Tremor is an involuntary rhythmic movement, similar to shaking. Along with slowness of movement and stiffness, tremor is one of the most common symptoms of Parkinson’s disease (PD), though about 20% of people with PD will never experience tremor throughout the course of their illness (American Parkinson’s Disease Association, n.d.). There are many possible types of tremor, but one of the most common associated with PD is a resting tremor, which means it occurs when the affected limb is relaxed and not moving. Tremor commonly occurs in the hands, feet, or legs, but it can also occur in the mouth, including the tongue, as well as the chin and jaw (American Parkinson’s Disease Association, n.d.). It typically presents on one side of the body (asymmetric), like many other PD symptoms, and often disappears with movement of the affected body part(s) (American Parkinson’s Disease Association, n.d.).

For most people, the tremor is not debilitating; however, it can be tiring, interfere with sleep, and may feel “internal” – the feeling that the shaking is inside your body, but you cannot actually see it.

Some people with PD also find their tremors to be socially embarrassing. They may become self-conscious, which can make tremors worse – symptoms tend to increase with fatigue, and in stressful or exciting situations. Tremors also temporarily increase following intense exercise. This is due to fatigue and physical stress your body is put in when exercising. It is completely normal and should not stop you from exercising, as the tremors will calm again after some rest. Earlier on in the disease, some people may find it possible to control their resting tremors if they physically contract muscles on the affected limb; however, this may become more difficult as the disease progresses.

The good news is, those who report tremor to be their most bothersome symptom tend to have a milder illness, progressing more slowly and likely living longer (American Parkinson’s Disease Association, n.d.). For those whose only PD symptom is tremor, there is also hope that the tremor may simply fade away over the course of many years (American Parkinson’s Disease Association, n.d.).

Drug therapy does not always control tremor, and out of the four basic motor problems associated with Parkinson’s, tremors exhibit the least predictable response to conventional antiparkinsonian medications (American Parkinson’s Disease Association, n.d.). Levodopa usually, though not always, helps to manage tremor. If levodopa and other dopaminergic medications are not successful, your doctor may prescribe a medication from a class of drugs called anticholinergics (Parkinson’s Foundation, n.d.). These drugs improve PD symptoms by inhibiting the brain neurotransmitter acetylcholine (Parkinson’s Foundation, n.d.). However, their use must be cautiously monitored, because they can induce cognitive and physical side effects (Parkinson’s Foundation, n.d.). Anticholinergics are especially beneficial for younger people whose primary symptom requiring treatment is tremor (Parkinson’s Foundation, n.d.).

Tremors rarely affect independence or safety, and you can live a full life despite experiencing a tremor. To self-manage your tremor, try these strategies:

• Try not to overuse your energy supressing or hiding your tremor; fatigue will likely worsen it.
• If you are going to a social or business function, allow yourself plenty of time to get ready and arrive without being rushed, and to avoid stress or anxiety.
• Grip something in your hand, such as a wallet or book, or hold onto a table or chair, to steady your tremor.
• Avoid alcohol and caffeine, as these can worsen tremor, or cause its onset.
• Some drugs may worsen tremor. Work with your healthcare team to find medications that work for you.
• Discuss treatment options with your doctor. You may qualify for new medications, therapies, or surgery, depending on the severity of your symptoms, and their impact on your daily living. Deep brain stimulation (DBS) surgery is one of the most reliable treatments for tremor in PD: 90% of people will experience a reduction in the severity of their tremor following DBS, with many reporting its complete resolution (American Parkinson’s Disease Association, n.d.).Practice stress management daily, and be sure to get enough rest.
• Try the below exercises to help improve muscle strength, which may help improve overall muscle control/tone and thus the resting tremor, although this is only speculation and not evidence-based.

Example Exercises

Arms and hands:

Push the arms forward and spread the palm/fingers as effortfully as you can. Hold for a few seconds while allowing more energy to flow out of your palms, then pull the arms back in as effortfully as you can, closing the fists. Make the movements as crisp as possible!

Other high-effort upper extremity exercises may include boxing or weightlifting.

Legs:

Squat down and hold, squeezing as many muscles as you can in your legs at the same time. Then stand up in one, crisp, sharp movement, pushing the hips forward. Hold the stand position and squeeze as many muscles in the body as you can. 

Sources

American Parkinson’s Disease Association (n.d.). Tremor in Parkinson’s. www.apdaparkinson.org/what-is-parkinsons/symptoms/tremor

Pacific Parkinson’s Research Centre, University of British Columbia, Vancouver, BC

Parkinson’s Foundation (n.d.). Tremor. www.parkinson.org/understanding-parkinsons/movement-symptoms/tremor

Shelly Yu, neuro physiotherapist, Vancouver, BC

Last updated: August 28, 2023