What are the physical therapy treatments for peripheral neuropathy?

From the Guidelines

Physical therapy for peripheral neuropathy should focus on a progressive exercise program combining strength training, balance exercises, and aerobic activities tailored to the patient's abilities, as this approach has been shown to improve functional status, walking performance, and quality of life 1.

Key Components of Physical Therapy

• A progressive exercise program with strength training, balance exercises, and aerobic activities
• Specific exercises such as toe raises, ankle rotations, and gentle walking, performed 3-5 times weekly for 20-30 minutes
• Manual therapy techniques like massage and joint mobilization to improve circulation and reduce pain
• Transcutaneous electrical nerve stimulation (TENS) for pain relief
• Gait training with assistive devices like canes or walkers if balance is compromised
• Education on proper footwear, foot care, and home exercise programs

Rationale for Recommendations

The 2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS guideline for the management of lower extremity peripheral artery disease recommends structured exercise therapy to improve functional status, walking performance, and quality of life 1. Additionally, a 2020 study published in the Annals of Oncology suggests that physical exercise and functional training can reduce symptoms of chemotherapy-induced peripheral neuropathy 2. While the provided evidence is not directly related to peripheral neuropathy, the principles of exercise therapy and physical rehabilitation can be applied to improve outcomes in patients with peripheral neuropathy.

Considerations for Treatment

Treatment duration and progression should be based on the severity of the condition and the patient's tolerance, with the goal of improving blood flow to damaged nerves, strengthening supporting muscles, maintaining joint mobility, and activating alternative pain pathways in the nervous system. A comprehensive approach to physical therapy, incorporating the key components mentioned above, can help improve function, reduce pain, and prevent complications in patients with peripheral neuropathy 3, 1, 2.

From the Research

Physical Therapy Treatments for Peripheral Neuropathy

• Physical therapy treatments for peripheral neuropathy include exercises and interventions aimed at alleviating symptoms and improving quality of life 4, 5
• Exercises for peripheral neuropathy (EPN) have been shown to improve balance, reduce pain and tingling, and decrease inflammatory markers such as TNF-α and CRP 4
• Low-intensity resistance training has also been found to be effective in improving physiological conditions and reducing complications of diabetic neuropathy 4
• Physiotherapy interventions, including electrotherapy, exercise therapy, and other therapies, have been used to mitigate the symptoms and complications of diabetic peripheral neuropathy 5
• Exercise therapy has been found to be the most effective intervention in reducing muscle weakness, pain, loss of balance, and lower limb dysfunction in patients with diabetic peripheral neuropathy 5

Specific Interventions

• EPN exercises, which focus on lower limb extremities, have been designed specifically for diabetic neuropathy patients and can improve imbalance, pain, and tingling 4
• Electrotherapy, such as transcutaneous electrical nerve stimulation, has been suggested as a primary treatment for focal peripheral neuropathic pain 6
• Topical agents, such as lidocaine 5% patches and topical capsaicin, can be useful in ameliorating pain in patients with peripheral neuropathy, but are often used in combination with other treatments 7, 6

Treatment Approaches

• A multidisciplinary approach to treatment, including physical therapy, pharmacological interventions, and lifestyle modifications, may be necessary to effectively manage peripheral neuropathy 7, 8, 6
• Treatment should be individualized and based on the specific needs and symptoms of each patient 8, 6
• Combination therapy, which involves the use of multiple treatments with different mechanisms of action, may be effective in patients who do not respond to single treatments 7, 6