Freezing

We know that freezing can happen when something interrupts a normal sequence of movement.

If part of your walking cycle is interrupted, the whole movement can come to a stop, or your steps may get smaller and smaller.

Although freezing can happen at any time, you may experience it when you are:

• starting to walk
• walking towards or through doorways
• moving from one style of flooring to another - such as from carpet to tile
• walking through a narrow or closed-in space
• turning or changing direction
• distracted by another task
• interrupted by an object, someone talking or something else that takes your attention
• in a busy or crowded place
• in a rush
• walking somewhere badly lit or dark.

All of these can stop you being able to keep a steady rhythm when you’re walking.

You may be more likely to freeze if you:

• are feeling anxious, stressed or panicked
• are feeling tired
• have trouble sleeping
• are feeling low or depressed
• have had hallucinations.

Freezing and changing surfaces

We usually take different-length steps on smooth surfaces compared to uneven ground. If you have Parkinson’s you may find it difficult to make these changes automatically.

For example, you may be able to walk without a problem on uneven surfaces, but freeze when the floor is smoother or has a patterned surface. Or the opposite might happen.

Some people who experience freezing are surprised that they have no problems going up or down stairs, but freeze as soon as they are back on flat ground.

Freezing in a busy place

If you freeze in a busy place, such as a supermarket or a station, give yourself time to stop, look and plan at regular points.

Some things to try:

• Step to one side, out of the main flow of people, and touch something solid like a wall to help your balance. 
• Look at the area ahead of you, checking for anything in the way, such as benches, street lights or trolleys.
• Decide the route you’ll take. Repeat this method of “pause, look, plan and walk” as often as you need to. Or guess the number of steps you’ll need, before walking towards that point. Then start counting them and aim to be at your destination by the target number.

No. There are different ways of managing freezing and “on/off” swings, so your specialist or Parkinson’s nurse should treat them as separate problems. Some people with Parkinson’s who have been taking levodopa for a while have “on” and “off” periods.

An “on” period is when your symptoms are controlled and your medication is working well. During an “off” period, or a “wearing off” period, Parkinson’s symptoms come back and are more difficult to manage.

Going from one to the other can happen very quickly. 

Being “on” or “off” is different from freezing. During “off” periods, some people with Parkinson’s are not able to move at all.

But freezing only affects certain movements or parts of the body. So although you might not be able to walk, you might still be able to grab an object. If your feet freeze and you try to reach for support from furniture or a wall that’s too far away, you may fall.

Although freezing and being “off” are different, freezing is more common during the “off” state and individual episodes of freezing tend to last longer.

Freezing or shuffling can affect your balance and make you more likely to fall over. 

Take care when walking along waterways and crossing busy roads. You may find it helpful to have someone with you when doing these activities.

It might help to avoid using escalators or automatic walkways, for example in shopping centres, train stations and airports.

You can also help prevent falls by:

• asking for help. A family member or friend and you freeze can hold your arm and support your balance while you focus on moving again
• avoiding distractions. Try to concentrate and avoid walking and talking at the same time. If you want to have a conversation, pause and touch something solid, such as a lamp post, when you want to talk
• planning ahead. If you cross a busy area, plan your route in short stages so that you're not having to concentrate on too much in one go
• slowing down when you turn. If you need to change direction, try not to turn too quickly or pivot on the spot. It's better to slow down and take a few extra steps to walk around in a half circle. Try to imagine your feet are following the numbers on the face of a clock
• choosing the right footwear. You might find shoes with low heels or flat soles are easier to walk in. Try to avoid unsupportive shoes, such as floppy slippers. An occupational therapist or physiotherapist can give you advice about this
• taking your time and not rushing.

Read more about what can help if you do fall, such as carrying a mobile and emergency contact numbers with you.

Your specialist might recommend medication to help with freezing. They'll explain the options which could be right for you and any potential side effects. 

Levodopa

Levodopa can help to relieve freezing. But some people who have been taking levodopa for longer may also be more likely to freeze. Researchers aren’t sure why this happens.

Your specialist will make decisions about your medication depending on what suits you best. Depending on your symptoms, they might suggest increasing your dose of levodopa. 

Always speak to your specialist or Parkinson’s nurse if you have questions about your treatment.

Levodopa and freezing during “off” periods

Freezing can happen during “on” or “off” periods, or both. More research is needed to fully understand how freezing is linked to levodopa.

