{"id":3331,"date":"2025-03-17T17:49:40","date_gmt":"2025-03-17T17:49:40","guid":{"rendered":"https:\/\/test7.samplewebsitelink.com\/parkinsonz\/?p=3331"},"modified":"2025-05-01T20:58:51","modified_gmt":"2025-05-01T20:58:51","slug":"understanding-pisa-syndrome-in-parkinsons-disease","status":"publish","type":"post","link":"https:\/\/test7.samplewebsitelink.com\/parkinsonz\/understanding-pisa-syndrome-in-parkinsons-disease\/","title":{"rendered":"Understanding Pisa Syndrome in Parkinson\u2019s Disease"},"content":{"rendered":"\n

Sara Whittingham MD<\/p>\n\n\n\n

March 17, 2025<\/p>\n\n\n\n

Pisa syndrome is a condition where a person\u2019s body starts leaning significantly to one side, usually without them realizing it. It often appears in people with Parkinson\u2019s disease, especially after years of living with the condition. Some describe it as feeling like their muscles are pulling them sideways or like their body just won\u2019t stay upright when they walk.<\/p>\n\n\n\n

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The Leaning Rhonda of Boston<\/mark><\/figcaption><\/figure>\n\n\n\n
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The leaning tower of Pisa<\/figcaption><\/figure>\n<\/figure>\n\n\n\n

Many people notice their leaning gets worse after walking a certain distance or when they\u2019re tired. For some, it happens mostly when standing still, while others find it worsens with vigorous exercise. One person shared that they lean so far they almost touch the ground, making activities they love\u2014like running\u2014much harder. Others say their shoulders and hips are uneven, and they only notice the lean when someone points it out or when they see themselves in a mirror.<\/p>\n\n\n\n

Doctors aren\u2019t entirely sure why Pisa syndrome happens. It might be due to changes in the brain\u2019s ability to control posture, or it could be caused by tight, overactive muscles on one side of the body. In some cases, Parkinson\u2019s medications might even play a role. The good news is that it can sometimes be improved with the right approach.<\/p>\n\n\n\n

Treatment options vary. Some people find relief with Botox injections, which relax the overactive muscles that contribute to the lean. Others swear by daily stretching and targeted physical therapy, though some say traditional therapy doesn\u2019t help much. A few have tried dry needling (similar to acupuncture) to release tight muscles. One person even joked that, as Parkinson\u2019s warriors, they often have to figure out solutions on their own and then teach their doctors what works!<\/p>\n\n\n\n

Though Pisa syndrome can feel discouraging, many who have it remain determined to keep moving forward. Staying active, finding the right therapies, and making small adjustments\u2014like taking breaks before the lean worsens\u2014can make a difference. While more research is needed, people living with Pisa syndrome are proving every day that it\u2019s possible to adapt and keep pushing forward.<\/p>\n\n\n\n

References: This article is a compilation of a discussion that took place on The Parkinson’s Fight Club Facebook group<\/a> initiated on March 17, 2025 by Michael Quaglia. Names and images have been used with permission.<\/p>\n\n\n\n

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I have several examples but this shows it the best. I have done this extremely starting in the middle of races and worsening as time goes on. It\u2019s also very painful and you absolutely cannot straighten up. I tried walking aids etc and nothing helped. I have had it off and on since 2016\/17, with and w\/o running. I usually did not even notice it until someone mentioned it to me or I saw a shadow. Then the pain would begin. The pain in these photos was unimaginable. If I hadn\u2019t had my friend with me as a guide I would have certainly quit. Here\u2019s a last photo at the finish line.- Rhonda Foulds<\/em><\/strong><\/p>\n\n\n\n

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I find this simple but complicated exercise works for me.<\/p>\n\n\n\n

With this exercise I use a block no higher than 2 inches, my knee on the block never bends. With my dropped leg I make sure my heal touches the floor. The only joint that moves is the hip. Note how this exercise also works my spine. As usual, check with your doctor if this is good for you. — Robert Emberly<\/strong><\/p>\n\n\n\n

\ud83d\udca1 What Causes It?<\/p>\n\n\n\n

Doctors aren\u2019t entirely sure what causes Pisa syndrome, but several factors seem to contribute:<\/p>\n\n\n\n

\u2022 Rigidity: Stiffness in the trunk or one side of the body can pull the posture out of alignment.<\/p>\n\n\n\n

\u2022 Dystonia: This movement disorder causes involuntary, prolonged muscle contractions that can lead to abnormal posture, including sideways leaning.<\/p>\n\n\n\n

\u2022 Muscle Compensation: The body may overcompensate for tightness or weakness on one side, creating imbalances.<\/p>\n\n\n\n

\u2022 Medication Side Effects: Some Parkinson\u2019s medications may contribute to postural changes.<\/p>\n\n\n\n

\u2022 Neurological Changes: Damage to parts of the brain responsible for posture and spatial awareness may also play a role.<\/p>\n\n\n\n

