Tremor: What It Is, What Makes It Worse, and How We Attack It

Tremor is one of the most visible and frustrating symptoms of neurological conditions. It's the shaking hand at the dinner table. The coffee cup you can't trust. The signature that doesn't look like yours anymore.

It's also one of the most misunderstood symptoms in neurology — and one of the most undertreated.

Most people are told to live with it. Medication can help in some cases. Surgery is an option for a narrow group. But for the vast majority of people dealing with tremor, the answer they get is some version of "manage it."

At LWA, we treat tremor like the neurological problem it is. And we go after it.

Before we talk about what to do, let's talk about what we're dealing with — because "tremor" is not one thing.

Resting tremor happens when the affected body part is relaxed and supported — the classic Parkinson's "pill-rolling" tremor in the hands. It typically improves with intentional movement.

Action tremor happens during voluntary movement. This includes:

• Intention tremor — worsens as you approach a target (reaching for a glass, touching your nose). Common in ataxia and MS. Caused by cerebellar dysfunction.
• Postural tremor — occurs when holding a position against gravity (arms outstretched). Common in essential tremor and some forms of MS.
• Kinetic tremor — occurs during any movement, not just targeted ones.

Why does this matter? Because the type of tremor tells you something about where the problem is in the nervous system — and that shapes how you train around it.

Understanding your triggers is half the battle. The most common tremor amplifiers:

Stress and anxiety. The sympathetic nervous system activation that comes with stress directly worsens tremor. This is why your hands shake more when you're nervous, and why people with neurological conditions often notice their tremor spikes in high-pressure situations. This is not weakness. It's neurology.

Caffeine. I know. Nobody wants to hear this. But caffeine is a central nervous system stimulant that directly amplifies tremor in most people. If your tremor is significantly impacting your quality of life, this is worth an honest experiment.

Fatigue. When your nervous system is depleted, its ability to regulate motor output degrades. Tremor gets worse at the end of the day, after long sessions, and after poor sleep for exactly this reason. This is another argument for taking sleep seriously.

Poor nutrition and blood sugar instability. Blood sugar crashes trigger a stress hormone response that worsens tremor. This is one of the reasons we push a carnivore or carnivore-leaning diet — stable blood sugar means a more stable nervous system.

Dehydration and electrolyte imbalance. Nerve conduction depends on electrolyte balance. Sodium, potassium, magnesium — when these are off, motor control suffers. This is not a small thing. It's one of the reasons we take electrolytes seriously at LWA.

Here's where most programs fall short: they work around tremor instead of working on it.

We work on it.

Weighted resistance training. Resistance training improves motor unit recruitment and coordination. It also builds the strength and stability that gives your nervous system a better platform to work from. Stronger muscles don't eliminate tremor, but they give you more control over the affected limb — and that translates to real function.

Proprioceptive training. Proprioception is your body's sense of where it is in space. In conditions like ataxia and MS, proprioceptive signals are often disrupted, which contributes to intention tremor and coordination problems. Targeted proprioceptive training — balance work, unstable surfaces, closed-chain movements — helps your nervous system recalibrate its position sense.

Task-specific practice. The nervous system gets better at what you practice. If tremor is affecting your ability to eat, write, or button a shirt, practicing those specific tasks — with appropriate modifications and progressions — drives neuroplastic adaptation in the exact circuits you need. This is not occupational therapy as an afterthought. It's targeted neurological training.

Breathing and stress regulation. As I wrote last week — your breathing pattern directly affects your sympathetic/parasympathetic balance. Slow, diaphragmatic breathing before and during challenging tasks reduces the stress-driven component of tremor. This is a skill, and it's trainable.

Timing and energy management. If tremor is worst when you're fatigued, we schedule the most demanding tasks and training sessions for when your nervous system is freshest. This isn't giving up — it's strategy.

I'm not going to tell you we can eliminate tremor in every case. That would be a lie, and I don't do that.

What I will tell you is that most people with tremor have never been through a structured program that actually addresses it as a neurological problem. They've been given medication, told to be careful, and sent home. That's not rehabilitation.

When you train the nervous system properly — when you address the underlying drivers, build the right physical foundation, and practice the specific functions that matter to you — tremor becomes something you manage from a position of strength rather than something that manages you.

That's a different life.

Tremor is not just something that happens to you. It's a signal from your nervous system — and your nervous system can be trained.

Know your type. Know your triggers. Build the foundation. Practice the functions that matter. And stop accepting "live with it" as the final answer.

Art Thomas is the founder and CEO of LWA. He has ataxia, went from a wheelchair to walking completely independently, and works with people across every neurological condition. LWA offers remote rehabilitation programs worldwide — for ataxia, MS, Parkinson's, stroke, TBI, and beyond. Book your FREE 30-minute Zoom consultation and let's build your whole-person plan.

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