Peripheral Neuropathy Physiotherapy: Techniques for Pain Relief

Peripheral neuropathy, often simply referred to as neuropathy, is a disorder of the peripheral nervous system, which encompasses all nerves outside the brain and spinal cord. This intricate network of nerves serves as the communication pathway between the central nervous system and the rest of the body, facilitating the transmission of sensory information and motor control. When these nerves are damaged or malfunction, it leads to a wide range of distressing symptoms and functional impairments.

Physiotherapists encounter quite often with patients having peripheral neuropathy. It's essential to have a good understanding of this condition to provide the best care for our patients.

 

Classification of Peripheral Neuropathy

 

Symptoms of Peripheral Neuropathy

• Numbness
• Tingling and Paresthesia
• Burning Sensation
• Sharp or Electric-like Pain
• Dull low-level pain described as an ache or throbbing
• Muscle Weakness
• Impaired Coordination
• Difficulty Walking
• Muscle Twitching or Cramps
• Sensitivity to Touch
• Loss of Reflexes
• Loss of Proprioception
• Altered Temperature Sensation
• Foot Problems - such as ulcers or calluses
• Gastrointestinal Symptoms - like diarrhea, constipation, or difficulty swallowing
• Cardiovascular Symptoms - may lead to heart rate irregularities and blood pressure fluctuations.
• Changes in Perspiration
• Sexual Dysfunction - like erectile dysfunction in men and decreased sexual responsiveness in women

 

Causes of Peripheral Neuropathy

• Diabetes
• Alcohol Abuse
• Infections

1. Viral Infections - like HIV, herpes zoster (shingles), and hepatitis C
2. Bacterial Infections - such as Lyme disease

• Autoimmune Disorders - conditions like Guillain-Barré syndrome, lupus, and rheumatoid arthritis
• Medications - certain antibiotics, antiretroviral drugs, and chemotherapy agents
• Toxic Substances - like heavy metals (e.g., lead, mercury), industrial chemicals etc.
• Heredity - such as Charcot-Marie-Tooth disease
• Physical injuries or accidents
• Vitamin Deficiencies - particularly B vitamins (e.g., B1, B6, B12
• Kidney and Liver Disorders
• Metabolic Disorders - like uremia and
• Inflammatory Conditions - sarcoidosis and celiac disease can affect the nerves
• Neurological Disorders - such as multiple sclerosis and Charcot-Marie-Tooth disease
• Idiopathic Cause

Other Risk Factors Include:

• Neuropathy risk increases with age
• Family History increases the risk for those with affected relatives
• Obesity
• Smoking
• Vascular Conditions - like atherosclerosis and high blood pressure

 

Physiological effect of Peripheral Neuropathy on our body

The physiological impact of peripheral neuropathy can vary depending on the type and severity of the condition, but it generally involves the following processes:

1. Nerve Damage - damage can occur at different levels, including the axons (nerve fibers) and the myelin sheath (the protective covering of the nerve fibers)
2. Impaired Sensation - hallmark physiological effects of peripheral neuropathy is impaired sensation which include numbness, tingling, and a reduced ability to feel pain, temperature changes, and pressure
3. Alterations in Motor Function - resulting in weakness, muscle atrophy, and coordination problems
4. Microvascular Changes - in certain neuropathies, such as diabetic neuropathy, there can be microvascular changes in the blood vessels that supply the nerves
5. Secondary Complications - it can lead to secondary complications, including skin injuries, ulcers, and infections in the affected limbs
6. Sensory Processing – can affect our perception of the external environment

 

Is peripheral neuropathy contagious?

No, peripheral neuropathy is not contagious. Peripheral neuropathy is a medical condition that results from damage to or dysfunction of the peripheral nerves, which are responsible for transmitting sensory and motor signals between the central nervous system (CNS) and the rest of the body. It is not caused by a virus, bacteria, or any infectious agent, and it cannot be transmitted from one person to another through physical contact or exposure.

