Peripheral Neuropathy Physiotherapy
Peripheral neuropathy involves damage to nerves anywhere in the body apart from the brain and spinal cord. It can affect nerves that control movement, sensation and automatic functions like digestion.
Peripheral neuropathy physiotherapy treatment aims to help people with the condition to maintain their independence, function and quality of life. Typically, this involves Therapeutic Supports designed to reduce the disability and pain often associated with peripheral neuropathy.
Neurological physiotherapists use various techniques to help someone with peripheral neuropathy reach their goals.
What is peripheral neuropathy?
Peripheral neuropathy is the term used to describe a range of Neurological Conditions that affect the peripheral nervous system.
The peripheral nervous system includes all the nerves outside the brain and spinal cord. This part of the nervous system transmits information to and from the brain and the body. It includes the autonomic nervous system, which is involved in controlling involuntary functions like the heartbeat and sweating.
Because peripheral neuropathy can affect nerves that control so many different things, symptoms of the condition vary widely.
- Sensory changes such as tingling, numbness, feeling like you’re wearing gloves and stockings, and loss of sensitivity to temperature
- Muscle weakness, wasting, cramps and twitching
- Loss of tendon reflexes
- Balance problems
- Neuropathic (nerve-generated) pain, which often feels like burning or shooting pain
- Changes to control of automatic functions like digestion, blood pressure and temperature control
- Complications such as leg ulcers and gangrene, which in some cases may lead to amputation.
Peripheral neuropathies typically develop over months to years, although some come on more quickly. They are very diverse, and symptoms can vary significantly from one person to the next.
What causes peripheral neuropathy?
Peripheral neuropathies are caused by numerous things, including:
Physical injury or compression
Trauma and pressure from bulging discs or arthritis can damage peripheral nerve tissues.
Some conditions, like Guillain-Barre syndrome and lupus, affect function of the peripheral nervous system. Some inherited conditions are also associated with peripheral neuropathy. These include Charcot-Marie-Tooth disease, familial amyloidosis and Friedreich’s ataxia.
About half of all people with diabetes will experience damage to the peripheral nervous system. Diabetic neuropathy risk increases as you get older, and nerve damage can have affects throughout the body. Many people have symptoms such as tingling, numbness and pain in the feet, legs, hands and arms, although some people have no symptoms. Poorly controlled blood glucose (sugar) levels can contribute to peripheral nerve damage.
Medicines and toxins
Some substances can damage peripheral nerves, including alcohol and some medicines used to treat cancer, heart conditions and HIV.
Infections including chicken pox, HIV, and hepatitis C can cause nerve damage.
A diet lacking adequate vitamins (including B1, B6, B12 and E), may lead to nerve damage.
Peripheral neuropathy physiotherapy treatment may be partly determined by the cause of the condition, as well as how symptoms are affecting the individual.
Physiotherapy management of peripheral neuropathy: an overview
In the management of peripheral neuropathy, physiotherapy focuses on supporting people to maintain their independence and ability to participate in daily activities such as study, work, home and community life.
Peripheral neuropathy physiotherapy treatment achieves this using treatment strategies designed to:
- improve or maintain your muscle strength and range of movement
- prevent muscle shortening (contracture) and deformity
- improve or maintain your balance and coordination
- assist with pain management
- help you manage the physical impact of your condition.
Peripheral neuropathy physiotherapy: What the evidence shows
Peripheral neuropathy physiotherapy management might include electrotherapy treatment to help with pain.
Research into physiotherapy for peripheral neuropathy has shown some promising results. For example, a 2018 systematic review analysed results from five studies that looked at physiotherapy interventions for people with chemotherapy-induced peripheral neuropathyi.[i] They found that strength and endurance training had positive effects on balance, leg strength, and function. Additionally, physiotherapy interventions led to a reduction in pain and numbness symptoms, along with better scores for quality of life.
