Peripheral Neuropathy: Finding Relief Through Physiotherapy

Peripheral neuropathy (PN) is a relatively common nerve disorder and presents as a challenge to more Indians than you think. It is a relatively common side effect associated with people with diabetes, Guillain Barre syndrome, vasculitis and those undergoing cancer treatment, where the peripheral nerves are either damaged or destroyed.

“I have a constant burning sensation in my hands. My feet feel like they’re asleep all the time. I can’t feel my toes. It’s like I’m walking on cotton balls. My feet feel like they’re on fire. The pain is like someone is stabbing me with needles.”

Dr Haripriya Kumaran (PT), Neuro physiotherapist at ReLiva Physiotherapy in Pune says, “Patients with neuropathic pain often report their symptoms like this! These only indicate that the nerves are not sending the signals properly.”

This article has been written to increase understanding about peripheral neuropathy. By recognising the early symptoms and knowing what are the warning signs of peripheral neuropathy and reporting these to the doctor, action can be taken. This may reduce the severity or progression of the symptoms, and prevent the possibility of irreversible nerve damage.

Overview  |   Symptoms   |   Causes   |   Types of Peripheral Neuropathy  |  Warning Signs  |  Treatment for neuropathy in legs and feet   |  Physiotherapy for Neuropathy   |  Self-Care Tips

What is Peripheral Neuropathy?

‘Peripheral’ means ‘situated away from the centre’ and refers to the outer areas of the body. ‘Neuropathy’ means ‘disease or malfunction of the nerves’.

In simple words, Peripheral neuropathy (PN) is a general term for nerve damage that occurs outside the brain and spinal cord. Due to the damage, the brain either does not receive signals or may receive the wrong signal. For example, the brain may not get a pain signal when something is hurting. Or it may receive pain signals when there is nothing that leads to pain.  

PN can affect any part of the body, but most commonly affects the hands and feet.

Symptoms of Peripheral Neuropathy

Peripheral neuropathy can cause a variety of symptoms, including:

• Numbness, tingling, or burning sensation in the hands or feet
• General weakness
• Increased sensitivity to touch causing pain (neuropathic pain)
• Balance problems
• Difficulty walking
• Decreased reflexes
• May also affect vision, hearing, bladder movement

Peripheral Neuropathy and its Incidence in India

The incidence of PN varies depending on the specific cause and the population studied. In India, the reported prevalence ranges widely, from 5 to 2,400 per 10,000 population. A medical study [1] reports,  India’s vast population encompasses various ethnicities and lifestyles, potentially impacting PN risk factors.

Causes of Peripheral Neuropathy

• Multiple causes: Numerous factors can cause PN, including diabetes, infections like leprosy, vitamin deficiencies, autoimmune diseases, and exposure to toxins.
• Diabetic neuropathy (DPN): A major contributor, with studies suggesting a prevalence of 10% to 90% in diabetic patients. This wide range reflects diverse populations and diagnostic methods.
• Other causes: Leprosy neuropathy, though declining due to control programs, remains a concern. Vitamin B12 deficiency, common in India, can also contribute.
• Urban vs. rural: Studies suggest higher PN rates in urban areas, potentially due to lifestyle factors and increased exposure to toxins.

Types of Peripheral Neuropathy

Peripheral neuropathy disease can be classified into different types based on the affected nerves and the extent of damage.

Types of Peripheral Neuropathy, by the extent of nerves affected:

1.    Mononeuropathy:

When only a single nerve is affected, resulting in localized symptoms in the area supplied by that nerve.

Common causes of Mono neuropathy include compression, trauma, and infections.

Carpal tunnel syndrome is an example of Mononeuropathy, where the median nerve in the wrist is affected, causing numbness and tingling in the hand and thumb.

2.    Polyneuropathy:

When a condition affects multiple nerves throughout the body, often causing symmetrical symptoms in the hands and feet, it is named as Polyneuropathy. This may be caused by various conditions, including diabetes, autoimmune diseases, vitamin deficiencies, and toxins.

Diabetic neuropathy is the most common type of peripheral neuropathy that is also polyneuropathic. It can cause burning pain, numbness, and weakness in the legs and feet.

Types of Peripheral Neuropathy, by which type of nerves are affected:

Nerves that can be affected by peripheral neuropathy are the motor (that which controls muscle movements), sensory (that which controls sensations) or autonomic (that which controls automated functions in the body such as blood pressure or bowel movements).

1.    Motor Neuropathy:

When the motor nerves are affected, it leads to muscle weakness, wasting, and difficulty in moving. This can be caused by various conditions, including autoimmune diseases, toxins, and inherited disorders.