\u2022 Multiple System Atrophy (MSA): A related condition to Parkinson\u2019s, MSA can also cause Pisa-like symptoms.<\/p>\n\n\n\n

\u2e3b<\/p>\n\n\n\n

\ud83d\udd0d Recognizing Other Postural Changes<\/p>\n\n\n\n

While Pisa syndrome specifically refers to sideways leaning, it\u2019s not the only postural issue people with Parkinson\u2019s may face:<\/p>\n\n\n\n

\u2022 Stooped posture with rounded shoulders<\/p>\n\n\n\n

\u2022 Forward head tilt (the chin juts forward)<\/p>\n\n\n\n

\u2022 Uneven hips or shoulders<\/p>\n\n\n\n

\u2022 Reduced range of motion in the trunk or back<\/p>\n\n\n\n

Sometimes these changes happen slowly, and it\u2019s only when others point them out\u2014or when photos reveal the lean\u2014that they become noticeable.<\/p>\n\n\n\n

\u2e3b<\/p>\n\n\n\n

\ud83d\udee0 How Is Pisa Syndrome Managed?<\/p>\n\n\n\n

There\u2019s no one-size-fits-all fix, but many people find some relief through a combination of therapies. Options include:<\/p>\n\n\n\n

\u2705 Physical Therapy<\/p>\n\n\n\n

\u2022 Focused on posture, balance, and strengthening underused muscles.<\/p>\n\n\n\n

\u2022 May include stretching, trunk rotation, or core exercises.<\/p>\n\n\n\n

\u2022 Regular PT can help prevent worsening and build awareness.<\/p>\n\n\n\n

\u2705 Medication Adjustments<\/p>\n\n\n\n

\u2022 If symptoms are linked to side effects, changing the dose or type of Parkinson\u2019s medication may help.<\/p>\n\n\n\n

\u2022 Always consult a movement disorder specialist before making changes.<\/p>\n\n\n\n

\u2705 Botox Injections<\/p>\n\n\n\n

\u2022 Used to relax overactive muscles pulling the body to one side.<\/p>\n\n\n\n

\u2022 Can be effective when dystonia is a contributing factor.<\/p>\n\n\n\n

\u2705 Dry Needling or Acupuncture<\/p>\n\n\n\n

\u2022 Some people have found relief through these methods, which may reduce muscle tension.<\/p>\n\n\n\n

\u2705 Assistive Devices<\/p>\n\n\n\n

\u2022 Walkers or trekking poles can improve posture and balance.<\/p>\n\n\n\n

\u2022 Wearable posture sensors may provide real-time feedback.<\/p>\n\n\n\n

\u2705 Daily Exercise<\/p>\n\n\n\n

\u2022 Core strengthening and posture training are essential.<\/p>\n\n\n\n

\u2022 Activities like Pilates, yoga, or tai chi can increase body awareness and balance.<\/p>\n\n\n\n

\u2e3b<\/p>\n\n\n\n

\ud83e\udded Tips for Moving Safely with Pisa Syndrome<\/p>\n\n\n\n

\u2022 Lead with your foot, not your upper body, when turning.<\/p>\n\n\n\n

\u2022 Shift your weight fully before taking the next step.<\/p>\n\n\n\n

\u2022 Avoid quick pivots\u2014turn your whole body slowly and with control.<\/p>\n\n\n\n

\u2022 Take breaks before the lean worsens during long walks.<\/p>\n\n\n\n

\u2e3b<\/p>\n\n\n\n

\ud83d\udcac Real Talk from the Community<\/p>\n\n\n\n

Many people share that Pisa syndrome tends to show up when they\u2019re rushing or tired. One person said, \u201cHe doesn\u2019t lean all the time\u2014mostly when he\u2019s in a hurry.\u201d Another noted that therapy helped a little, but they had to try multiple approaches to find what worked.<\/p>\n\n\n\n

A few have joked that they\u2019re \u201cteaching their doctors\u201d what really helps, after trying Botox, stretching, and dry needling. And although it can be discouraging, many emphasize the importance of staying active, adjusting expectations, and keeping a sense of humor.<\/p>\n\n\n\n

\u2e3b<\/p>\n\n\n\n

<\/p>\n\n\n\n

\ud83e\udde1 Final Thoughts<\/p>\n\n\n\n

Pisa syndrome can feel like one more frustrating challenge in an already complex disease\u2014but it doesn\u2019t mean the end of independence or activity. With the right tools, support, and persistence, people with Parkinson\u2019s are proving every day that they can adapt, advocate, and keep moving forward\u2014lean and all.<\/p>\n\n\n\n

If you or your care partner notice signs of leaning, talk to your neurologist or physical therapist. The earlier it\u2019s addressed, the better the outcomes may be.<\/p>\n\n\n\n

You don\u2019t have to stand up straight to stand strong. Keep fighting.<\/p>\n\n\n\n