Exercise as a Treatment for Peripheral Neuropathy

Despite all of the excuses we may come up with to skip exercise when we have peripheral neuropathy, we actually have even more reasons to make exercise a priority if we are managing this condition. Why? Because science actually tells us that exercise can not only make us safer by strengthening muscles that aid in balance and movement, but exercise can even work to reduce neuropathic pain! Researchers Li Li and Jim McMillan stated that recent studies have shown that that "the activation of spinal glial cells via the enzyme glycogen synthase kinase 3 and increases in the production of both pro-inflammatory cytokines and brain derived neurotropic factor are crucial steps." Since many of the most common causes of peripheral neuropathy cannot be fully treated, it is critical to understand that routine exercise may not only help prevent some of those causes, but that it has also proven to be an effective means of alleviating some of the condition’s most distressing symptoms. Studies have also shown all it took was 10 weeks of exercise to significantly reduce pain and symptoms in men and women with DPN.

Now does all this mean that you need to get in the weight room pump it up like Hans & Franz. There are three main types of exercises ideal for people with peripheral

neuropathy: balance, stretching, and aerobic. It is important to approach exercise differently with neuropathy though, we must make sure what we do before all else, is safe. However, with safe exercise we can better maintain blood sugar (For DPN patients), build strength, lesson pain, lower high blood pressure, improve blood flow to extremities, prevent muscle wasting, improve sleep, reduce cramps, etc.

neuropathy: balance, stretching, and aerobic. It is important to approach exercise differently with nephropathy though, we must make sur what we do before all else, is safe. However, with safe exercise we can better maintain blood sugar (For DPN patients), build strength, lesson pain, lower high blood pressure, improve blood flow to extremities, prevent muscle wasting, improve sleep, reduce cramps, etc. neuropathy: balance, stretching, and aerobic. It is important to approach exercise differently with nephropathy though, we must make sur what we do before all else, is safe. However, with safe exercise we can better maintain blood sugar (For DPN patients), build strength, lesson pain, lower high blood pressure, improve blood flow to extremities, prevent muscle wasting, improve sleep, reduce cramps, etc.

Step 1: Consult Your Doctor

You should consult with your medical professional before beginning exercise because your neuropathy may affect how your body responds or does not respond to injury or activities that can risk injury. An example would be with feeling loss in your feet, you may stub your toe, twist your ankle, or even get blisters, without feeling them. Neuropathy patients have even been known to fracture their ankles (which required surgical intervention) and not know it because they cannot feel the full amount of pain it caused. So it is a good idea to make sure your doctor goes over any specific risks associated with your particular condition and also checks your extremity blood flow and any potentials for other risk factors such as ulceration. Also, your doctor could prescribe Physical Therapy (PT) to you and your insurance will cover part or all of your PT. Your doctor should look over the exercises you are thinking about doing.

Step 2: You Will Not Be Exercising Like Your Pre-Neuropathic Self

You are going to want to start with activity that takes your condition into account as well as your current physical state. You may want to start out with more simple balance and stretching exercises as you will most certainly do if your doctor has prescribed PT. I will put some basic balance and stretching exercises below to even start at home which I remember from doing my own PT. One big mistake of neuropathy patients, is to start out with walking thinking it is not high impact. However, long to medium distances even walking can now be too high-impact for you. Try instead walking shorter distances, or even better, try stationary cycling, swimming, or even chair exercises depending on your condition but all low impact. Remember the keys here are we want to increase our balance, stretch out our muscles, and get a good aerobic workout. This means for some of us doing the basic stretching included below and then trying to move constantly for up to 30 minutes is all it will take. The key here is again, low impact! Water therapy can also be prescribed through your PT. Another great choice is rowing on stationary machines.

Step 3: Wear the Right Footwear

This is always important, but with nephropathy it can be vital! You want to make sure you wear shoes that have good anti-roll protection (helps your balance), with good padding, and a snug fit. You want socks that reduce friction and pull moisture away from your skin (to avoid ulcers or blisters). I just wrote an article "Neuropathy and Footwear" about what I personally have researched and use. You can check it out here.

Step 4: Use the Neuropathic Training Triad (Balance, Stretching, and Aerobic) and Increase Slowly

Here again we want to mix our exercise up. Balancing exercises are key for nephropathy sufferers. The condition can leave your joints and muscles feeling stiff and sometimes week. However this is just your muscles needing that "activation." This will improve your balance and prevent falls.

