Physical Therapy for Diabetic Peripheral Neuropathy

the evolving care for patients with dpn

One of the long term effects of Diabetic peripheral neuropathy (DPN), a condition caused by long-term high blood sugar levels, is debilitating nerve damage. More than half of patients who have Diabetes will suffer from some form of neuropathy.

The most common form of diabetic neuropathy is peripheral neuropathy which affects the legs, feet, toes, hands, and arms. (source)

Sometimes patients won’t have symptoms associated with their neuropathy while others may suffer from one or a combination of the following issues:

• numbness or insensitivity to either pain or changes in temperature
• tingling, burning, or prickling sensation in the extremities
• acute, sharp pains or cramps in the extremities
• extreme sensitivity to touch
• reduced balance and coordination

Skin ulcers on the feet are a common side effect of Diabetic peripheral neuropathy. Reducing activity and staying off the feet is the most common course of action for those who suffer from these skin ulcers. However, it has been found that this limiting of activity actually has a harmful effect. An article published in Physical Therapy Journal found stated that “People with DPN should be encouraged to maintain and even increase weight-bearing activities, rather than avoid them.”

The concern with weight bearing activities for DPN patients with skin ulcers is that physical activity puts them at greater risk for further breakdown of the skin. However, it has been proven that the skin is able to positively acclimate to the stress of physical activities. What’s more, studies are now showing that DPN patients who are more physically active actually have a more favorable outcome then those who remain in-active.

Therapeutic exercise used during physical therapy can help patients with DPN in the following ways:

• Reduce pain
• Restore and improve nerve function
• Prevent recurrence

What’s more, physical therapy modalities can be used to help reduce symptoms associated with DPN.

Related Article: Physical Therapy for Chemotherapy-Induced Peripheral Neuropathy

Physical Therapy Modalities to Treat Pain Associated with Diabetic Peripheral Neuropathy

• Paraffin Therapy: Heat therapy in the form of paraffin therapy can be beneficial in reducing the pain associated with diabetic peripheral neuropathy. During heat therapy, the blood vessels expand, bringing more circulation to the treated area. At a cellular level, this increases the amount of healing nutrients and oxygen to the area and aids in removing waste products that cause inflammation and pain.
• Electrical Stimulation: A study, Effects of Electrical Stimulation on Wound Healing in Patients with Diabetic Ulcers, found that the pulsed, bi-phasic waveform available in electrical stimulation was beneficial in healing the tissues for Diabetic patients with open ulcers caused by DPN.
• Low Level Laser Therapy: Another study, Efficacy of low level laser therapy on painful diabetic peripheral neuropathy, found that low level laser therapy was able to reduce pain, improve nerve regeneration and manage complications associated with foot ulcers in patients with DPN.

Diabetic peripheral neuropathy can be debilitating, but it can be treated effectively with physical therapy and therapeutic exercise. This is a change from the old mindset which encouraged rest for recuperation. More education must be provided and shared in order to encourage DPN patients to seek proper treatment and care.