The right exercises can be a catalyst for regaining motor control in clients sidelined with neuropathic pain. Negotiating with peripheral neuropathy when personal training has its challenges, but you can make movement possible again.
Peripheral neuropathy is a widespread and potentially incapacitating pathological condition that encompasses over 100 different forms of nerve damage. An estimated 20 million people in the United States suffer from its deleterious effects: weakness, numbness, and pain, most commonly in the hands and feet.
Menacing Manifestation
Risk factors for developing peripheral neuropathy include the following:
- Diabetes mellitus/poorly controlled blood sugar levels
- Alcohol abuse
- Vitamin B deficiency
- Infections such as Lyme disease, shingles, hepatitis C and HIV
- Autoimmune diseases such as rheumatoid arthritis and lupus
- Kidney/liver/thyroid disorders
- Overexposure to toxins
- Repetitive motion tasks
- Family history of neuropathy
Although symptoms will vary from patient to patient, individuals living with peripheral neuropathy generally exhibit a few classic characteristics:
- Gradual onset of numbness, prickling or tingling in hands/feet, occasionally spreading into arms/legs
- Sharp/ throbbing/ freezing/ burning pain
- Extreme sensitivity to touch
- Lack of coordination/clumsiness
- Muscle weakness or paralysis
- Loss of balance
- Dizziness upon standing
- Sexual dysfunction
Often worse at night, neuropathic pain is further exacerbated by disruptive sleep patterns. Coupled with an over-sensitization of pain receptors in the skin, patients often report feeling severe pain from seemingly innocuous stimuli, such as bed sheets draped lightly over the body.
How Neuropathy Develops
The human body’s peripheral nervous system sends information from the brain and spinal cord to the rest of the body, most notably to the muscles in an effort to generate movement.
Peripheral nerves also send sensory messages back to the central nervous system. Similar to static on a telephone line, peripheral neuropathy distorts and may even interrupt this process.
Large sensory fibers register vibration and positional awareness. Damage to these fibers results in a general decrease of sensation, which patients liken to wearing gloves and stockings, as well as diminished reflex response.
Positional awareness challenges often render complex movements like walking, fastening buttons, or maintaining balance frustrating and difficult.
Small sensory fibers transmit pain and temperature sensations. Patients suffering from damage in this area of the nervous system may fail to perceive an injury such as a cut or an infected wound.
Others may not detect pain that warns of impending heart attack or other acute conditions. Loss of such sensation is a particularly serious problem for individuals with diabetes, contributing to the high rate of leg/foot amputations among this population.
Autonomic nerve damage symptoms are diverse since the parasympathetic and sympathetic nerves control nearly every organ in the body. Commonly experienced problems include an inability to sweat normally, which may lead to heat intolerance; a loss of bladder control; and an inability to control muscles that expand or contract blood vessels as they strive to regulate blood pressure.
A drop in blood pressure upon rising (a condition known as postural or orthostatic hypotension) may result in dizziness or fainting.
Can Exercise Help or Hinder Peripheral Neuropathy?
The adoption of healthy lifestyle habits can reduce the effects of peripheral neuropathy. A balanced diet, smoking cessation, and regular exercise are all helpful.
Since many underlying causes of peripheral neuropathy cannot be fully treated, it is critical to understand that routine exercise may not only help prevent some of those causes but has also proven to be an effective means of alleviating some of the condition’s most distressing symptoms.
Paying close attention to foot care and wounds, especially when pain sensation has been greatly diminished, can greatly improve one’s quality of life. Such changes often create conditions that may even encourage nerve regeneration.
Cultivating Cardio/Strength/Balance
Research has shown that strengthening exercises for peripheral neuropathy lead to a moderate improvement in muscle mass along with a decrease in atrophy. In addition, properly chosen exercises may reduce cramping and can help control blood sugar levels. A comprehensive exercise routine should include four kinds of activities: aerobic, flexibility, balance, and strength training.
In addition to what we can offer clients through personal training, physical and occupational therapy can help to improve balance and gait, fine motor skills, dexterity, and coordination.
Balance/ proprioceptive exercises challenge the receptors in the toes, ankle, and feet to send signals back to the spine. By encouraging the body to pay more attention to these receptors, tripping and falling will dissipate over time.