Example: Guillain-Barré syndrome, an autoimmune disorder that attacks the motor nerves, causing rapid muscle weakness and paralysis.

2.    Sensory Neuropathy:

The sensory nerves control sensations. When they are affected, it leads to symptoms like numbness, tingling, burning pain, and difficulty feeling temperature or pain. This can be caused by various conditions, including diabetes, vitamin deficiencies, and infections.

Example: Small fiber neuropathy, a type of sensory neuropathy that affects the small nerve fibers responsible for pain, temperature, and autonomic functions.

3.    Autonomic Neuropathy:

The autonomic nerves control involuntary functions like heart rate, blood pressure, digestion, and bladder function. When they get affected, it is named as autonomic neuropathy. This often causes symptoms like dizziness, lightheadedness, sexual dysfunction, and difficulty controlling body temperature.  This may be caused by various conditions, including diabetes, Parkinson’s disease, and autoimmune diseases.

Treatment for Neuropathy in Legs and Feet: How is neuropathic pain treated?

Peripheral Neuropathy Treatments

Doctors prescribe the medicine according to the need. It might be topical or oral medications. Vitamins supplements, hormones, pain relievers with anti-depressants are different options to treat neuropathic pain.

In addition to medicines, other treatment may be required to help you manage other symptoms.

For example, if you have muscle weakness, and problem with balance and walking you may need physio therapy for neuropathy to learn exercises to improve your muscle strength. TENS therapy may also help in reduction of pain.

You may also need to wear splints to support weak ankles or use walking aids to help you get around.

Physiotherapy is most beneficial for Peripheral Neuropathy to achieve the following outcomes:

• Reduced pain and discomfort
• Improved muscle strength and function
• Enhanced balance and gait
• Increased flexibility and range of motion
• Improved quality of life
• Reduced risk of falls and complications

Want to try Physiotherapy for Relief from Neuropathic pain?

At a ReLiva Physiotherapy clinic near you or Go for Home Physiotherapy

What are the warning signs of peripheral neuropathy?

Signs and symptoms depend on the type and the cause of neuropathy. Our team of physio experts have put together a list of complaints that people of peripheral neuropathy disease most often report.

Peripheral Neuropathy: Sensory Symptoms

Peripheral Neuropathy: Motor Symptoms

Peripheral Neuropathy: Autonomic Symptoms

Do you sense onset of some/ any of these symptoms of Neuropathic pain?

Physiotherapy offers hope and relief for peripheral neuropathy. Take the step towards a pain-free, active life today!

Who can benefit with Physiotherapy for Peripheral Neuropathy?

Research suggests that physiotherapy can be a valuable component of managing Neuropathy, though its efficacy can differ depending on the specific type and cause.

Physio therapy for neuropathy has been found to be especially helpful for patients with conditions, namely:

• Diabetic Neuropathy: Research suggests physiotherapy based exercise programs, can effectively improve pain, balance, and walking ability in people with diabetic neuropathy. This includes strengthening, aerobic, and flexibility exercises.
• Sciatica: Physiotherapy is often the first-line treatment for sciatica, focusing on manual therapy, core strengthening, and stretching to relieve pain and improve mobility.
• Carpal Tunnel Syndrome: Physiotherapy can help manage carpal tunnel symptoms through nerve glides, stretches, and splinting to reduce pressure on the median nerve.
• Foot Drop & Wrist Drop: Physiotherapy, splinting and exercises have been established as most effective mode of conservative treatment. Stretching exercise is required to improve the patient’s way of walking, range of motion of the knee/ wrist and strengthen the surrounding muscle, increase balance, and posture and reduce fear and risk of falling.
• Chemotherapy-Induced Peripheral Neuropathy: Studies suggest exercise programs in patients with chemotherapy-induced neuropathy can offer moderate pain relief and improve muscle strength. Transcutaneous electrical nerve stimulation (TENS) therapy can sometimes help reduce pain by delivering tiny electrical impulses to specific nerve pathways at or near the site of pain.

Physiotherapy Management for Peripheral Neuropathy

Physiotherapy can play a crucial role in managing peripheral neuropathy. It can significantly improve symptoms, prevent complications, and enhance quality of life. At ReLiva, the team of physiotherapists work with neuropathy patients with the following goals in mind:

Goals of Physiotherapy in Acute stage Peripheral Neuropathy:

1. Maintenance of Range of motion of all joints
2. Circulation to be maintained
3. Prevention of Muscle atrophy
4. Reduction of Pain
5. Healing and Prevention of complication

Goals of Physiotherapy in Recovery stage Peripheral Neuropathy:

1. Muscle re-education
2. Strengthening of muscles
3. Sensory re education
4. Functional training

The physios work with the patients using a mix of Physiotherapy Interventions to achieve different goals of neuropathy treatment.

