physiotherapy for polyneuropathy

PHYSIOTHERAPY IS ESSENTIAL FOR PATIENTS WITH POLYNEUROPAPTHY

Physiotherapy is crucial to remain mobile and active if you suffer from polyneuropathy. It can also help with the symptoms like pain, tingling and paresthesia. In this article you will find effective methods of physiotherapy and instructions on how to help yourself.

AN OVERVIEW OF THE DIFFERENT METHODS

1. Exercise therapy:

Balance training, strength training, vibration training

2. Methods to keep the muscles relaxed and flexible:

Massage and stretching

3. Electrotherapy:

High-Tone-Therapy and TENS

1. BALANCE TRAINING

The most important way to remain mobile using physiotherapy despite having polyneuropathy is balance training.

To keep your balance, you have to feel exactly what position your body is in and constantly adjust your body's position and your muscle tension. To do this, you need a good feeling for your own body and a good control of your movements. The more you practice your balance, the better you get at feeling the position of your body and controlling your movements.

This method has been used for a long time and has proven successful for both competitive athletes and senior citizens. Balance training improves coordination and thus makes movement easier because you learn to use your strength better and this, in turn, relieves the stress on your muscles. In addition, balance training reduces the risk of falls and injuries in people of all fitness levels - both high-performance athletes and older generations.

In the recent years, several studies have shown that those who suffer from polyneuropathy can reduce the risk of falling due to balance training and further improve their ability to walk safely and be active despite their condition.

One good study can be found here: Duregon (2018)

The reason why this works is, that balance training helps your brain to adapt to the nerve damage in polyneuropathy.
Balance exercises are hard work for your nervous system and force it to adapt to new situations constantly. This causes a training effect that can help compensate for the damages done by polyneuropathy.

BALANCE TRAINING IN PHYSIOTHERAPY SEEMS TO HELP AGAINST PAIN

Balance training has another surprising positive effect: it often reduces the pain caused by polyneuropathy.

I myself have already seen how the pain and discomfort of some patients improved through balance training. In several studies it was also observed that patients who developed polyneuropathy due to chemotherapy had less pain and discomfort if they did balance training (you can read two of the study here: Kleckner et al. (2018); Streckmann et al. 2014)

However, this effect does not seem to occur in all patients and the reason for this is not yet clear. I personally would recommend to try and see for yourself if this type of training helps with your symptoms.

Balance Training Polyneuropathie Symptome.png

You can find exercises to try at home here:

Exercise for Polyneuropathy

2. STRENGTH TRAINING IN PHYSIOTHERAPY FOR POLYNEUROPATHY

Strength training is an essential part of physiotherapy for polyneuropathy for several reasons:

1. Strengthening one part of your body can compensate for weaknesses elsewhere.

Those who train in spite of polyneuropathy can often help their muscles to perform better in the long term. For example, if you have little strength in your lower legs due to polyneuropathy, you can still train your thighs and thus at least partially compensate for the deficits. Tasks that can no longer be performed by muscles in one place are then performed by other muscles somewhere else. For example, even with very weak calves, you can still walk up and down stairs if the muscles in your thighs are strong.

2. Strength training not only strengthens the muscles, but also the bones.

When you do strength training, especially with heavy weights, you do not only train your muscles, but your bones, too. This is because the bones have to withstand and transmit the force applied by the muscles. This makes the bones denser and less likely to break in case of an accident. Interestingly, it is not necessary to train on machines to achieve this. According to a study in the international journal for osteoporosis (Osteoporosis international), exercises with free weights are even more effective for building bone mass than training on machines (you can read the study here: Shojaa et al. 2020).

3. Strength training makes more nerve endings grow and activates more muscle fibres.

In order to activate a muscle, signals are sent from the nerves to the muscle fibres, which make them contract. The more muscle fibres are activated by the nerves simultaneously, the bigger the force the muscle can produce. This is important, because you can never activate all your muscle fibres at the same time. However, if you do strength training, your body learns to activate a larger percentage of the muscle fibres at a time. This is due to new nerve endings growing in your muscles if you train. This is especially helpful if you are losing muscle strength due to polyneuropathy as such training allows more muscle fibres to work despite the disease. It is therefore possible to maintain stronger muscles for a long period of time despite having polyneuropathy.

