Low Back Pain – Is it Parkinson’s Disease?

by LMatthews on September 21, 2013

low back pain or parkinsons disease

Sound familiar? Some symptoms overlap between spinal stenosis and Parkinson's disease.

Parkinson’s disease and low back pain might at first seem like quite unlikely conditions to be mistaken for each other. However, there are patients who develop Parkinson’s disease without the familiar tremor, with mechanical back pain diagnosed at first, only to be followed by progressive symptoms of the nuerodegenerative disorder.

Is your low back pain actually caused by spinal stenosis or is something else going on that needs quite different treatment?

The symptoms of Parkinson’s disease tend to progress slowly and include:


  • Bradykinesia (slowness of movement or difficulties initiating movement)
  • Rest tremor (usually in one of the hands during early stages)
  • Rigid or stiff arms and legs
  • Stiffness in the neck
  • Postural instability

These symptoms become progressively worse as the neurodegnerative disease develops, with patients experiencing even greater difficulties initiating movement, such as being unable to rise from a chair or start walking from a standing position.

Do Patients with Parkinson’s Disease Always Have a Tremor?

Pain, including low back pain, may occur in Parkinson’s disease, as can urinary and bowel incontinences, urinary tract infections, weakness, numbness, and spasm in the legs and arms, and muscle wasting. These are all also symptoms of lumbar spinal stenosis and/or cervical spinal stenosis where neck stiffness, or instability in the neck, and headaches can occur. With around 30% of patients with Parkinson’s disease presenting with a tremor at rest, these symptoms of spinal stenosis are usually able to be attributed to the neurodegenerative condition. However, where no tremor is present the diagnosis of Parkinson’s disease may be missed initially, delaying appropriate treatment for symptoms.

Similarities Between Parkinson’s Disease and Spinal Nerve Compression

Patients with low back pain may also slow down their movement and develop abnormalities in how they walk, often to avoid the pain of spinal nerve impingement and irritation. As we live longer there are more people experiencing osteoarthritis-induced spinal stenosis, as well as neurodegenerative conditions, meaning that mechanical causes of low back pain, and Parkinson’s disease are increasingly prevalent. Spine specialists, including osteopaths and chiropractors will, therefore, need to be aware of the possible signs of diseases such as Parkinson’s that may masquerade as a spinal issue, allowing for prompt referral for assessment and diagnosis.


How Common is Parkinson’s Disease

Although there is no surgery or treatment that can cure, reverse, or really slow down the degeneration of neurons in Parkinson’s disease, there are treatments that can help reduce symptoms and improve quality of life. There are around 6.3 million people worldwide living with Parkinson’s disease, with estimates of double this figure by 2016.

Overlap of Spinal Stenosis and Parkinson’s Disease

Diagnosis of Parkinson’s disease usually occurs in older adults, with cases such as those of Michael J. Fox who was diagnosed before the age of thirty, quite rare. The difficulty of diagnosis is compounded by the fact that the incidence of arthritis and spinal disc degeneration, with spinal stenosis and pinched nerves, is also increasingly likely as we age. Spinal stenosis may be detected on scans of the spine and symptoms may then be attributed to the mechanical obstruction in the spine, whereas neurological degeneration could be contributing, or entirely to blame for the symptoms a patients is experiencing.

Differentiating Back Pain and Neurodegenerative Illness

Learning how to differentiate mechanical low back pain and early Parkinson’s disease without tremor is a serious challenge, therefore, as some 60-90% of people experience back pain during their lifetime. Doctors may notice that patients take longer to resume a sitting position after lying down for assessment, or develop more pronounced scuffing of the feet as they walk into the office. Other signs may be an actual reduction in pain and, instead, an increase in impairment of mobility. A physician may then decide to reassess a case that had previously appeared a cut and dried issue of spinal stenosis and low back pain.

Spotting Signs of Parkinson’s Disease

Patients may report falling over their own feet, having increasing problems getting in and out of their car and performing simple tasks such as peeling vegetables or even writing. To add further complexity, some of the medications given for low back pain treatment can cause side effects that mimic symptoms of Parkinson’s disease and neurodegenerative disorders in general. These may include antidepressants that can lead to slower movements and shuffling gait.

Treating PD vs LBP

Treatments for low back pain (LBP) from mechanical causes and Parkinson’s disease (PD) may actually be remarkably similar in some cases, with physical therapy and exercise recommended in both groups for most patients. However, those with Parkinson’s disease can experience significant abatement of symptoms with Levodopa treatment to replace missing dopamine in the central nervous system. Symptoms of depression connected to low back pain may also lessen when the underlying cause of the condition is identified, making it especially important that cases of Parkinson’s disease disguised as low back pain are quickly resolved.

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