Freezing of Gait in Parkinson's: Causes and Management

Freezing of gait (FOG) is one of the most distressing and disabling symptoms of Parkinson's disease. It manifests as a sudden, temporary inability to move the feet forward, often described as feeling "glued to the floor." Freezing episodes typically last a few seconds but significantly increase fall risk and reduce mobility and confidence.

Freezing is triggered by specific situations: turning (particularly in tight spaces), passing through doorways, approaching a chair to sit down, starting to walk, and dual-tasking (walking while talking or carrying objects). Stress, anxiety, and time pressure also increase freezing frequency. Interestingly, freezing often occurs less on open ground and more in confined or complex environments.

Cueing strategies are the most effective management approach. These provide external triggers that help the brain overcome the freezing episode:

Visual cues: stepping over a line on the floor, a laser pointer projecting a line to step over, or imagining an obstacle to step across. Tape lines on frequently frozen-through doorways can be very effective.

Auditory cues: counting rhythmically ("one, two, one, two"), using a metronome set to walking rhythm, or marching music. The rhythmic beat helps maintain stepping.

Mental cues: imagining stepping over a log, visualising a normal walking pattern, or mentally rehearsing the movement before executing it.

Other strategies include: stopping and resetting (pausing, relaxing, then starting again), shifting weight from one leg to the other before stepping, and turning in a wide arc rather than pivoting.

Our Parkinson's physiotherapy service helps patients identify their specific freezing triggers and develop personalised cueing strategies. At home, we can practise in the exact environments where freezing occurs. Our falls prevention programme addresses the fall risk associated with freezing, while our neurological physiotherapy service provides comprehensive Parkinson's management.