Diagnosing Peripheral Neuropathy

The diagnostic process begins is done as following:

1. Assess Patient's Medical History: Gather information about the patient's medical history, including any underlying conditions, medications, and risk factors.
2. Risk Factors: Determine if there are risk factors for peripheral neuropathy. If yes, refer the patient to a neurologist or primary care physician (PCP) for further evaluation. If no risk factors are present, proceed with further assessment.
3. Physical Examination: Perform a thorough physical examination, focusing on neurological and muscular aspects.
4. Clinical Indicators: Based on the physical examination, assess clinical indicators for peripheral neuropathy.
5. Symptoms & Complaints: Discuss the patient's symptoms and complaints in detail.
6. Sensory Symptoms: Determine if the patient experiences numbness or tingling in the affected areas. If yes, proceed with further testing. If no, conduct additional assessments.
7. Numbness/Tingling: If numbness or tingling is present, consider additional testing such as electromyography (EMG) or nerve conduction studies (NCS). If not, proceed with further assessments of muscle strength.
8. Confirm Diagnosis: After further testing, confirm the diagnosis of peripheral neuropathy.
9. Develop Individualized Treatment Program: Create a physiotherapy treatment plan based on the diagnosis and the patient's specific needs.
10. Monitor Symptoms and Progress: Continuously monitor the patient's symptoms and track their progress.
11. Adjust Treatment Plan: Make adjustments to the treatment plan as needed to ensure the best possible outcomes.
12. Regular Reassessment: Periodically reassess the patient's condition to track changes and improvements.

 

Physiotherapy Management

Neuromuscular Reeducation: 

This approach focuses on retraining the nerves and muscles to improve coordination, balance, and proprioception. It can help individuals regain control over their movements and reduce the risk of falls.

Balance Exercises: 

Balance training is essential to improve proprioception and prevent falls. Activities can include:

• standing on one foot
• walking on a balance beam
• heel-to-toe walking

Coordination Drills: 

These exercises focus on improving the coordination between muscle groups. They may include activities like:

• leg raising
• marching in place
• step-ups

Sensory Stimulation: 

Techniques such as tapping, massage, or using textured surfaces can help stimulate the sensory receptors in the feet and improve awareness of foot position.

Mirror Therapy: 

This technique involves using a mirror to provide visual feedback during movement. It can be particularly useful for retraining the brain to recognize and control movements in affected limbs.

Isometric Contractions: 

Isometric exercises involve muscle contractions without joint movement. These exercises can help strengthen muscles without excessive strain on the joints and can be especially beneficial for individuals with peripheral neuropathy.

Functional Activities: 

Practicing everyday activities like walking, climbing stairs, and reaching for objects can help individuals relearn and improve their functional movements.

Joint Range of Motion Exercises: 

Gentle exercises that focus on maintaining or improving joint mobility can be beneficial in preventing joint stiffness and contractures.

Proprioceptive Neuromuscular Facilitation (PNF): 

PNF techniques involve stretching, contracting, and relaxing specific muscle groups to improve motor control and flexibility.

Resistance Exercises: 

Using thera bands or light weights can help individuals strengthen their muscles while also improving neuromuscular control. The emphasis is often on low-impact, resistance-based exercises to prevent overexertion.

Cognitive Exercises: 

Some techniques may include cognitive tasks combined with physical activities to challenge the brain-muscle connection. For example, a physiotherapist might instruct a patient to perform specific movements in response to verbal cues.

Balance Training: 

Balance exercises are crucial for individuals with neuropathy to reduce the risk of falls and injuries. Activities that challenge balance, such as standing on one foot or using balance boards, can be included.

Electrotherapy/Modalities: 

Some physiotherapy modalities, such as transcutaneous electrical nerve stimulation (TENS), Faradic stimulation or therapeutic ultrasound, may be used to help manage pain and improve blood flow to the affected areas.

Orthotic Devices: 

Custom-made or over-the-counter orthotic devices may be recommended to provide support, improve foot function, and relieve pressure on sensitive areas.

Education: 

Educating the patient about self-care and foot care is essential. This can include guidance on choosing appropriate footwear, managing symptoms, and preventing complications like ulcers.

Aerobic Exercise: 

Low-impact aerobic exercises like swimming, stationary cycling, or water aerobics can help improve overall cardiovascular health without putting excessive stress on the feet and legs.