If you tend to freeze during “off” periods, levodopa may help by reducing the length of your “off” periods. Changes to the type and timing of your medication may help you “switch off” less often. Talk to your specialist or Parkinson’s nurse about any changes to your medication. Don’t suddenly stop taking your medication as this can be dangerous.

When freezing happens during “on” periods, this usually can’t be treated with levodopa.

If you freeze during “on” periods, your specialist may suggest reducing your dose of levodopa to help with your freezing. They may not do this if changing your dosage might make your other Parkinson’s symptoms worse.  

An occupational therapist is a health professional who helps people to be as independent as possible.

They give advice on making your home or workplace safer or easier to manage. This may include showing you easier ways to do a task or activity. They can also give advice about equipment to make things easier and safer.

An occupational therapist can help you to move more easily around your home in areas that can cause you to freeze. They can also help you find ways to manage a freezing episode in other situations. If you have difficulty organising day-to-day life, or feel very anxious, an occupational therapist can help with this too.

Your GP, Parkinson’s nurse or specialist can refer you to an occupational therapist. 

You can also pay for private occupational therapy. To find a private occupational therapist in your area, contact the Royal College of Occupational Therapists.

Read more about occupational therapy for Parkinson’s.

A physiotherapist is a healthcare professional who helps keep people moving and able to carry out daily tasks for as long, and as safely, as possible. They can help improve your:

• posture
• mobility
• muscle strength and tone
• balance
• muscle stiffness.

They can also give you strategies to reduce your risk of falling if you freeze. These include exercises to strengthen the muscles that keep you upright and improve your posture and walking.

A physiotherapist may be able to visit you at home. Or you might have an appointment in their clinic or a gym.

Physiotherapy and your posture 

Parkinson’s can cause changes to your posture, which your physiotherapist can help with. If your Parkinson’s has caused your movements to become slower or more stiff, you may find that your posture is more “stooped”, with your:

• knees bent
• heels off the ground
• head forward.

This can make you more likely to freeze. And as the mechanism that controls your movement and balance isn’t working as well, you may be more likely to fall.

A physiotherapist might help you learn to:

• put your heel down first when you walk – helping you stay steady
• better manage doing two things at the same time (like carrying something while walking) and know where to focus your attention
• move your weight to one side ready to step forward with the opposite leg
• use different ‘cues’ (things you can do to encourage a movement to restart)
• manage your freezing in a variety of places and situations, so your memory will be triggered more quickly in real-life situations. 

Your GP, specialist or Parkinson’s nurse can refer you for physiotherapy. In some areas, you will be able to self-refer. If you’re referred to an NHS service, there may be a waiting list for treatment.

You can also choose to see a physiotherapist privately, which you will need to pay for. The Chartered Society of Physiotherapy can help you find a private physiotherapist.

Read more about physiotherapy for Parkinson’s.

Your physiotherapist can give you advice on walking aids. The wrong walking aid can make freezing worse, so it’s important to get professional advice.

Some people with Parkinson’s find that they can walk better without any aids, once they’ve learned the movement skills to manage the problem.

We have more information about equipment to help you get around, including handrails for stairs or walls, walking sticks and walking frames. 

Read more about equipment to help you get around.

Small lasers which can attach to walking sticks, frames or your shoes are becoming more popular. By shining a light on the ground to guide your feet to the next step, these might help you restart your walking by prompting your movement. Lasers might not work as well if you use them in brightly lit places, or outdoors in the sunshine.

A Lasercane is a walking stick designed to work in the same way. It projects a red laser beam onto the ground and cues you to step over the light when your feet freeze. 

Deep brain stimulation is a type of surgery that can help some people with Parkinson’s. It’s not suitable for everyone, but some people find it helps their freezing.

Read more about deep brain stimulation for Parkinson’s.

Several techniques use a specific strategy or a “cue” to trigger your movement once you’ve frozen. A cue is a signal or prompt which tells your body to do a certain thing, such as step forward.

Knowing these will help you to take control of your freezing, and may reduce any worries you have when it happens. It may help to tell your family and friends about them too, so that they can help suggest things when you’re out walking together.

The techniques on this page have been recommended by occupational therapists and physiotherapists with experience of working with people with Parkinson’s.

Remember that each method may work in different situations and at different stages of Parkinson’s. So, try a few things to find out which methods work best for you.  You may even find ways to reduce or avoid freezing altogether. 

If a movement isn’t flowing well, making the effort to think about each separate part of a familiar movement can help you get going.

When you feel yourself freeze, the first thing to do is to stop moving, or to slow down. This gives you time to refocus on balance, think about your next move and prepare your body to start again, which can reduce the risk of falling.