Pain Management:

• Manual therapy: Techniques like massage, joint mobilizations, and ultrasound can reduce pain and stiffness.
• Electrical stimulation: Transcutaneous electrical nerve stimulation (TENS) can provide pain relief.
• Education: Learning about pain mechanisms and self-management strategies empowers patients.

Strengthening and Improving Muscle Function:

• Targeted exercises help maintain muscle strength, especially for those with motor neuropathy, improving mobility and independence.
• Balance and Gait Training: Specific exercises improve balance and coordination, reducing fall risk and enhancing walking ability. 

Improving Flexibility and Range of Motion:

Regular stretching helps prevent joint stiffness and contractures, maintaining flexibility.

Education and Self-Management Strategies:

• Foot care: Learning proper foot care techniques helps prevent ulcers and infections, crucial for those with diabetic neuropathy.
• Activity modification: Changing the pattern of performing activities to reduce stress on affected nerves is essential.
• Assistive devices: Canes, walkers, or braces may be recommended for improved mobility and safety.

Self Care Tips for Patients with Peripheral Neuropathy

Living with peripheral neuropathy requires adapting your lifestyle to manage symptoms and prevent complications. Here are some important do’s and don’ts to remember:

DO’s:

1. Foot Care:

• Check your feet daily for cuts, blisters, redness, or swelling. Tell your doctor right away if you find anything concerning.
• Wash your feet daily with warm water and mild soap. Dry them thoroughly, especially between your toes.
• Keep your feet moisturized regularly using fragrance-free moisturizer to prevent dryness and cracking.
• Wear shoes that fit well, with good cushioning, arch support, and wide toe boxes. Avoid tight shoes or high heels.
• Protect your feet from extreme temperatures by wearing socks and shoes in cold weather, and never walk barefoot on hot surfaces.

2. Exercise:

• Stay active with regular physical activity.
• Moderate exercise like walking, swimming, or cycling can improve pain, balance, and overall well-being. Consult your doctor or physiotherapist for a personalized exercise plan.
• Stretch regularly to maintain flexibility and range of motion in affected areas.

3. Lifestyle:

• Eat a healthy diet rich in vitamins, minerals, and antioxidants to support nerve health. Limit processed foods, sugar, and alcohol.
• Manage stress with relaxation techniques like meditation, deep breathing, or yoga to prevent symptom worsening.
• Ensure you get enough sleep, as it’s crucial for overall health and nerve function.

DON’Ts:

• Do not ignore symptoms like worsening pain, numbness, or weakness. Report to your doctor promptly.
• Avoid driving or operating machinery if you experience drowsiness or blurred vision.
• Never walk barefoot to prevent foot injury. Always wear shoes.
• Quit smoking to prevent worsening nerve damage and circulation problems.
• Avoid excessive alcohol consumption as it can worsen neuropathy symptoms and interfere with medication.
• Don’t use heating pads without checking foot temperature, as impaired sensation increases the risk of burns.
• Never neglect proper foot care to avoid serious complications like infections and ulcers.

Physiotherapy can help ease neuropathy symptoms and improve your quality of life. Give it a try for relief and better mobility.

This article is contributed by physiotherapist Dr Haripriya Kumaran (BPT, MPT Neuro). She is a Neuro physiotherapist with a strong passion for improving the lives of patients by providing exceptional care and rehabilitation services to individuals with neurological disorders. 

Scholarly References:

[1] Epidemiology of Peripheral Neuropathy: An Indian Perspective, Sweety Trivedi, Alak Pandit, Goutam Ganguly, and Shyamal Kumar, doi: 10.4103/aian.AIAN_470_16 

[2]  Effectiveness of physiotherapy interventions on improving quality of life, total neuropathy score, strength and reducing pain in cancer survivors suffering from chemotherapy-induced peripheral neuropathy – a systematic review, Nikita H. Seth & Irshad Qureshi (2023); Acta Oncologica, 62:9, 1143-1151

[3] Physiotherapy interventions for pain relief in individuals with peripheral neuropathic pain: A systematic review and meta-analyses of randomized controlled trials. Contemporary Clinical Trials. Kannan P, Bello UM, Winser SJ. ;2023 Feb 1;125:107055.

[4] The efficacy of physiotherapy interventions in mitigating the symptoms and complications of diabetic peripheral neuropathy: A systematic review. Jahantigh Akbari N, Hosseinifar M, Naimi SS, Mikaili S, Rahbar S. ; Journal of Diabetes & Metabolic Disorders. 2020 Dec;19:1995-2004.

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