Physical Therapy, Exercise and Neuropathy

Physical Therapy, Exercise and Neuropathy

Article “Physical Therapy, Exercise and Neuropathy” reviewed by Dr. Waden E. Emery III, MD, FAAN, Board Certified Neurologist, Lighthouse Point, Florida and endorsed by Karen Sheppard, Physical Therapist of Fort Lauderdale, Florida.

Q: “Should someone with neuropathy do daily exercises so they don’t lose muscle strength?

A: It is important to work closely with your treating physician ensuring that it is okay to enter into an exercise or physical therapy program. That being said, the proper exercise and supervised physical therapy can be very important components in any complete treatment approach to many peripheral neuropathies. The best exercises are low impact, which are the right kind for anyone with neuropathy. The wrong kind or too much exercise will increase symptoms because damaged nerves will attempt to work in overload.

Many neuropathy patients will tell you that swimming is one of the best exercises for the neuropathy patient. Mims Cushing in her 2009 book, You Can Cope With Peripheral Neuropathy: 365 Tips for Better Living (www.amazon.com ) has great suggestions on this subject from patients who have been there.

Q: “Will physical therapy cure neuropathy?”

A: Some neuropathy patients go to physical therapy (PT) with unrealistic goals, thinking that PT is a cure for neuropathy. PT does NOT cure neuropathy. One exception is entrapment neuropathies. A skilled physical therapist and other medical specialists can be very helpful in relieving the pressure on the nerve(s).

Important goals for physical therapy or exercise are to maintain muscle strength, improve gait, balance, coordination and flexibility. Also to improve balance issues and the ability to walk (using both the eyes for visual information and feet), increase one’s being able to hold things and more.

Muscle weakness, muscle atrophy, loss of coordination, dizziness, loss of feeling in the feet and hands, all demand the attention of an expert physical therapist knowledgeable about the effects of various types of neuropathy on muscle and nerves.

Q: “What have you learned about exercise, physical therapy and the symptoms of neuropathy?”

A: DO NOT work through the pain if you have neuropathy. Gym coaches may have taught you “no pain, no gain” — DO NOT even go there! With neuropathy the quantity and focus of exercise or physical therapy is determined by your diagnosed condition, symptoms, and pain. Exercise and physical therapy must take into account the extent of inflammation of the nerves, amount of damage to the nerves, the degree of blockage to them, and how much they have been injured.

Q: “Can you do harm with the wrong type or quantity of exercise?”

A: Yes. With exercise for the neuropathies, a little is a lot and quality, focus, and regularity are all important. Those things are more important than how much exercise you do. With neuropathy you must dismiss much of what you have been taught about exercise. As mentioned above, you must NOT work through the pain or you may increase your symptoms. Over use of inflamed or injured nerves will cause them to stop working temporarily and you may feel a cement-like numbness in your feet and legs, or other strange and painful symptoms in your body.

A good physical therapist with knowledge of the neuropathies will understand you. If a physical therapist is unavailable,purchase a copy of the DVD  by Dr. Hansen On Exercise for the Neuropathies.

Learning your limits, knowing how to pace yourself, adjusting daily activities and exercising correctly, are important insights for physical therapy or any exercise program for a person with neuropathy.

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About the Author

LtCol Eugene B Richardson, USA (Retired) BA, MDiv, EdM, MS

Col Richardson has suffered with severe neuropathy for over 45 years. A 27 year military veteran and veteran of the Vietnam War, he was diagnosed with a progressive chronic peripheral neuropathy resulting in severe disability. This diagnosis has been confirmed as due to exposure to Agent Orange. It was not until 2010, 42 years after his exposure to Agent Orange, that his diagnosis was recognized by Veterans Affairs as service connected.

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10 Comments

    1. This resource is in Pennsylvania… see counties noted in the message.

    1. Shirley: I would check out the neuropathy center at the University of Chicago and see if they have connections with a physical therapist that understands neuropathy. Basically you are looking for low impact exercises that understand the damage that may have been done to your nerves. The tap SIT AND BE FIT in the RESOURCE tab of the website may also be something you may want to consider. Gene

  1. how do i assess nerve damage due to spinal anesthesia needle trauma. my son had foot drop after appendectomy for more than a month now

    1. Marites: Nerve damage is determined by what is called the Nerve Conduct Test and the EMG for damage to large fiber nerves. For damage to small fiber nerves this requires a simple skin biopsy done by a specialty lab. Go to the NSN TODAY tab and on the left side you see categories of topics. When you get down to Small Fiber Neuropathy you will see an article on skin biopsy. Print this and take it to the doctor if they have no clue. As for the EMG and Nerve Conduct Test, you need a Board Certified Neuromuscular Neurologist who are specially trained not only to administer these tests, but also to interpret them. If you need for information send an e mail to gene@neuropathysupportnetwork.org and we will respond with an answer. If neuropathic pain is an issue go to the NSN TODAY tab and under neuropathic pain, read all those articles. As for the foot drop, you son should use a cane or some other supporting device to prevent falls until this resolves. The other issue is for other tests to be done to make sure that it is from the spinal anesthesia needle…. and not some other neuropathy issue. If you send an e mail I can send a document on diagnosis etc… Best Gene

  2. Thank you Doctor for the valuable information.. I had been diagonised with ideopathic small fiber neuropathy 3 years back.. my shootin pains in the legs subsided with Lyrica, amitryptaline, cymbalta and duloxetine…I still take them.. But all of a sudden the mild shooting pains are coming back and there is a pain on top and under the feet…I forgot that I am a neuropathic patient and brisk waljed excessively for the past one month…Is it the reason for my pains? I have stopped walking now…Could you please suggest a way Doctor, that will help reduce my pains…Thanks in advance

    1. Beena: Yes, the walking more likely than not, forced damaged nerves to work, thus increasing your neuropathic pain. It is important that you do only exercise that are low impact, appropriate in type, and intensity. When any exercise increases the neuropathic pain, stop. To understand this go to this link: http://neuropathyjournal.org/exercise-and-neuropathy/
      Maybe there is some simple ideas that may help, such as a topical cream that the doctor can order to help with burning pains at night (Dr. Hunter mentioned the ingredients physicians use in these compounds includes Lidocaine, ketamine, gabapentin, and amitriptyline, mixed by a compounding pharmacy in percentages as prescribed by the physician)
      Some patients have found that resting your burning skin in cool tap water (not FREEZING) for 15 minutes before bed to calm the damaged nerves. Other patients find that warm water, (NOT hot) helps rather than the cold water. These ideas come from Dr. Latov’s (MD, PhD) book and the one by Mims Cushing. Mention the formula to your doctor! I will send an E mail with more information.

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