What is peripheral neuropathy?

Peripheral neuropathy is a type of nerve damage affecting nerves that connect our brain to the rest of our body. Neuropathy literally means “nerve disease”. Peripheral refers to distal body parts such as the feet and hands.

Peripheral neuropathy is commonly caused by diabetes. It usually affects the feet, in which the individuals feel tingling, burning, or numbness in a stocking distribution.

We call it a stocking distribution because the areas affected by the neuropathy are exactly as the areas a pair of socks would cover. The only difference is how high the socks are. Severe cases can affect even the knees.

Aside from the feet, peripheral neuropathy can also affect the hands in a glove distribution. Tingling, burning, or numbness will be felt starting at the fingers and move their way up until the wrists.

The changes in sensation felt can be really discomforting. Alongside the sensations that we mentioned earlier, patients with diabetic neuropathy can also have altered perception towards pain.

They can feel less pain than usual such as not feeling a cut they got from a cat’s scratch. Conversely, they might feel more pain than a normal person that even a small paper cut makes them scream in agony.

Of course, there multiple medications that a physician will recommend at a clinic visit to relieve the symptoms and treat diabetes.

However, there are also exercises that a person can opt to do daily to further improve their symptoms. In this article, we will be discussing 5 evidence-based exercises that have been proven to help with diabetic neuropathy.

Is it safe for people with peripheral neuropathy to exercise?

It’s kind of a deep-rooted idea in our subconscious that when a person falls ill, then they should get as much rest as possible. This may be true for certain diseases, but definitely not for all of them.

Peripheral neuropathy is one such condition that one should be encouraged to move around and exercise. In fact, it has been established in multiple research studies that exercise can improve pain, balance, numbness, and lot more in those with neuropathy.

Some people may discourage exercise, specifically those using weights in those with neuropathy because it can increase the risk of foot ulcers. This is actually a myth.

A study was published in the Physical Therapy and Rehabilitation Journal that tested if weight-bearing exercises could increase the risk of foot ulcers. They found that after 6 months, these exercises did not cause significant increases in foot ulcers.

Moreover, there may be concerns of falling when doing balance exercises. I mean, these exercises are meant to challenge your sense of stability. This is also a myth.

In fact, multiple studies, including a study from the Physical Therapy and Rehabilitation Journal, debunked the myth that these exercises would increase the chances of falling.

So, it’s definitely safe for a person with diabetic peripheral neuropathy, or peripheral neuropathy caused by other conditions for that matter, to include exercise in their daily routine.

What exercises are good for peripheral neuropathy?

1. Walking

Also known as cardiovascular conditioning or simply “cardio”, aerobic exercise is a group of exercises that gets the heart pumping.

For healthy individuals, aerobic exercises include running, jumping rope, cycling, and swimming. However, people with neuropathy need an alternative that is less intense but still effective.

The U.S. Department of Health and Human Services physical activity guidelines gives walking, gardening, and water aerobics as medium level aerobic activities that are suitable for older adults.

According to a study published in the Journal of pain Medicine, having well-planned walking sessions managed to improve quality of life in patients with diabetic peripheral neuropathy.

They followed the researcher’s 16-week workout plan. The main focus was to walk three times a week, for 30 minutes for each session. As the weeks go by, the participants were asked to increase the duration of each session slowly, until they would walk 50 minutes by the end of week 16.

The result of this workout plan was that the pain felt from neuropathy were less likely to interrupt their daily life. They could walk more comfortably, sleep more soundly, and overall improved their relationship with others. By improving their quality of life, the experiment was a success.

Walking is such a simple activity but has profound benefits. You can walk around your neighborhood, around the house, or when going to buy groceries.

In fact, the participants in the study were given options to use a treadmill, cycle ergometer, or elliptical trainers to give them freedom of choice.

2. Strength training

Strength training involves the use of our muscles in ways that require more effort than usual. It is a type of muscle-strengthening training that can be done by using weights or resistance bands.

One of the issues faced by those with peripheral neuropathy is that their legs get weaker and weaker over time. This can make simple tasks like standing up or walking so exhausting.

Moreover, nerve connections are weaker in these individuals because of either reduced number of nerves, or the specialized insulation of those nerves, called myelin, have gone thinner.