To help with this, try the plan method:

⦁ STOP: calm yourself and take a breath

⦁ THINK: what do you want to do?

⦁ PLAN: how are you going to do it?

⦁ DO: complete the task or movement

The weight shift method might help too:

• If you freeze, don’t try to move forward straight away. Instead, gently move most of your weight to one leg. This will encourage you to step forward with the opposite foot. Count “one, two, three, step” or say “ready, steady, go” to get moving again.
• You may be able to restart walking again by gently rocking your head and shoulders, transferring your weight from side to side. This can help you shift your body weight to your supporting leg.
• It may help to talk to yourself out loud: “move my weight to left leg, then step with right” (or vice versa). You may have to rock from leg to leg to release the weight on each foot before stepping off.
• For most people, it’s best to move their weight onto their "good" leg, and step forward with the other.

Another example of the weight shift method could be “kicking the stick”. This is where you place your walking stick in front of each foot and gently kick it as you take a step. The momentum from your kick then helps you move forward to take your step. You can do this using one foot at a time, or alternating between both feet.

Using counting, sound or a rhythm can often help:

• When you stop to open a door, walk on the spot to keep the stepping rhythm going. After freezing or pausing, decide which foot you’re going to step with first. Then say “one, two, three, step” or “ready, steady, go” out loud or silently. If you have someone with you, they could say this for you.
• If an area often causes you to freeze, using rhythm might help you pass through a “trouble spot” without a problem. You could sing or hum a tune in your mind or out loud. Count your steps in groups of 10, or say out loud, “one, two, one, two”  or “left, right, left, right”.
• Say a “trigger” word to yourself such as “step” or “go”. Download music onto your phone, so you can listen to it as you walk.
• Use a metronome to restart your walking. A metronome produces a regular tick or beat to help musicians keep to a rhythm. You can find them easily online, by downloading an app, or in musical instrument shops. Check you can use the small control buttons before you buy one.

You may also find it helpful to think about your walking as a march. You could walk to a rhythm, saying “one-two, one-two” in your head or out loud as you step.

You might be able to find more cueing strategies and ideas online, such as on YouTube.

We have a video about using a metronome to help with freezing at the bottom of this page. 

If you find it hard to start a movement, try doing the action in your mind first. This is sometimes called visualisation. 

Try to imagine doing the action in detail, without any movement difficulties. This is sometimes called “mental rehearsal”.

Athletes and musicians often use this technique to practise and improve their performances. It works because thinking about moving uses the same areas of the brain we use to actually make these movements.

For example, to get up from an armchair when you feel stuck:

• Imagine moving your bottom to the front of the seat, keeping your feet slightly apart and tucked close to the chair, your hands ready to push down on the armrests.
• Then imagine the feeling of pushing down through your legs and arms and leaning forward as you stand up easily.
• After you’ve run through the actions in your mind, get ready to move by saying, “one, two, three, stand”, as you do the set of actions you’ve just imagined.

If you often freeze in the same places at home, you could try using floor strips. They can help if you have problems turning or changing direction on patterned flooring. 

Here’s how to use them:

1. Take some sticky tape, in a colour that’s different from the floor or carpet.
2. Cut the tape into three or four strips of 40cm to 55cm (15in to 22in).
3. Stick them firmly to the floor or carpet, 35cm to 50cm (13in to 20in) apart.
4. Where there’s a corner, place the strips in a fan shape around the bend.
5. If the floor colour or texture changes through a doorway, put a strip on the join. If the flooring is the same on each side of the doorway, put a strip at the same distance on either side of the threshold.

If you aren’t sure how to use floor strips, speak to your Parkinson’s nurse for further advice. 

When you walk over the strips, you can step on or between the lines. When they become worn or unstuck at the edges, replace the strips with fresh tape, or ask someone to do this for you.

We have a video about using floor strips at the bottom of this page. 

• If different coloured rugs or mats make you freeze, remove them from your usual route through a room. Try placing them somewhere you don’t walk often, such as under the window. Plain flooring and uncluttered spaces make moving around easier.
• If your steps are too fast for your body to keep up with, concentrate on slowing down your stepping rhythm and think about making larger steps. This can help to overcome shuffling, which often happens before a freeze.

Not every cueing technique will work for everyone. What’s important is to try to find one that works for you. Your physiotherapist or Parkinson’s nurse will be able to help you come up with ideas and then you can experiment to see which ones work best.