Sara Whittingham MD
March 17, 2025
Pisa syndrome is a condition where a person’s body starts leaning significantly to one side, usually without them realizing it. It often appears in people with Parkinson’s 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’t stay upright when they walk.
Many people notice their leaning gets worse after walking a certain distance or when they’re 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—like running—much 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.
Doctors aren’t entirely sure why Pisa syndrome happens. It might be due to changes in the brain’s ability to control posture, or it could be caused by tight, overactive muscles on one side of the body. In some cases, Parkinson’s medications might even play a role. The good news is that it can sometimes be improved with the right approach.
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’t help much. A few have tried dry needling (similar to acupuncture) to release tight muscles. One person even joked that, as Parkinson’s warriors, they often have to figure out solutions on their own and then teach their doctors what works!
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—like taking breaks before the lean worsens—can make a difference. While more research is needed, people living with Pisa syndrome are proving every day that it’s possible to adapt and keep pushing forward.
References: This article is a compilation of a discussion that took place on The Parkinson’s Fight Club Facebook group initiated on March 17, 2025 by Michael Quaglia. Names and images have been used with permission.
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’s 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’t had my friend with me as a guide I would have certainly quit. Here’s a last photo at the finish line.- Rhonda Foulds
I find this simple but complicated exercise works for me.
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
