lost dopamine and can be used to treat tremor, stiffness, slowness, and problems walking. As Parkinson’s progresses and more of these dopaminergic medications are needed to address symptoms, you may experience motor fluctuations and frustrating side effects of the added or increased medication, like dyskinesia. Dyskinesia is uncontrollable, jerky movements of the arms and legs caused long-term use of levodopa.
  • Amantadine Hydrochloride
    • Amantadine can be used alone or in conjunction with other medications to treat slowness, stiffness, and tremor. Amantadine has a unique role in the treatment of Parkinson’s because it is the only medication that treats motor symptoms while potentially reducing dyskinesias.
  • Anticholinergics
    • Anticholinergic medications are used to block the neurochemical acetylcholine, which can help reduce rest tremor. These medicines do not improve other motor symptoms such as rigidity, slowness or walking problems. Anticholinergic medications should be used cautiously as they can cause side effects such as dry mouth, blurred vision, dry eyes, constipation, memory problems and confusion, especially in people who are older.
  • Add-on medications
    • Medications like COMT inhibitors, MAO-B inhibitors, and adenosine receptor antagonists can be used to extend how long your other medications are effective and/or how long your symptoms are well-controlled by your medication routine.
A Note About Medication Effectiveness

There used to be a concern among healthcare providers that certain Parkinson’s medications would become less effective over time. As a result, some adopted a philosophy of “levodopa sparing,” or using the lowest possible dose of levodopa in an attempt to conserve the medication’s effectiveness for as long as possible.

This medical perspective is no longer believed to be valid. Numerous research studies have shown Parkinson’s medications should be started as soon as symptoms start to interfere with your quality of life. Research has also demonstrated finding an optimal combination and dosage of medications has strong potential benefits such as reducing the risk of falls, improving quality of sleep and increasing your ability to exercise.

That said, many people do discover medications are not as effective as they used to be the longer they live with the disease. The reason has less to do with how long you have been using Parkinson’s medications and more to do with the amount of damage Parkinson’s has done to dopamine-producing nerve cells. As Parkinson’s progresses, more nerve cells that produce dopamine die, leaving less and less dopamine in the brain. Most Parkinson’s medications work to replace lost dopamine, but since current medications can only replenish so much lost dopamine, the more dopamine you lose, the less effective medications will be controlling the various symptoms of Parkinson’s.

You may experience less time when the medications are working effectively (called ON times) and longer, more frequent periods where medications are not working and symptoms return or get worse (called OFF times). During OFF time, problems walking or speaking and other Parkinson’s symptoms like tremor, stiffness, slowness, posture, balance and anxiety may become more pronounced.

As OFF times increase, medications may need to be taken closer together. This can cause dyskinesia, uncontrollable, jerky movements of the arms and legs that comes as a side effect of adding or increasing dopaminergic medication.

Sometimes the side effects of Parkinson’s medications can be even more frustrating than the symptoms these medications are trying to treat. If you are experiencing dyskinesia, begin recording when you experience on times, off times, dyskinesia as well as when you take your medications to help you to keep an ongoing conversation with your doctor about the most effective ways for you to use and adjust your Parkinson’s medications.

Learn more about how medications can help you live well.

Surgical Therapies

As Parkinson’s symptoms progress, increasing medications to address them can bring significant side effects. One of the most common and frustrating side effects of Parkinson’s medications is dyskinesia, uncontrollable movements of the arms and legs. Surgical therapies are explored after medications have been optimized and the side effects of adding more medications start to outweigh the benefits the medications provide. Current surgical therapies include deep brain stimulation and enteral suspension of carbidopa-levodopa.

Deep brain stimulation therapy (DBS) involves placing small electrodes into places in the brain affected by Parkinson’s. The wires emit continuous electrical impulses (stimulation) from a device similar to a heart pacemaker. These impulses positively affect the parts of the brain that influence movement and can improve many motor symptoms such as tremor, stiffness and slowness. DBS may also make daily activities like getting in and out of chairs, walking, dressing and bathing easier.

When the stimulator is working well, you may experience symptom control very similar to what you experience from your best ON time with your medications. Depending on stimulation locations and other device settings, you may even need less or even no medications and the on periods may last longer, with less severe off periods.

Focused Ultrasound is another surgical intervention for Parkinson’s. Unlike DBS, FUS is a non-invasive procedure, meaning no incisions or implanted hardware are required. It uses highly focused ultrasound waves, guided by MRI, to precisely target and treat small areas deep within the brain that contribute to Parkinson’s symptoms. Because no device is implanted, there is no need for ongoing adjustments or battery replacements, and recovery time is typically shorter than with traditional surgery. However, unlike DBS, the effects of FUS are not adjustable or reversible, and the treatment is usually performed on only one side of the brain.

FUS is most commonly used to reduce tremor. By interrupting abnormal signaling in specific brain circuits, it can provide meaningful symptom relief, particularly for people whose tremor does not respond well to medications.

FUS may be an option for individuals who are not candidates for DBS or who prefer a non-implant approach. As with all surgical therapies, careful evaluation by a movement disorder specialist is important to determine whether this treatment is appropriate based on a person’s symptoms, goals, and overall health.

Exercise

Studies show regular exercise can help anyone improve heart health, increase strength, improve endurance, reduce fatigue and positively impact mood and self-esteem. With this in mind, it’s not surprising that research continues to illustrate the incredible impact exercise can have on both the motor (and non-motor) symptoms of Parkinson’s. Exercise can help manage many symptoms of Parkinson’s, especially tremor, balance, depression and fatigue. Research also suggests exercise may even help protect the areas of the brain affected by Parkinson’s from getting worse (a phenomenon known as neuroprotection), which may slow the progression of Parkinson’s.

Specific research studies have found people with Parkinson’s who participated in high-intensity exercise experienced noticeable improvement in their overall movement and even a reduction of tremor after exercising. In other studies, individuals with Parkinson’s who exercised more required less additional medication and had the slowest rate of change over the course of a year.

Other Strategies to Help with Motor Symptoms

  • Take your medication on time! This helps minimize off times that can make tremor worse.
  • Streamline your focus to reduce multitasking. Rest your elbow on the table when taking a drink to stabilize yourself or sit down when you button your shirt to concentrate more intently on the task at hand.
  • Reduce stress. Nerves and feeling stressed, in general, can make tremor worse, as can fatigue.
  • Consider adaptive technologies and products designed to make everyday tasks easier, such as specially-designed razors, pens, keyboards, utensils, cups and dishes.

The biggest thing you can do to manage the motor symptoms of Parkinson’s is to remain active in your own care. Document your symptoms and how they change over time, consult friends and family about what they notice, and bring your notes to your doctor. There are tools to help with the tracking process. But also pay attention to your stress level and other things that worsen your symptoms–including your diet.

While motor symptoms are often the most visible part of Parkinson’s, they are also some of the most treatable. Understanding how these symptoms show up in your body is the first step toward managing them effectively.

With the right combination of medication, exercise, therapy, and support, many people with Parkinson’s are able to improve how they move and feel. Pay attention to changes in your movement, share them with your care team, and take action early—because even small steps can make a meaningful difference over time.

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