By: Richard DeFalco, DPT, OCS, CSCS, CWcHP
Numbness and tingling in the lower legs, decreased balance, inability to sense where your body is in space... if these are symptoms that you experience, you may be suffering from peripheral neuropathy. More and more, there are patients being referred for physical therapy for treatment of their neuropathy.
Neuropathy is a diagnosis that is classified by an inability of nerves to transmit information to and from the brain. It commonly affects the ability of those nerves to transmit information regarding sensation as well as appropriate muscle control and sometimes autonomic control (the automatic control of visceral functions such as sweating, heart rate, and blood pressure.) There may be only one nerve that is affected such as in a mononeuropathy or several nerves as in a polyneuropathy. A classic pattern of nerve involvement is one that exists in peripheral neuropathy.
Some of the causes of peripheral neuropathy are diabetes, alcoholism, inherited disorders, autoimmune disorders, an entrapped peripheral nerve, medication side effects, exposure to toxins, infection, and physical injury.
With peripheral neuropathy the longer nerves in the body are most often affected first and speak to the reason as to why symptoms are often felt first in the feet and/or hands and progressing towards the trunk. Some of the initial symptoms are burning, tingling, and numbness starting in the feet. Patients will often report a "sort of stocking glove" distribution of neurological deficit. In other words, the initial report of symptoms (numbness, burning, and tingling) they may feel resemble the pattern of wearing an invisible glove or pair of stockings. This is because the condition will affect multiple nerves in the affected extremities.
Just as sensation can be affected, so can motor function, leading to the inability to coordinate muscle movement. One may start to notice a loss of muscle size and abnormalities of muscle tone. Again, usually starting in the extremities first, one may notice a decreased ability to control their ankle dorsiflexors (the muscles on the front of the lower leg responsible for lifting your toes and foot towards your shin), which will ultimately result in impaired ambulation. The resultant loss of sensation and motor function can lead to a decreased ability to maintain balance with a subsequent increased risk for falls.
This leads to the reasoning of a referral for physical therapy. Between pharmacological management and physical therapy interventions, an appropriate treatment plan can be devised to help manage the symptoms that lead to further complications including falls, fractures as a result of falls, and head injuries as a result of falls.
There have been multiple controlled studies that demonstrate that a moderate-intensity exercise program can be successful in improving measures of muscle strength, physical function, activities of daily living, and other quality of life measures in individuals living with peripheral neuropathy as well as other neuromuscular disorders. Moreover, when individuals are educated on the risk factors leading to falls and implement strategies to thwart them, there is a resultant decrease in the frequency of falls.
At Professional Rehabilitation Services, we treat a wide variety of musculoskeletal and neurological conditions using the latest in evidence based therapies provided by highly credentialed physical therapists. In addition to being licensed physical therapists, our providers have additional specialty certifications in orthopedics, manual therapy, sports, and vestibular treatment. Professional Rehabilitation Services now has three locations, with the newest office located at 1301 48th Ave North, Myrtle Beach, SC. For further information on this or other related topics you can contact Richard DeFalco, DPT, OCS, CSCS, CWcHP at Professional Rehabilitation Services (Myrtle Beach) (843) 839-1300, Brian P. Kinmartin PT, DPT, MTC, OCS, STC, CWcHP, (Pawleys Island) (843) 235-0200, or Richard A. Owens MPT, OCS, Cert.SMT (Surfside) (843) 831-0163, or visit our website at www.prsrehabservices.com