4. Even in old age and with severe polyneuropathy, getting stronger is still possible.

Many people assume that because of polyneuropathy or age they can no longer build any strength or muscles. In my practice, I regularly work with people over 80 and 90 who suffer from polyneuropathy. Through targeted training, an increase in strength is almost always possible. If the polyneuropathy paralyses one part of the body, it is usually still possible to increase strength in another part. This is not just my personal finding but has been reported in several scientific studies. Here is a review of scientific papers: (Tofthagen et al. 2012).

In the picture below you can see how a patient of mine at age 91 with severe polyneuropathy managed to do more and more squats during just a few training sessions. The effect was long lasting in this case. Today, two years later, he can do over 50 squats.

You can find detailed information on training for polyneuropathy in my artcile on Sport and polyneuropathy

TRAIN YOUR HANDS AND FINGERS WITH THERAPY CLAY AND PEAS

One method that is used very often is to knead therapeutic clay or peas to maintain the strength of the fingers. Therapeutic clay seems to be more effective. All you need to do is squeeze the clay in your hands. This is a lot harder than it sounds and can be a pretty good workout.

To maintain your fine motor skills, you can do specific training for them. One good way of training is to simply do a a lot of things in everyday life that are demanding for your fine motor skills. This is because skills that are practised frequently are more likely to continue to be performed even as polyneuropathy progresses. Examples are knitting, writing or drawing and all types of handcraft activities.

3. STRETCHING FOR POLYNEUROPATHY

One of the goals of physiotherapy for polyneuropathy is to keep the muscles in a normal, smooth state and to prevent muscle tightness. You also want to maintain mobility as much as possible. Stretching is an important part of this.

Stretches can also help to reduce pain. This is because the pain in polyneuropathy is not always caused by nerve damage. Often, you also have pain because your muscles are tight because they are constantly overworked due to the disease. In such cases, stretching exercises can often improve the pain considerably.

CAN STRETCHING IN PHYSIOTHERAPY HEAL THE NERVE DAMAGE IN POLYNEUROPATHY?

Some people assume that stretching the nerves can contribute to an improvement or regeneration of the nerves in polyneuropathy. This is suspected because there have been animal experiments in which the test animals were administered poisons that trigger polyneuropathy and such stretches were performed at the same time. As a result, the experimental animals that underwent nerve stretches had less severe polyneuropathy than those who did not stretch.

However, I doubt that this effect can also be achieved by stretching in humans with polyneuropathy. I have tried such stretches myself with some patients and could not find any effect on the nerves. I therefore assume that physiotherapeutic stretching exercises only have a positive effect on the muscles and not directly on the nerves.

4. PHYSIOTHERAPEUTIC MASSAGe FOR POLYNEUROPATHY

Like stretching, massage can be helpful in polyneuropathy, especially to reduce pain. Obviously, massage con not heal the damaged nerves. However it can have very positive effects on the muscles, that can reduce the pain significantly.

In my own experience, tight muscles very often play a part in the development of pain in polyneuropathy. This is because the disease leads to a loss of muscle strength and different movement patterns. Therefore, the muscles are constantly overworked. The muscles react to this by becoming tight and hardened. This can cause a tremendous amount of pain. This is why in polyneuropathy it is usually impossible to distinguish whether the pain is due to nerve damage or due to cramped muscles. Consequently, you should always try to see if treating the muscles can reduce the pain.

5. VIBRATION TRAINING FOR POLYNEUROPATHY

Vibration training is considered one of the most effective physiotherapeutic methods to ease the symptoms of polyneuropathy. It seems to be particularly helpful to combat the pain associated with the disease. There are now a number of studies that have observed improvements in pain and discomfort using vibration training.

