The “Pull Test” is simple and easy to perform and provides useful information. It is useful to assess postural instability in PwP.

The examiner stands behind the patient and firmly pulls backward his/her shoulders.

  • The test is normal (negative) if the PwP maintains balance and makes up to two steps backward, recovering his/her balance.

  • The test is positive if s/he takes multiple steps backward, or falls. (MunhozHelio, 2014).

If the test is positive before starting B1 and improves or normalizes during thiamine therapy, that is an important sign that the effective dose has been found, as no other treatment is currently reported to produce those results (Costantini’s website).
The Pull test can be performed periodically (e.g. on a weekly basis).

Selected references

Renato P. MunhozHelio A. Teive, Pull test performance and correlation with falls risk in Parkinson’s disease, Arq. Neuro-Psiquiatr. 72 (08), Aug 2014

Dr Costantini’s website on High-dose Thiamine (HDT) Therapy for Parkinson’s Disease, accessed 28.02.2023

Text author: Sergio Pièche
Page updated - 24/04/23