Therefore, by strengthening the muscles through exercise, not only will the muscles grow stronger, but the nerve connections that control those muscle groups will also improve too.

The U.S. Department of Health and Human Services physical activity guidelines gives examples for strength training that are suited for older adults. They included weight-training, resistance-band training, calisthenics or body-weight training, and even mundane tasks such as carrying groceries.

Now, in the case for peripheral neuropathy, a study by Isfahan University of Medical Sciences in Iran experimented how strength training could benefit those with the condition.

Even though their study did include aerobic exercise and vitamin D supplementation, the participants did improve in various ways. After 12 weeks of training, they had reduced numbness, tingling, pain, and weakness in the lower limbs.

Their training consisted of a minimum of 30-minute-sessions, 3 times per week on Monday, Wednesday, and Friday.

Examples of strength training exercises that can be safely done by those with peripheral neuropathy are kitchen counter calf raises, chair squats, and seated dorsiflexion, according to the Foundation for Peripheral Neuropathy.

3. Balance training

Balance training is just how it sounds: it’s training to improve balance. It’s a type of static exercise where you maintain a certain position as long as possible.

People with peripheral neuropathy have reduced awareness of their limbs because of the weakening of nerves. This is because of the weakening of those nerves due to conditions such as diabetes mellitus,

If you can’t feel your feet at all, then how would you feel the floor you’re stepping on? This will make tasks such as climbing the stairs so difficult, and you’re a risk of falls.

The U.S. Department of Health and Human Services physical activity guidelines gives examples for balance training exercises. They include walking, sideways walking, heel walking, toe walking, and standing from a sitting position.

These are easy and safe exercises to be done by those with neuropathy at risk of falling. To further reduce the difficulty, you can hold onto something for support, like a piece of furniture. Even better, have another person help you along the exercise.

A study conducted in Shiraz University of Medical Sciences, Iran sought to find out how certain balance exercises would improve balance in diabetic neuropathy. The balance exercises that they tested out were Frenkel exercises and Swiss ball exercises.

A Swiss ball is a durable ball made from PVC. It can be obtained in various sizes as small as 40cm (15 inch), and as big as 80cm (31 inch).

Balance-related exercises for a Swiss ball typically requires you to maintain a certain position on the ball, such as sitting or leaning on it. This video is great if you’re looking to try it out.

Frenkel exercises, on the other hand, are a group of exercises created by Heinrich Frenkel, a Swiss physician and neurologist. Here is a YouTube video demonstrating the lower limb Frenkel exercises.

Getting back to the study in Iran we mentioned earlier, they concluded that both the Swiss ball exercises and Frenkel exercises managed to improve balance. However, Swiss ball exercises were actually better in that regard.

What precautions must be taken when exercising?

Now, before starting to exercise, a few precautions or extra steps must be taken. Healthy individuals can just grab a pair of running shoes and go for a jog without a thought in mind, and they’ll do just fine.

However, if you have peripheral neuropathy, you may be at risk of foot ulcers not because of the exercises themselves, but because of the conditions you’re exercising in.

Here is a list of things you need to take into account:

• Wear suitable footwear. Wear shoes that are not too tight or too loose. Even better, get a prefabricated pair of insole orthotics to be fitted into your shoes. This will improve comfort and reduce pressure at the feet.
• Don’t exercise in the rain or in wet shoes. Exercising in these conditions can increase the friction between your skin and your shoes, making your feet at risk of foot blisters. We have a whole article of foot blisters for your convenience.
• Don’t go past your limit. It’s best for those with peripheral neuropathy to exercise in a low intensity.
• Exercise with a friend. Having a friend with you while you exercise not only motivates you to keep going but is also safer. In case anything happens, your friend will be there to help.
• Take care of your feet. If you have diabetic feet and have not developed ulcers, we recommend reading our article on diabetic foot care.

Conclusion

Exercise tailored for peripherally neuropathic individuals are crucial in improving both symptoms and quality of life.

It may be tempting to go all-in and push yourself to the very limit in hopes of quick success, but consistent efforts to rid of sedimentary lifestyle is actually much better than short-lived bursts of intense exercise.

When in doubt, consult your podiatrist or physician for medical advice.