Physical Therapy for Diabetic Peripheral Neuropathy

Peripheral neuropathy is a common complication of diabetes in which nerve function is diminished or lost due to uncontrolled high blood sugar levels. It is commonly experienced in the hands and feet and can cause feelings of numbness and tingling in the affected limbs, a loss or absence of sensation, burning or sharp pain, and increased sensitivity to touch in the affected area. Physical therapy plays a vital role in helping those with peripheral neuropathy improve and maintain function, enhance overall quality of life, and alleviate symptoms of diabetic peripheral neuropathy.

What is Diabetic Peripheral Neuropathy?

Peripheral neuropathy is a common complication of diabetes in which nerves are compromised due to uncontrolled high blood sugar levels. It is experienced by more than 50% of those with diabetes and is an important risk factor for skin breakdown, amputation, and reduced physical mobility. Peripheral neuropathy is most often experienced in the hands and feet and many with the condition have polyneuropathy, which means that many different nerves are affected.  

Peripheral neuropathy is caused by microvascular abnormalities that result in nerve damage. The chronic hyperglycemia of diabetes impairs microvascular circulation by disrupting cellular communication, causing thickening of the nerve fibers and decreased capillary blood flow. Hyperglycemia also triggers chronic inflammation, oxidative stress, and mitochondrial dysfunction, which contributes to metabolic dysregulation and subsequent altering of neurotrophic expression and deficiencies in growth factors that influence nerve growth and regeneration, protection, and survival. This leads to delayed reflex responses to postural changes due to decreased nerve conduction velocity and causes balance impairments and an increased risk of falling.

[Information Source from Kluding, et. al Review Study]

Symptoms of peripheral neuropathy include:

• Numbness and tingling, starting in the feet and hands and spreading to the limbs

• Loss or absence of sensation, or your ability to sense contact with outside objects

• Burning, sharp, or electric-like pain

• Increased sensitivity to light touch

• Clumsiness or decreased coordination in affected limbs

• Weakness or paralysis in muscles or parts of the body that are affected by nerves

• Bowel or bladder incontinence

• Temperature intolerances

• Balance impairments and increased risk of falling

• Poor wound healing

• Excessive sweating or skin dryness

• Flushed or pale skin

• Abnormal nail growth

• Decreased ability to participate in normal functional activities

Physical Therapy for Diabetic Peripheral Neuropathy

Physical therapy plays a vital role in helping those with peripheral neuropathy improve and maintain function, enhance overall quality of life, and alleviate symptoms of diabetic peripheral neuropathy. Controlling and lowering blood glucose levels through diet and exercise is key to helping prevent and possibly reverse some of the effects of diabetic neuropathy. Physical therapy can be effective in restoring balance and sensation that has been lost due to neuropathy through a personalized therapeutic exercise and treatment program.

Physical therapy interventions can help restore the health of neurons, improve circulation, provide guided practice of integrating internal and external sensory input, offer patient education on sensation loss and fall risk and home modification instruction, and involve strengthening muscles and improving joint range of motion.

Physical therapy for peripheral neuropathy can include:

• Nerve gliding exercises to move nerves, as this promotes nourishment and healing of the nerve.  To function well, nerves require movement, blood flow, and space which nerve gliding exercises help to provide.

• Moderate-intensity aerobic and weight training exercises to improve strength in affected limbs and the core and enhance overall function

• Balance and coordination training using the parallel bars, a balance pod, the rebounder, or balance training exercises on our clinic’s Astroturf

• Use of braces to protect injured nerves and help patients move safely

• Patient education on safety, home modifications, preventing complications, and compensatory strategies

• Manual therapy neural tissue mobilizations to reduce pain and improve blood circulation to the affected nerves

• Use of the TENs unit to help reduce pain, using light electrical charges to disrupt pain signals from damaged nerves.

Numerous research studies have found that regular exercise can play a critical role in improving metabolic dysregulation and blood glucose levels and promoting nerve regeneration and function. Recently, further research studies have noted that exercise under the supervision of a physical therapist is safe and effective even for those with diabetic peripheral neuropathy. One study involving 20 patients with diabetic peripheral neuropathy revealed that those patients who engaged in lower extremity exercise interventions experienced improvements in all three functional outcome measures when compared with the control group which showed no significant improvements. The exercise group experienced improvements in tandem stance, single-leg stance, and functional reach after the three-week exercise program. 

A longitudinal study of 80 people with diabetes who were monitored for four years showed that those who participated in brisk walking four hours a week had a lower frequency of motor or sensory neuropathy at the end of the study, highlighting the protective effect of exercise against developing diabetic neuropathy.

A review of the existing literature on exercise and neuropathy noted that those patients who participated in a controlled exercise regimen through physical therapy demonstrated improved balance, gait, mobility, and nerve conduction velocity, which correlated with decreased chronic pain. Another study showed a statically significant decrease in average pain scores at week six of treatment in those patients who were undergoing neural tissue mobilization through nerve gliding exercises and physical therapy manual therapy than the control group who did not undergo the intervention.  

Are you or a loved one experiencing diabetes and peripheral neuropathy? Work with a physical therapist to help manage diabetes with exercise and safely maintain function!