A 2020 systematic review analysed 19 studies into the effectiveness of physiotherapy for managing the symptoms and complications of diabetic peripheral neuropathy.[ii] Reported results from electrotherapy treatment included improvements in pain, postural stability, foot sensation, physical activity, sleep quality, and life satisfaction. Exercise therapy led to improvements in foot and ankle function, foot muscle strength, range of motion, walking speed, balance, physical activity levels and neuropathic symptoms.
Similarly, a 2021 systematic review of 29 studies concluded that exercise and manual therapy are beneficial for people with diabetic peripheral neuropathy.[iii]
A 2020 narrative review found there is a growing evidence base for physiotherapy in the treatment of peripheral neuropathic pain.[iv] However, more research is needed to develop treatment recommendations.
Physiotherapy for peripheral neuropathy
Peripheral neuropathy physiotherapy treatment will depend on your symptoms, overall health and therapy goals. As experts in movement and function, physiotherapists design personalised treatment programs for each individual. Physiotherapy for peripheral neuropathy will often include:
Walking (gait) training
Gait training can help to improve your ability to walk further, as well as the quality of your gait. Your physiotherapist might prescribe a program of walking training for you to complete on your own, or with help from a support person.
Activities that raise your heart and breathing rate can help to maintain or improve your fitness, endurance and ability to stay active. Examples of aerobic exercise include brisk walking, cycling, boxing, rowing and riding a stationary bike. Your physiotherapist can help you find a type of exercise that you enjoy and is suited to your goals.
Activities that build muscle strength can help to improve or maintain your functional ability. Examples include exercises using resistance bands, weights, or body weight (such as squats, lunges and push ups).
Peripheral neuropathy often causes changes to sensation and muscle strength. These can lead to balance problems and falls. Balance training can help you to stay steady on your feet and assist with falls prevention.
Flexibility or stretching exercises help to keep your joints mobile. To prevent muscle stiffness and shortening, your physio might give you stretches to do yourself, or with help from them or a support person.
Prescription of assistive devices
Your physio might recommend assistive devices – such as walking aids or orthoses – to help you stay active at home and in the community.
To help with neuropathic pain, your physio might use hands-on techniques such as soft tissue massage, as well as electrotherapy. They may also prescribe devices such as splints or compression garments to help with peripheral neuropathy symptoms.
Training support people
For some people, peripheral neuropathy is associated with other conditions that have a significant impact on function, and formal and informal supports may be involved in their care. Physiotherapy may include training support people to assist with activities such as mobility, transfers, and completing an exercise program.
Peripheral neuropathy physiotherapy treatment with Active Ability
The NDIS registered physiotherapists at Active Ability are experienced at supporting people with peripheral neuropathy associated with a range of disabilities and health conditions.
We’ll do an assessment to see how peripheral neuropathy is affecting your function or ability to participate in important activities, then design a personalised plan to help you reach your therapy goals.
To help you achieve what matters to you, Active Ability also has NDIS registered clinical dietitians and accredited exercise physiologists on staff. This allows us to offer multidisciplinary support to help you maintain or improve your independence, health and quality of life.
We don’t have a waiting list or travel charges, so you can start physiotherapy once you’re ready, while getting the most from your NDIS funding.
[i] – Rehabilitation Oncology (2018). Physical Therapy–Based Interventions Improve Balance, Function, Symptoms, and Quality of Life in Patients With Chemotherapy-Induced Peripheral Neuropathy: A Systematic Review. https://journals.lww.com/rehabonc/Abstract/2018/07000/Physical_Therapy_Based_Interventions_Improve.5.aspx. Accessed online 7.12.2022.
[ii] – Journal of Diabetes and Metabolic Disorders (2020). The efficacy of physiotherapy interventions in mitigating the symptoms and complications of diabetic peripheral neuropathy: A systematic review. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7843894/. Accesses online 7.12.2022.
[iii] – Applied Sciences (2021). Exercise and Manual Therapy for Diabetic Peripheral Neuropathy: A Systematic Review. https://www.mdpi.com/2076-3417/11/12/5665/htm. Accessed online 7.12.2022.
[iv] – Pain Reports (2020). Physiotherapy for people with painful peripheral neuropathies: a narrative review of its efficacy and safety. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7808681/. Accessed online 7.12.2022.