The more information the body receives from the joints at receptors, the more it becomes accustomed to these signals, and an improved stabilizing response develops.
Some of the activities that can be encouraged for those suffering from neuropathy include stationary cycling, semi-recumbent cycling, and water exercises. Water activities and semi-recumbent cycling are especially beneficial for those with orthostatic hypotension since the pressure of water surrounding the body as well as the semi-recumbent posture helps to maintain blood pressure.
Chair exercises are also beneficial: seated ankle circles performed while extending 1 leg at a time, and performing circles both clockwise and counter-clockwise, are easily tolerated by even the weakest of clients.
Researchers note that yoga is also helpful in reducing stress levels, blood pressure, and inflammation, all of which can affect the progression of diabetes-related neuropathy. Although yoga might feel less intense compared with cycling or strength training, it still gets the heart pumping and can facilitate the building of lean muscle mass.
Such exercises increase the supply of blood, oxygen, and glucose going to the cells’ mitochondria, allowing the production of energy in a more efficient manner. Facilitating blood flow to peripheral nerves may result in fewer neuropathic symptoms, increased strength, and improved balance.
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Duration
Patients with clinically significant autonomic neuropathy typically demonstrate a lower exercise tolerance, resulting in large part from the reduced cardiac output and faulty redistribution of blood flow to the muscles.
Consequently, the duration of exercise in these clients must be determined individually. A workout may initially be tolerated for less than 30 minutes; advise clients not to increase the intensity of the exercise to compensate for a shorter session. Over time, comfort levels will allow for longer workouts.
The Role of Cancer
Chemotherapy-induced peripheral neuropathy (CIPN) is an under-addressed problem in the field of oncology. If nerves in the hands are affected, clients may have difficulty grasping dumbbells. Tubing or resistance bands with handles may be a safer, more effective option.
Peripheral neuropathy may develop at any phase of one’s cancer journey. A new study revealed that 50% of women who have undergone chemotherapy report symptoms of peripheral neuropathy long after their treatment has ended, and often present with a significantly higher incidence of altered walking patterns.
“Women with peripheral neuropathy reported significantly lower physical functioning, significantly more difficulty with tasks of daily living, and increased fall risks” says the study’s lead author, Kerri Winters-Stone.
Understanding the process and side effects of peripheral neuropathy can allow us to better serve our clients. We can offer them the chance to regain movement that they may have thought to be permanently lost. Together you can face this challenge head-on and witness the magnificent life-affirming transition.
Have you worked with a client dealing with chemotherapy-induced peripheral neuropathy?
References
www.curetoday.com/articles/women-experience-long-term-neuropathy-after-chemotherapy-leading-to-falls
www.sitandbefit.org/balance-exercises-neuropathy/
www.ncbi.nlm.nih.gov/pmc/articles/PMC5385995/
laserneuropathypaintreatment.com/neuropathy-pain-treatment/importance-of-balance-exercises-for-neuropathy-treatment/
www.mayoclinic.org/diseases-conditions/peripheral-neuropathy/symptoms-causes/syc-20352061
www.mskcc.org/blog/managing-chemotherapy-induced-peripheral-neuropathy-after-treatment
www.everydayhealth.com/type-2-diabetes/living-with/best-exercises-managing-diabetic-neuropathy/
www.slideshare.net/DanaFarber/how-exercise-can-help-neuropathy
academic.oup.com/ptj/article/90/11/1568/2737714
journal.diabetes.org/diabetesspectrum/98v11n4/pg231.htm
www.ncbi.nlm.nih.gov/pmc/articles/PMC3983517/
www.foundationforpn.org/living-well/lifestyle/exercise-and-physical-therapy/
www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Peripheral-Neuropathy-Fact-Sheet
Cathleen Kronemer is an NFPT CEC writer and a member of the NFPT Certification Council Board. Cathleen is an AFAA-Certified Group Exercise Instructor, NSCA-Certified Personal Trainer, ACE-Certified Health Coach, former competitive bodybuilder and freelance writer. She is employed at the Jewish Community Center in St. Louis, MO. Cathleen has been involved in the fitness industry for over three decades. Feel free to contact her at trainhard@kronemer.com. She welcomes your feedback and your comments!
