Cogwheeling in Parkinson's Disease

Cogwheeling in Parkinson's disease is that jerky feeling in your arm or leg that you (or your doctor) can sense when rotating that limb or joint. It is an early symptom of Parkinson's.

The feeling is similar to a ratchet wrench that hesitates before "clicking" forward into its next position. Cogwheeling was named for the cogwheel, a toothed wheel or gear that clicks forward and back, rather than running smoothly.

Cogwheeling is thought to be related to two of the three primary symptoms of Parkinson's disease: tremor (shaking) and rigidity (muscle stiffness). In Parkinson's, rigidity leads to resistance to any type of movement, while tremor leads to your muscles tensing and then relaxing.

Many people with Parkinson's disease definitely can feel their joints or limbs as they cogwheel. Some people describe it as an almost audible "click" as the joint moves forward a notch on the cogwheel. Others say the cogwheeling can be very painful. The cogwheel symptom may appear on one side of your body, but not on the other.

Many doctors use cogwheeling as one in a series of tests to see if a person may have Parkinson's disease. To perform this test, your doctor will ask you to relax and then will move your limb – your wrist, arm, or leg. If the "clicking" feeling is present, and if your doctor encounters resistance while moving the limb, then it's likely you have Parkinson's disease.

If the cogwheeling isn't immediately obvious, your doctor may ask you to move the corresponding limb or joint on the opposite side of your body – for example, raise and lower your left arm at the same time she's moving your right wrist. This action can help to tease out the cogwheeling effect if it's particularly subtle.

Since cogwheeling appears to be related to two primary symptoms of Parkinson's disease (rigidity and tremor), treatments for the condition can control it.

Drugs your doctor may use to treat your Parkinson's include levodopa and dopamine agonists. Both are considered effective treatments for rigidity and tremor, although they may become less effective over time as your disease progresses.

Regular exercise also can help keep your muscles more limber and lessen the cogwheeling effect. Dancing to music is one particularly fun activity that may help to reduce stiffness.

In addition, if you find you're getting so stiff that you're having trouble with normal daily tasks, you may want to consider physical therapy. A good physical therapist can provide instruction for the best ways to move (and to exercise) to counter your rigidity and lessen the cogwheeling effect.