Objective: To describe clinical changes following pelvic periosteal stimulation in patients with Parkinson’s disease (PD) and axial symptoms.

Background: Axial symptoms in PD, including postural instability and gait dysfunction, are often difficult to treat with dopaminergic therapy [1]. Because the periosteum is richly innervated and mechanosensitive pathways may influence musculoskeletal stiffness and sensorimotor function [2][3], pelvic periosteal stimulation with dry needling (Fluoroscopy-guided Interventional Microadhesiolysis and nerve Stimulation, FIMS) was explored as a potential adjunctive intervention.

Method: We retrospectively reviewed patients with PD admitted to a single center over a one-year period (n=68). Twelve patients underwent FIMS, and 5 patients with documented pre- and post-treatment functional assessments were included in this case series. Localized mechanical stimulation of the pelvic periosteum was applied at four-week intervals. In Cases 1–4, treadmill gait analysis (FDM-T) data were reviewed. In Case 5, who was wheelchair-dependent, range of motion (ROM), manual muscle testing (MMT), and visual analog scale (VAS) scores were assessed.

Results: Among the 4 ambulatory patients, gait parameters improved after treatment. Walking speed increased from 0.8 to 1.5 km/h in Case 1, from 0.4 to 1.0 km/h in Case 2, and from 0.5 to 0.9 km/h in Case 3. In Case 4, walking speed remained the same (0.8km/h), but stride length increased immediately from 26 to 39 cm after the procedure. In Case 5, hip flexion and knee extension strength improved from Fair (F) to Fair Plus (F+) on MMT, and axial pain decreased by 50% (VAS 10 to 5).

Conclusion: Pelvic Mechanosensitive ion channels, like PIEZO1/2 and TRPV, are highly concentrated in the periosteum [4]. Activation of the PIEZO-TRPV complex can directly mitigate local ECM stiffness and improve proprioception [5] [6] [7]. In this retrospective case series, pelvic periosteal stimulation was associated with improvements in gait-related or functional measures in patients with PD and axial symptoms. Although the underlying mechanism remains unclear, periosteal stimulation may represent a potentially useful adjunctive approach. These preliminary findings warrant prospective controlled studies using standardized outcome measures and follow-up.

References: [1] Bove F, et al. How resistant are levodopa-resistant axial symptoms? Response of freezing, posture, and voice to increasing levodopa intestinal infusion rates in Parkinson disease. Eur J Neurol. 2023;30(8):2253-2261. doi:10.1111/ene.15839.
[2] Zhao Y, et al. Piezo1 and tissue fibrosis: insights into its role and potential for modulation. Burns Trauma. 2024;12:tkaf054. doi:10.1093/burnst/tkaf054.
[3] Wang Y, et al. PIEZO1 mediates periostin+ myofibroblast activation and pulmonary fibrosis in mice. J Clin Invest. 2025;135(2):e184158. doi:10.1172/JCI184158.
[4] Li X, Han L, Nookaew I, et al. Piezo1/2 mediate mechanotransduction essential for bone formation through concerted activation of NFAT-YAP1-ß-catenin. eLife. 2019;8:e52779. doi:10.7554/eLife.52779.
[5] Coste B, Mathur J, Schmidt M, et al. Piezo1 and Piezo2 are essential components of distinct mechanically activated cation channels. Science. 2010;330(6000):55-60. doi:10.1126/science.1193270.
[6] Woo SH, Lukacs V, de Nooij JC, et al. Piezo2 is the principal mechanotransduction channel for proprioception. Nat Neurosci. 2015;18(12):1756-1762. doi:10.1038/nn.4162.
[7] Nagel M, Chesler AT. PIEZO2 ion channels in proprioception. Curr Opin Neurobiol. 2022;75:102572. doi:10.1016/j.conb.2022.102572.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/pelvic-periosteal-stimulation-for-axial-rigidity-in-parkinsons-disease-a-retrospective-case-series/