It is one of the strangest and most unsettling things that happens in Parkinson’s.
You are walking perfectly well. Then you come to a doorway, or you go to turn, or somebody speaks to you, and your feet simply stop. They feel glued to the floor. Your upper body wants to keep going, which is exactly how people end up falling forward.
A few seconds later it releases and you walk on normally.
It is called freezing of gait, and it frequently frightens people more than almost any other symptom, partly because it is so sudden and partly because it is hard to explain to anybody who has not experienced it.
The useful thing to know is that it is reasonably well understood, it has recognizable triggers, and there are specific strategies that help.
What it feels like
People describe it in a few consistent ways.
Feet stuck or glued to the floor.
Legs that will not do what the brain is asking.
Taking a series of very small rapid steps without actually going anywhere.
Or simply stopping, unable to start again.
It usually lasts a few seconds, though it can feel considerably longer, and it tends to release on its own or when something changes.
The frustrating part is that it is frequently inconsistent. Somebody who freezes in their hallway may walk without difficulty outside, which can make it look to others as though it is not a genuine problem. It is.
When it tends to happen
Freezing has triggers, and recognizing yours is one of the more useful things you can do.
The common ones.
Starting to walk. Getting going from standing still is one of the most frequent triggers.
Turning, particularly tight turns. Turning in a confined space such as a bathroom or at the top of stairs is a classic.
Doorways and narrow spaces. Something about passing through a narrow gap is a strong trigger for many people.
Changes in floor surface, such as moving from carpet to tile, or a patterned floor.
Crowds and busy environments.
Approaching a destination, such as the last few steps to a chair.
Doing something else at the same time, including talking, carrying something, or thinking about something.
Time pressure, including a ringing phone or needing to get somewhere.
And stress or anxiety, which make almost every trigger worse.
The strategies that help
This is the practical part, and the general principle behind most of it is interesting.
Automatic movement is what Parkinson’s affects most. Deliberate, consciously directed movement tends to be better preserved. So most freezing strategies work by converting walking from something automatic into something deliberate.
Rhythm helps. Counting out loud, a metronome, or music with a clear steady beat gives the movement an external rhythm to follow. Many people find they can walk considerably better to music than without it.
Visual targets help. Stepping over a line on the floor, over a walking pole laid down, or over your own foot. Some people use laser pointers attached to a cane or walker, which project a line to step over.
Marching exaggerates the pattern and frequently breaks a freeze. Lifting the knees deliberately high for a few steps.
A weight shift first. Rocking gently side to side before attempting to step gives the body something to work with rather than trying to start from completely still.
Stepping backward or sideways first. For some people, a freeze releases if the first movement is in a different direction.
Counting into it. One, two, three, step.
And instruction. Saying “big step” out loud, to yourself, frequently works better than simply trying harder.
Different strategies suit different people, which is why finding yours matters more than any particular list. It is worth testing several.
The things that do not help
Worth saying, because they are what people instinctively do.
Trying harder. Pushing against a freeze generally does not release it and frequently results in the upper body going forward while the feet stay put, which is how falls happen.
Being hurried. Somebody standing nearby saying come on tends to make it worse rather than better.
Panicking, which is entirely understandable and which tightens everything up.
And attempting to turn quickly to get out of it, which is a common way to lose balance.
The most useful instruction when it happens is to stop trying to walk, stand still for a moment, use your strategy, and then go.
Changes around the house
A number of practical adjustments reduce how often this happens.
Clear the doorways. Narrow gaps trigger freezing, so making them as wide and uncluttered as possible helps.
Remove clutter from walking routes generally, which also addresses trip hazards.
Think about floor transitions. Changes from carpet to hard flooring are a common trigger, and where they cannot be removed, some people find a visual cue at the transition helps.
Improve lighting, particularly on routes used at night.
Arrange furniture so that turns are wider where possible, since tight turns are a strong trigger.
Consider removing rugs, which trigger freezing and cause trips.
And look at the route from bed to bathroom specifically, because that journey combines several triggers with reduced alertness and poor light.
Falls
Freezing and falls are closely linked, for the obvious reason that stopping suddenly while your weight is moving forward puts you off balance.
Which makes a few things worth building in.
Balance training, practiced deliberately and regularly.
Strength work, particularly for the legs, so that you can actually recover when you start to go.
Practicing getting up from the floor, which is a genuinely useful skill and one that reduces how frightening a fall is.
And reporting falls, including ones where you were not hurt. They get underreported constantly and they are important information for your team.
Medication timing
Freezing frequently relates to how well symptoms are controlled at a given moment.
Many people find they freeze considerably more during periods when their medication is wearing off.
If you notice a pattern, that is worth tracking and taking to your neurologist or specialist nurse. A few notes about when freezing happens relative to your doses is genuinely useful information for them.
Freezing that happens consistently at the same point in your medication cycle is a different conversation from freezing that happens all the time.
Any adjustments to medication belong with your specialist team rather than being made independently.
For family and friends
A short section, because the people around somebody who freezes frequently want to help and are not sure how.
Do not rush them. The instinct to say come on is strong and it makes things worse.
Do not pull on their arm. It tends to destabilize rather than help.
Learn their strategy, and prompt it calmly. If counting works for them, count with them.
Give them space and time.
And if they are in a doorway or a tight spot, it can help to simply stand back, because somebody standing close in a narrow space adds to the problem.
When to speak to your team
New freezing that has not happened before.
Freezing becoming more frequent or lasting longer.
Falls, including ones without injury.
A pattern linked to your medication timing.
Freezing that is affecting your confidence or your willingness to go out, which is worth addressing rather than adapting around.
And any sudden change, which should be assessed promptly.
This is treatable
That is the main message. Freezing is unsettling and it is not something you simply have to accept and work around.
The strategies above help a great many people, and finding the ones that work for you is something that benefits enormously from somebody working through it with you rather than reading a list.
Freedom Functional Wellness offers a free discovery visit at no cost and no obligation. You will get an assessment of your walking, balance and freezing triggers, help identifying the cues that work for you specifically, and a program that addresses the balance and strength underneath it.
We work alongside your neurologist and medical team, not instead of them.
