Move Forward Guide

    Physical Therapist's Guide to Peripheral Neuropathy

    Peripheral neuropathy (PN) is a condition affecting the nerves of the body that results from nerve damage or disease. PN leads to alterations in sensation and movement and can cause pain. It also may be associated with other disease processes, such as diabetes. Although the symptoms of PN can cause discomfort and loss of function, there is evidence that PN may improve over time. Treatment by a physical therapist can help reduce symptoms and improve an individual's quality of life.


    What is Peripheal Neuropathy?

    PN is a condition that affects the nerves of your body. It is generally classified by the number of nerves affected, the type of nerve cells affected, or the process affecting the nerves.

    Common classifications of PN include:

    • Mononeuropathy. This is a condition only affecting 1 nerve. It is often a result of the compression of a nerve, which creates an onset of symptoms. Carpal tunnel syndrome is an example of a mononeuropathy, in which compression of the median nerve in the arm results in altered sensation, pain, and weakness.
    • Polyneuropathy. This is a condition affecting many nerves and is generally a result of a disease process that affects the entire body, such as diabetes. This type of PN can result in an individual experiencing symptoms in various body parts, on both sides of the body.

      It has been estimated that diabetic peripheral neuropathy affects approximately 12% to 50% of those with Type 2 diabetes. It has been predicted that 439 million people worldwide will develop diabetes by the year 2030, and 236 million will experience associated PN.
    • Neuritis: This is a condition that results from inflammation of a nerve. There are many causes of this type of PN, including infection, injury, or exposure to chemicals.

    How Does it Feel?

    To understand symptoms of PN, we must first understand that nerves have influence over 2 primary functions, and with PN, these functions may be altered: (1) sensation, and (2) movement.

    People with PN may experience:

    • Numbness and tingling, starting in the feet and hands, and eventually spreading up the limbs (in polyneuropathy).
    • Loss or absence of sensation (the ability to sense contact with outside objects).
    • Pain, often described as burning, sharp, or "electric-like."
    • Increased sensitivity to light touch.
    • Clumsiness or decreased coordination in the affected limb(s).
    • Weakness or paralysis in the muscles or parts of the body affected by the nerve or nerves.
    • Bowel or bladder changes (nerves controlling these functions may be affected).
    • Temperature intolerances (generally to heat).
    • Decreased ability to participate in normal functional activities.

    How Is It Diagnosed?

    A thorough examination by a medical professional will help determine if you have symptoms of PN. There are several methods and tests a clinician may use to make a diagnosis, such as testing your reflexes, sensation, and muscle strength.

    If you have suspected symptoms, your physician may also order blood work, diagnostic imaging (such as MRI), or nerve conduction testing. These tests are generally ordered based on the suspected origin of symptoms.


    How Can a Physical Therapist Help?

    Physical therapists play a vital role in helping individuals improve and maintain functions that may be limited by PN. Your physical therapist will work with you to develop a treatment plan to help address your specific needs and goals.

    Because the cause, type, and symptoms of PN can all vary, the approach to care will also vary. Your physical therapist may provide the following recommendations and care:

    Nerve Gliding Activities. Your physical therapist can show you effective exercises that move and "glide" your nerves. Nerve gliding focuses on allowing the nerves to move more easily as you bend and straighten your joints. This therapy can help manage mononeuropathies.

    Moderate-Intensity Exercise. Your physical therapist may recommend moderate-intensity exercises to help improve your strength and physical function.

    Balance and Coordination Activities. Your physical therapist may work on strategies to improve your balance and coordination, both of which may be altered by PN. Improving balance and coordination can help decrease your risk of falling.

    Education. Your physical therapist may educate you on how to safely manage PN. Your education will vary based on your individual needs, and may focus on improving your safety, preventing further complications, and finding alternative ways to perform certain tasks.


    Can this Injury or Condition be Prevented?

    Because there are many conditions associated with PN, such as diabetes, some basic lifestyle modifications can help reduce the risk of its development. PN currently affects approximately 3% to 4% of individuals over the age of 55 in the United States. That rate increases substantially in individuals with associated disorders, such as diabetes.

    Maintaining an active, healthy lifestyle with routine checkups by your physical therapist, may help reduce your risk of developing certain types of PN and the complications associated with it. Your physical therapist is trained to notice any changes in factors, such as your strength, sensation, and functional ability that could suggest development of PN.


    Real Life Experiences

    Tom is a 56-year-old retiree who enjoys playing golf at his local course every week. Recently, Tom began to notice that his feet were feeling numb and "tingly" in the morning, and then throughout the day. When walking on the golf course, he noticed that he had bouts of clumsiness, stumbling a few times. During his last golf game he fell. He decides it's time to see his physical therapist.

