By Anthony Egizi, DPT & Clinic Manager at ApexNetwork Physical Therapy in South City/St. Louis, MO
Peripheral Neuropathy is a condition where the nerves into the feet and the hands begin to decrease ability to send proper signals to the brain. The brain is told that there can be pain, decreased sensation with light touch, pressure, proprioception, and temperature when sensory nerves are affected. Motor nerves may also be affected by Peripheral Neuropathy causing motor weakness.
What does this mean when it happens to our bodies? We use light touch to feel the ground with our feet or to feel that something is in our hand. Pressure is sensed so that we can walk on a surface without falling or to hold an object in our hand so we can manipulate it without dropping the object. Proprioception is our bodies ability to determine where in space we are so that we can manage to stay upright and not on the ground due to a fall. Finally, temperature recognition is important so that we don’t burn our hand in the oven or burn our feet in the sand. Though sensation is usually the first of the symptoms you can also have weakness due to nerve damage, and at that point balance is an issue and fall prevention is key.
It is important to understand the reasons that may lead to a diagnosis of Peripheral Neuropathy. Contributing factors include: trauma, compression injury (herniated disc, nerve entrapment), diabetes, infections, exposure to toxins (medications, environmental, or alcohol), cancers, or autoimmune disorders. What is most seen in the clinic setting are those who have this diagnosis due to diabetes or a nerve compression injury. Due to the varied contributing factors, treatment can vary based on the particular cause of Peripheral Neuropathy one may be diagnosed with. With that being said, strengthening is the most important treatment protocol because of possible weakness, but also because of the balance dysfunction that occurs.
Strengthening – Lower extremity strengthening needed for maintaining or improving balance and gait. Exercises include use of thera-bands, hand weights, or weight bearing activities for core, hip, knee, and ankle strengthening.
Balance Training – Done to provide the required balance for gait, standing, and most activities of daily living. Exercises include single leg stance, bilateral leg stance, tandem standing, and standing with eyes closed.
Nerve Glides — When neuropathy is due to nerve entrapment nerve glides can be used to help get the nerve moving properly so stress is taken off of the nerve.
Posture Training – This can be help in cases of nerve entrapment to allow nerve movement to occur.