“Appropriate neuropathy exercises are a vital part of any CIDP intervention plan because of its potential to improve strength and endurance, thereby minimizing muscle shrinkage and improving function and mobility.” This quote is from an OUTSTANDING article in the August – September 2010 issue of I.G. Living (IGLiving.com). The article was written by Mathew David Hansen, DPT, MPT, BSPTS who practices in Washington State and is titled “Exercise for CIDP.”
Dr. Hansen produced a great DVD on Exercise for neuropathy patients. We highly recommend this DVD as it confirms what the NSN has been saying for years about the wrong type of exercise involving damaged nerves. Dr. Hansen has contributed to the work of the NSN and when you use the special code when ordering the DVD, part of your price is donated back to the NSN.
The principles shared in his article are the quintessential guides for any therapist and provides all neuropathy patients wisdom in their own neuropathy exercise program. These principles are what I, in working with my own physical therapist and neurologist, discovered during many years of physical therapy for neuropathy.
I have been ‘counseled and attacked’ by some so called ‘experts’ who still think that “working through the pain,” as my football coach encouraged us to do in high school, is appropriate for neuropathy patients. It is not.
When I followed instructions from those who thought they knew best it resulted in many horrible experiences for me: severe bone pain, horrific electric shocks, significant numbness and extreme fatigue along with the frightening experience of my legs from the waist down turning into cement when I was told to “push through the pain.”
For some patients the pain might go away, but this more often than not, was due to the relapsing and remitting patterns (Click on link to see explanation) of the symptoms of neuropathy. Sometimes neuropathic pain and symptoms stop for a period (remit) and we do not know why this is so, but unfortunately they may return (relapse). These periods of remittance are often mistakenly thought to be due to some event, treatment or behaviors, yet remitting of symptoms are totally unrelated to the event. I think of the patient who thought ivory soap between the legs stopped leg cramps was uninformed at best and this type of recommendation hurts us all in our quest for help!
A neuropathy patient shared with the NSN the following experience and is used with the patients permission:
“In 2005, pain in my hands and feet led to a diagnosis of diabetes and diabetic neuropathy. Brisk walking on my treadmill (30 to 35 miles a week) brought me back to my high school weight and an A1C of 5.8. However because of my neuropathy, brisk walking became too hard on my feet, causing blisters and temporary numbness in my toes despite my best efforts. At the suggestion of one of my doctors 2013 I purchased an exercise machine to help control my blood sugar. Unfortunately, I used the machine incorrectly. By Feb. 2014, the outer halves of my big toes were numb. I did not realize it was a warning sign and could morph into (greater neuropathic) pain. Thinking the numbness meant the nerves were dead and I could do no further damage, I maintained my workouts. In September 2014, my big toes and balls of my feet suddenly became hypersensitive to pressure and the simple act of walking, brought increased burning, pain, electric shocks and stabbing sensations, especially in the big toes and balls of my feet. The neuropathic pains from the wrong exercises plagued and continue to plague my every step. I can no longer use the exercise machine, have difficulty walking and spend most of my time on my side in bed. When I walk, it is on my heels and the sides of my feet. I purchased seven cashiers mats for our wood floors and stand on folded towels in the shower. I am waiting on a quad cane in hopes it will reduce the weight on my feet when I walk. My most important reason for writing is doctors and neuropathy patients need to be aware of the dangers of over exercising or doing the wrong kind of exercise as this will exacerbate neuropathic pain. Increased pain in exercise and numbness for neuropathy patients are signs that something is wrong and must be investigated. The irony is that I unknowingly caused compression/trauma-induced neuropathic pain while trying to control my blood sugar! Exercise is good, but the wrong type and kind for a neuropathy patient with damaged nerves is dangerous. I cling to the hope that this is a temporary situation and not chronic or worse, progressive. If I can prevent just one person from inadvertently causing severe neuropathic pain or more damage to damaged nerves, by spreading the word about hazards of the wrong type and kind of exercise, perhaps some good can come from my misfortune.” TK
For hundreds of neuropathy patients whom I have counseled over the years, the pain did not go away with regular exercise. The only possible exception might be for those with an entrapment neuropathy, but even here the principles still apply. According to Hansen, when the ideas listed in his article were followed, every goal of physical therapy and exercise were accomplished in therapy without pushing through the pain. In fact any increase in neuropathic pain or symptoms signaled that the focus of the therapy needed to be adjusted. This is what my physical therapist taught me and she was right!
Hansen’s key words are “appropriate exercise” for those with neuropathy. His “FITT principle” meaning that exercise must be focused on FREQUENCY, INTENSITY, TIME AND TYPE OF ACTIVITY, in response to the neuropathy patient’s physical state at the time, is fact. These principles are the essence of what I have written about and this has been confirmed numerous times in my experience over the years. Even today some physical therapists believe that if patients adhere to a regular exercise regimen, over time, they notice that their overall pain levels go down. They state that the difficulty for most PN patients is to overcome the initial increase in pain that comes with exercise. I contend that the problem here is not with the neuropathy patient, but with the failure to apply the principles stated in Hansen’s article. The issues of exercise for the neuropathy patient, whether CIDP or other causes, are more complex than working through the pain might suggest.
Neuropathy Exercises are important for the neuropathy patient in order to maintain muscle mass and increase flexibility, balance and other issues faced by the neuropathy patient. If physical therapists apply Hansen’s ideas, then they will do a great service for the neuropathy patient. to learn more about Dr Hansen’s Exercise DVD be sure to read the Neuropathy Journal’s article Exercise for Neuropathy DVD