Kessler et al. (2020) and some other research groups observed improvements in symptoms in patients with diabetic polyneuropathy. In addition, vibration training has (small) effects on muscle strength and balance and can improve your walking capability.

Furthermore, Streckmann et al. (2019) compared vibration training and balance training in patients with polyneuropathy after chemotherapy. They found that vibration training helps more with pain, while balance training helps more with the other symptoms of polyneuropathy. Accordingly, it makes sense to do both.

It is important not to start vibration training too intensively and especially not to train for too long at a time. If you immediately start a long training session with strong vibrations without having done vibration training before, you run the risk of overstraining yourself. This can often lead to muscle tension and pain all over the body. At the very beginning, you should only stand on the vibration plate for one minute and then take a longer break.

Even if you are already better trained, it is best to alternate one minute of vibration with one minute of rest. 5 cycles seem to be enough. If you apply the vibration for longer, your nerves get tired and do not react to the vibration anymore. Therefore you do not get better training effects by standing on a vibration plate for a long time.

It is important to be aware that, to my knowledge, it has not yet been clarified exactly how strong the vibration should be. My personal assumption is that on the commercially avaiblable devices, high vibration levels should be used, because slow vibrations are less stimulating to the nerves.

EXERCISES ON THE VIBRATION PLATE

Generally, standing on the vibration plate without doing extra exercises seems to be enough to reduce pain in polyneuropathy. The vibration then already affects the legs and stimulates the nerves. However, you can also use the time on the vibration plate more effectively by doing additional exercises. Here is a selection of exercises with different levels of difficulty:

Standing on the vibration plate with your eyes closed.
This will train your balance and body awareness at the same time as the vibration training.
Squats on the vibration plate.
This will improve the strength of your legs.
Move from regular stance to standing on your tiptoes and then slowly move back down again.
This will train the strength of your calves.
If you have a lot of pain or balance problems, you can also simply sit on a chair next to the vibration device and place your feet on the device.

Make sure not to run any risk of falling while you are doing these exercises. You should have something to hold on to in case you lose your balance or, even better, a training partner standing next to you and supporting you in case you loose your balance.

VIBRATION TRAINING FOR THE HANDS AND ARMS

Standing on a vibration plate is not the only thing you can do. You can also use it for your arms if you have problems in your hands due to polyneuropathy.

To do this, sit on the ground directly in front of the plate and place your hands on it while it vibrates.

You can additionally bend and stretch your arms and thus move your upper body up and down (similar to push-ups). In this way you train the strength of your arms while applying the vibration.

6. ELECTROTHERAPY IN PHYSIOTHERAPY FOR POLYNEUROPATHY

Another method used in physiotherapy for polyneuropathy is electrotherapy. Here, hhe nerves are stimulated electrically. There are two main methods:

1. TENS (Transcutaneous Nerve Stimulation).
This method is mainly used to relieve acute pain. The treatment directly targets the nerves and has an analgesic effect. Immediately after treatment with TENS, people often feel less pain. However, this effect usually disappears after a few hours. TENS therefore does not result in any long-term improvement.

2. High tone therapy
High tone therapy uses special electric currents in which the frequency and strength are varied. (The exact physical processes are beyond the scope of this article and can be read about here). More importantly is the question of effectiveness. There are studies that found a small positive effect when high tone therapy was used daily for several months. However, most studies have only been done in diabetic polyneuropathy. I know of only a few studies in other forms of polyneuropathy. My own patients who have tried the method mostly tell me that the high tone therapy has not brought them any lasting improvement. From my point of view, it is therefore not yet possible to know for sure how effective high tone therapy actually is in physiotherapy for polyneuropathy.

PERSONAL CONSULTATION

If you would like to discuss your individual situation and the treatment and training options with me, please contact me for an personal consultation.

CHRISTIAN BITZER

M.A. Sports Science (Universities of Freiburg, Stuttgart and Granada)

B.A. Sports Therapy (University of Freiburg)

Sports therapist for internal medicine and orthopedics (DVGS)

Phone: 0176 66 86 91 51
Email: Bitzer.Sporttherapie@gmail.com