    During his examination, Tom reports that he felt like his feet "just gave out" on the golf course, and he’s worried it might happen again. He describes the numbness and tingling in his feet, and his recent bouts of stumbling.

    Tom’s physical therapist asks him about his medical history. Tom admits he was recently diagnosed with Type 2 diabetes and is on medication for high blood pressure. He reports he had suspected he was diabetic for the past year or two, but was too nervous to find out for sure.   

    Upon examination, Tom’s physical therapist notes a decrease in strength and sensation in both of Tom's feet and ankles. Using further tests, he detects that Tom also has decreased coordination in his legs, and poor balance when standing.

    Tom's physical therapist explains that these symptoms may be related to a nerve condition called peripheral neuropathy, which is often associated with diabetes. He contacts Tom's doctor, and recommends that Tom receive physical therapy treatment for a few weeks to work on his balance and coordination.

    On his next visit, Tom reports that his doctor has indeed diagnosed peripheral neuropathy and has prescribed medicine for the condition. His physical therapist works with him over the next few weeks to strengthen his muscles and improve his balance.

    After several weeks of physical therapy, Tom's physical therapist determines he has improved strength in both of his legs as well as improved balance. Tom now feels much more confident about walking outdoors, and has returned to the golf course. He reports that his renewed strength and confidence are making his retirement much more enjoyable.

    This story highlights an individualized experience of PN. Your case may be different. Your physical therapist will tailor a treatment program to your specific needs.


    What Kind of Physical Therapist Do I Need?

    All physical therapists are prepared through education and experience to treat conditions, such as PN. However, when seeking a provider you may want to consider:

    A physical therapist who is a board-certified clinical specialist, such as a Geriatric Care Specialist (GCS) or Neurological Care Specialist (NCS), or who has advanced knowledge, experience, and skills that may apply to your condition. You want to seek a physical therapist who is well-versed in the treatment of PN or other neuropathic disorders.

    You can find physical therapists who have these and other credentials by using Find a PT,the online tool built by the American Physical Therapy Association to help you search for physical therapists with specific clinical expertise in your geographic area.

    General tips when you're looking for a physical therapist (or any other health care provider):

    • Get recommendations from family and friends or from other health care providers.
    • When you contact a physical therapy clinic for an appointment, ask about the physical therapists' experience in helping people with peripheral neuropathy.
    • During your first visit with the physical therapist, be prepared to describe your symptoms in as much detail as possible, and keeping a journal highlighting when you experience pain will help the physical therapist identify the best way of approaching care

    Further Reading

    The American Physical Therapy Association (APTA) believes that consumers should have access to information that could help them make health care decisions, and also prepare them for their visit with their health care provider.

    The following articles provide some of the best scientific evidence for the treatment of PN. The articles report recent research and give an overview of the standards of practice both in the United States and internationally. The article titles are linked either to a PubMed* abstract of the article or to free full text, so that you can read it or print out a copy to bring with you to your health care provider.

    Tuttle LJ, Hastings MK, Mueller MJ. A moderate-intensity weight-bearing exercise program for a person with type 2 diabetes and peripheral neuropathy. Phys Ther. 2012:92(1):133–141. Free Article.

    Kluding PM, Pasnoor M, Singh R, et al. The effect of exercise on neuropathic symptoms, nerve function, and cutaneous innervation in people with diabetic peripheral neuropathy. J Diabetes Complications. 2012;26(5):424–429. Free Article.

    Uusitupa M, Tuomilehto J, Puska P. Are we really active in the prevention of obesity and type 2 diabetes at the community level? Nutr Metab Cardiovasc Dis. 2011:21;380–389. Article Summary on PubMed.

    Coppieters MW, Butler DS. Do “sliders” slide and “tensioners” tension: an analysis of neurodynamic techniques and considerations regarding their application. Man Ther. 2008;13(3);213–221. Article Summary on PubMed.

    Pinar L, Enhos A, Ada S, Gungor N. Can we use nerve gliding exercises in women with carpal tunnel syndrome? Adv Ther. 2005;22(5):467–475. Article Summary on PubMed.

    Gordois A, Scuffham P, Shearer A, Oglesby A, Tobian JA. The health care costs of diabetic peripheral neuropathy in the US. Diabetes Care. 2003:26(6):1790–1795. Free Article.

    * PubMed is a free online resource developed by the National Center for Biotechnology Information (NCBI). PubMed contains millions of citations to biomedical literature, including citations in the National Library of Medicine’s MEDLINE database.

    Authored by Joseph Brence, PT, DPT, FAAOMPT, COMT, DAC. Reviewed by the MoveForwardPT.com editorial board.


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