If you’re an ortho or sports physical therapist (PT), Parkinson’s disease (PD) may seem like a “neuro” issue—important, but not your primary focus. Yet many patients you treat for rotator cuff tears, arthritis, lumbar pain, and sports injuries either already have PD or will develop it during your career. You may be one of the first professionals who can spot early signs and change their long-term trajectory.
This article makes the case that PD is already in your caseload, that exercise for PD is fundamentally an athlete-style problem, and that adding LSVT BIG® to your skill set is a natural next step.
The PD Wave in Musculoskeletal (MSK) Care
The number of people living with PD is rising rapidly. Estimates suggest cases could more than double worldwide from 11–12 million in 2021 to over 25 million by 2050. This increase isn’t confined to movement-disorder centers—it’s walking into every outpatient MSK and sports practice.
These are the same people who want to keep playing pickleball, come in with persistent shoulder or back pain, or need post-operative rehab. On paper, they look like your typical caseload—but their nervous system may be changing under the surface.
When PD Looks Like an MSK Condition
Musculoskeletal pain is one of the most common non-motor complaints in PD and can appear years before diagnosis. Neck, low back, shoulder, hip, or knee pain often lead people with early PD to PT clinics, where complaints are easily labeled as purely orthopedic.
As an MSK expert, you’re positioned to notice when the story doesn’t add up. Early PD can show up as “frozen shoulder” with reduced arm swing, persistent neck pain with axial stiffness disproportionate to imaging, slower sit-to-stand movements, or decreased facial expression and small-stepped gait.
These patients make you think, “Something else is going on.” PD may be that something else. Recognizing these patterns doesn’t mean diagnosing PD, but it does mean documenting what you see and encouraging timely medical evaluation. You may be the first clinician to suspect PD and advocate for early assessment.
Exercise for PD: Think Like a Sports Scientist
The last decade has transformed how we think about exercise in PD. Instead of “activity is good if tolerated,” current perspectives emphasize structured, progressive, often high-intensity training using sports-science principles you already apply: specificity, overload, progression, frequency, and recovery.
Guidance for PD increasingly supports endurance training at moderate to vigorous intensity, resistance training with sufficient load, and multicomponent programs including balance and agility. This is familiar territory for MSK specialists who design post-ACL programs and return-to-play progressions.
Treating people with PD “like athletes” acknowledges that their nervous system can respond to high-effort, task-specific training, especially when started early. It leverages your ability to push, progress, and motivate people safely toward higher performance.
LSVT BIG: Intensive, Structured, and Familiar
LSVT BIG is an intensive, amplitude-based treatment developed specifically for people with PD. It’s typically delivered one-on-one, one hour a day, four days a week for four weeks, with a focus on driving larger-amplitude movement across everyday tasks.
For MSK focused PTs, several aspects should feel familiar. The intensity and dose resemble post-operative or return-to-sport phases. Core exercises tie directly to functional mobility—gait, transfers, reaching, turning, and dual-task situations. Research shows improvements in gait speed, balance, functional mobility, and motor severity scores that reach clinically important thresholds.
Think of LSVT BIG as performance training for the PD nervous system. The goal is bigger, faster, more coordinated movement; the training block is a defined four-week period with structured homework; and maintenance resembles an off-season program with ongoing practice to sustain gains.
Why MSK Specialists Should Get Certified
If you primarily identify as an MSK, ortho, or sports PT, here are practical reasons to pursue LSVT BIG certification:
1. PD is already in your caseload. More older adult athletes will have or develop PD during your career, often entering your care with pain or stiffness before seeing a neuro specialist. Being prepared to recognize PD signs and offer an evidence-based program is part of good MSK practice.
2. Move from chasing pain to changing movement. Traditional MSK plans focus on local impairments, while in PD those impairments are driven by a global movement disorder affecting amplitude, speed, and automaticity. LSVT BIG addresses the underlying movement problem, not just its orthopedic consequences.
3. The framework matches how you already think. LSVT BIG emphasizes intensity, repetition, specificity, and progression in ways that mirror sports and performance rehab. You’re not abandoning your MSK identity—you’re extending it to a population that needs your mindset.
4. It differentiates you and expands impact. Certification signals advanced competency, positioning you as the go-to clinician for people with PD who want to stay active and a bridge between neuro and ortho worlds.
PD Is in Your Lane
Your practice may be labeled “ortho,” “sports,” or “MSK,” but your patients’ nervous systems don’t follow billing categories. As PD prevalence rises, more of your patients will be living with early or established PD, and you’re often the one who watches them move week after week—long enough to notice subtle bradykinesia, reduced arm swing, or axial rigidity that others might miss.
When you pair that observational advantage with a high-intensity, athlete-style framework like LSVT BIG, you’re no longer just managing pain—you’re helping people recalibrate their movement, stay independent longer, and continue doing activities that give their lives meaning. PD isn’t someone else’s population anymore—it’s already in your MSK caseload, and getting certified in LSVT BIG is one of the most direct ways to be ready for patients who are already counting on you, even when their referral just says “shoulder pain.”
To learn more about Online and Virtual Live LSVT BIG Training and Certification, click HERE.
AI (Perplexity) was used to assist in the creation of this blog. All content was reviewed, edited, and approved by human author(s).
