Exercise

Research has shown that strengthening exercise moderately improves muscle strength in people with peripheral neuropathy. In addition, regular exercise may reduce neuropathy pain and can help control blood sugar levels.
Refer to a Physical Therapist or a healthcare provider regarding an exercise program that's right for you.

A comprehensive physical activity routine includes four kinds of activities:

• Aerobic Exercise
• Flexibility Exercise
• Strength Training Exercise
• Balance Exercise

Aerobic exercise:
Increases your heart rate, works your muscles, and raises your breathing rate. For most people, it's best to aim for a total of about 30 minutes a day, between 3-5 days a week. If you haven't been very active recently, you can start out with 5 or 10 minutes a day and work up to more time each week. Or split up your activity for the day -- try a 10-minute walk after each meal. Here are some examples of aerobic exercise:

• Take a brisk walk (outside or inside on a treadmill)
• Take a low-impact aerobics class
• Swim or do water aerobic exercises
• Stationary bicycle indoors

 

Flexibility Exercises
Flexibility exercises, also called stretching, help keep your joints flexible and reduce your chances of injury during other activities. Gentle stretching for 5 to 10 minutes helps your body warm up and get ready for aerobic activities such as walking or swimming.  Here are some flexibility exercises you can do at home.

 

Check with your physician before beginning any exercise program.

Calf Stretch

Place one leg far behind you with the toe pointed slightly inward.  Take a large step forward with the opposite foot.  With the front knee slightly bent lean forward keeping your back heel on the floor.  You should feel a muscle stretch in the calf of your back leg.

Hold:  15-20 seconds on each leg
Repeat:    3 repetitions each leg/2 times a day.

 

Seated Hamstring Stretch 

Sitting on the front half of a firm chair, place one leg out straight with the foot pointing up.  Bend the opposite knee so that your foot is flat on the floor.  Center your chest over the straight leg, and slowly straighten your back until you feel a muscle stretch in the back of your leg.

Hold:  15-20 seconds on each leg
Repeat:    3 repetitions each leg/ 2 times a day.

 

Plantarfascia Stretch

 

While facing a door frame, place your heel as close to the door frame as possible.  Slowly lean forward, allowing your heel to slide back as your toes extend upward. To increase the stretch, bend the front knee toward the door frame.  You should feel a muscle stretch in the bottom of your foot and along your heel cord.

Hold:  15-20 seconds
Repeat:    3 repetitions each leg/2 times a day.

 

Strength Training
Strength training, done several times a week, helps build strong bones and muscles and makes everyday chores like carrying groceries easier for you. With more muscle, you burn more calories, even at rest. Here are some ways to do it:

• Join a class to do strength training with weights, elastic bands, or plastic tubes
• Lift light weights at home

Below are strengthening exercises you can do at home.

 

Seated Dorsiflexion

While seating on the front half of a chair place both feet flat on the floor.  Gradually pull the toes and ankle up as high as you can.  Slowly let them down.
*To make this exercise more challenging position your feet closer to your body.

Repeat:    10-15 times
3 repetitions/2 times a day.

 

Chair Squat

    

Using a firm chair with armrests, position your feet in a split stance with one foot at the base of the chair and the other foot placed comfortably in front and slightly out to the side.  Slowly transfer your weight forward until your legs are supporting your body weight.  Slowly press up with your legs to standing.  To lower yourself, slowly reach for the chair with your hips.  Touch the chair with your hips and press back up for your next repetition.  Do not "plop" in chair or rest in between repetitions.

Repeat: 10 -15 times
2 Repetitions/2 times a day.

 

Kitchen Counter - Calf Raises

While standing at the kitchen counter, place two finger tips on the counter. Stand on one foot lifting the other  heel off the floor, standing on your toes (as you strengthen your muscles, try to alternate your heels as shown in the picture above).  Slowly lower your heel to the floor and repeat.  Once you are on your toes control your lowering.  Do not just drop down to the floor.

Repeat:    10-15 times   
2 repetitions on each leg /2 times a day.

 

 

Balance
Keeping your balance system healthy is especially important if you have problems due to illness, such as joint pain, weakness or dizziness. Balance training can help you get back to normal, and overcome feelings of stiffness or unsteadiness. Balance, in particular, is emerging as an important element for the elderly. Older muscles are smaller and slower and respond less efficiently when you need to brace yourselves, making you more vulnerable to falls.

 

Kitchen Counter- Standing Balance

While standing at the kitchen counter, place two finger tips on the counter.  Stand on one foot lifting the other off the floor.  Slowly lift your hands away from the counter and maintain your balance as long as you can.  Minor balance checks are acceptable as long as you continue to maintain your balance with minimal help from your hands.

Hold: 5-10 seconds
2 repetitions on each leg/2 times a day.

 

Hip Flexion

Hold table or chair with one hand, then one fingertip, then no hands; then do exercise with eyes closed, if steady.  Stand straight: holding onto table or chair for balance. Slowly bend one knee toward chest, without bending waist or hips.  Hold position for 5-10 seconds.  Slowly lower leg all the way down. Repeat with other leg.

Hold: 5-10 seconds 
2 repetitions on each leg/2 times a day.

 

Hip Extensions

Hold chair or table with one hand, then one fingertip, then no hands; then do exercise with eyes closed, if steady. Stand 12 to 18 inches from chair or table.  Bend at hips; hold onto chair or table.  Slowly lift one leg straight backwards.  Hold position for 5-10 sections.  Slowly lower leg and repeat with other leg

Hold: 5-10 seconds
Repeat: 2 repetitions on each leg /2 times a day

 

Side Leg Raise

Hold chair or table with one hand, then one fingertip, then no hands; then do exercise with eyes closed, if steady. Stand straight, directly behind chair or table, feet slightly apart.  Hold chair or table for balance.  Slowly lift one leg to side, 6-12 inches.   Slowly lower leg and repeat with other leg. Your back and knees are straight throughout exercise.

Hold: 5-10 seconds
Repeat: 2 repetitions on each leg/2 times a day

Be active throughout the day.  In addition to formal exercise, there are many opportunities to be active during the day.  Being active helps burn calories.  The more you move around, the more energy you'll have.

 

PHYSICAL THERAPY

Physical therapy may be helpful in maintaining strength, mobility, and function regardless of the underlying cause of Peripheral Neuropathy (PN). Patients with diabetic neuropathy may also benefit from physical therapy, however, diabetic neuropathy patients must also tightly control their blood sugar levels to prevent major fluctuations.

The objectives of physical therapy include:

• Maintaining and improve functions via a range of motion - passive range of motion exercises consist of progressive stretching and self stretches
• Strengthening muscles - this includes exercising against increasing resistance, use of weights, and isometric exercise
• Balance training provides stability and prevents falls
• Physical therapists can also recommend braces and/or splints to enhance balance and posture
• Splinting is often used in the treatment of compression mononeuropathies, such as carpal tunnel syndrome

Occupational Therapy

Occupational therapy is instrumental in helping a patient cope with the functional, vocational, and social impact of peripheral neuropathy by:

• Improving sensory-motor skills
• Teaching the patient to avoid exposure to environmental or industrial toxins
• Teaching self-care activities
• Teaching the patient safety issues, (e.g., paying more attention to the terrain when walking since falling or tripping may pose a risk for patients with PN)
• Teaching the patient to pay attention to issues which involve automatic functions (e.g., learning how to change positions smoothly to avoid a sudden drop in blood pressure and the risk of falling)