Side Leg Raise

1. Using a chair or counter, steady your balance with one hand.

2. Stand straight with feet slightly apart.

3. Slowly lift one leg to the side and hold for 5–10 seconds.

4. Lower your leg at the same pace.

5. Repeat with the other leg.

6. As you improve balance, try this exercise without holding onto the counter.

Calf Raise

1. Using a chair or counter, steady your balance.

2. Lift the heels of both feet off the ground so you’re standing on your toes.

3. Slowly lower yourself down.

4. Repeat for 10–15 reps.

ABC’s—Ankle Range of Motion Exercises

1. Use only your ankle and foot to “write” each letter of the alphabet from A to Z. Keep leg straight. Do not bend knee or hip.

2. Repeat.

Toe Curls

1. Pull your toes down to make a fist with your foot. Curl your toes and grab a towel.

2. Hold this position for 2 to 3 seconds and then release.

3. Increase this gradually up to 10 times with each foot.

Toe Splays

1. Sit with your knees bent and feet on the floor. Pull your toes up towards your body as much as possible and spread your toes apart.

2. Hold for five seconds.

3. Increase this gradually up to 10 times with each foot.

Bipedal Toe and Heel Raises

1. Stand in front of a counter, sink, or chair that is the same height at your waist.

2. Place your feet shoulder width apart. Rise up on the balls of your feet, and hold for five seconds.

3. Return to start position and rock back on heels for five seconds. Return to start position.

4. Increase this gradually up to 20 times.

Stretching increases your flexibility and warms up your body for other physical activity. Routine stretching can also reduce your risk of developing an injury while exercising. These are both important in to a neuropathy sufferers. Remember we have most likely been more inactive due to the pain caused by our condition. We have to let those muscles remember being used.

Calf stretch

1. Sit with your back against the wall or the headboard of the bed.

2. Hook a belt, sheet, or towel around the top of your right foot and pullhe foot up towards your body. The right knee should stay straight.

3. Hold 30 seconds. Repeat this exercise with the left foot.

4. Repeat three times per leg.

Seated hamstring stretch

1. Sit on the edge of a chair.

2. Extend one leg in front of you with your toe pointed upward.

3. Bend the opposite knee with your foot flat on the floor.

4. Position your chest over your straight leg, and straighten your back until you feel a muscle stretch.

5. Hold this position for 15 – 20 seconds, up to 30 seconds.

6. Repeat three times per leg.

Or Hamstring Stretch

1. Hook a belt, sheet, or towel around your foot. While lying down on your back, lift your leg to a 90 degree angle or as far up as possible.Keep your knee straight.

2. Hold this position for 15 – 20 seconds, up to 30 seconds. The opposite legshould stay straight on the bed or floor. Repeat the same exercise with the opposite leg.

3. Repeat three times per leg.

Knee to Chest Stretch

1. Lie down on your back with your legs out straight. Bring your right leg up towards your chest. Place your hands behind the right knee tohelp pull the knee closer to your chest. Hold 30 seconds. Lower your right leg to the start position and repeat the same exercise with the left leg.

2. Repeat three times per leg.

Sciatic Nerve Glide

1. Pull your right knee towards your chest. Bend your right knee and gently lift your leg so your knee goes straight. Once you feel a little tension in your leg, put your leg back down to the bent position.

2. Repeat 10-20 times per leg.

Wall Slides

1. Stand with your back against the wall, Keep your head, shoulders, and back against the wall with your feet out in front and slightly wider than shoulder width.

2. Slowly lower your buttocks, sliding down the wall until your thighs are just above parallel to the floor. Keep your back flat.

3. Hold this position for 5 to 15 seconds.

4. Return to standing position.

5. Repeat 10-20 times.

We have added these to a PDF that you can print out and/or download. Download Here

For many of us, these balance builders and stretches are going to take us time to build up too even doing them repeatedly, and that is fine. Just like everything else with this condition, it takes time. Try doing them one day a week, then two days, then three. Once you get to a point where you are comfortably doing them three days a week, increase the repetitions. Once you have these mastered, you can start adding some of the aerobic exercises to complete the triad. I can promise you if nothing else, you will have more balance and if you are on a cane, you will be well on your way to using it less. As for the pain, would you not try anything for 10 weeks to see if it worked?

Remember....

"Do something today that makes tomorrow a better day!"

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