By Francesca Gimigliano, MD PhD, University of Campania “Luigi Vanvitelli,” Napoli, Italy; and Stefania Mozzillo, Istituti Clinici Scientifici Maugeri Spa – Società Benefit, Campania, Italy
Peripheral neuropathies include a wide group of syndromes due to damage to peripheral, sensitive, motor and autonomic nerve fibers. Nerve fibers’ altered function is the basis of sensory (tingling, pinpricks, numbness, and pain) and muscular disorders. Patients often experience difficulty in walking, climbing and descending stairs, standing, maintaining balance and handling objects. Moreover, they complain of becoming easily fatigued and diminished ability to carry out daily life activities. All this causes limitations in patients’ participation in social life and has a negative impact on their quality of life.
Rehabilitation represents an important aspect of the multidisciplinary management of these patients. The goal of rehabilitation is to maintain, and where possible, maximize function, prevent complications and maintain or improve autonomy in daily life activities. In particular, functioning objectives are: preventing or reducing muscle-tendon retractions and/or joint deformities, reducing hypotrophy from non-use, recovering exercise tolerance, preventing falls from balance impairments, and improving manual dexterity.
Rehabilitation generally includes stretching, muscle strengthening, balance and motor coordination exercises, aerobic training, and occupational therapy.
Muscle strength reduction is the prevalent impairment of most of patients suffering from peripheral neuropathies. Strength reduction is characterized by an imbalance between antagonist muscle groups, favoring muscle-tendon retractions. This can evolve to joint deformities. A typical example is the equine deformity of the foot due to the retraction of the Achilles tendon. This hinders active movement, promoting a vicious cycle that inevitably leads to a progressive reduction in motor performance. Static and/or dynamic stretching exercises have the aim of recovering and/or increasing joint mobility. The positive effect of muscle stretching seems to be related to the changes induced in the muscle-tendon unit1. Published studies using different exercise protocols support a duration between 90 seconds and 2 minutes of stretching for each muscle group1.
Progressive and selective muscle strengthening exercises have the aim of recovering muscle strength. These are repeated muscle contractions, which, depending on the case, can be isometric (muscle contraction in the absence of joint movement), and/or isotonic (muscle contraction versus a progressive resistance, associated with joint movement). Scientific studies have shown a moderate effectiveness of strengthening exercises on the muscle strength of neuropathy patients2.
Aerobic activities, such as using an exercise bike or treadmill with a progressive increase in intensity and duration, represent the treatment of choice for improving resistance to effort. In patients with type 2 diabetes or pre-diabetes, sessions lasting 30 minutes to 2 hours, 2 or 3 times a week are recommended.
Both stretching exercises and the treadmill have given excellent results in improving walking in patients suffering from hereditary neuropathies such as Charcot-Marie-Tooth3.
Muscle strengthening and balance exercises, proprioceptive platforms, treadmill, and virtual reality represent valid strategies to improve stability and coordination in patients with peripheral neuropathies, and to reduce their risk of falls4.
Rehabilitation represents a valid therapeutic strategy in the treatment of patients with peripheral neuropathies in order to improve their autonomy in the activities of daily living. The wide range of exercises available makes research in Physical and Rehabilitation Medicine a real challenge. Future studies are needed to better define standardized rehabilitation protocols in terms of timing and types of exercises.
1. A review of the acute effects of static and dynamic stretching on performance.
Behm DG, Chaouachi A.
Eur J Appl Physiol (2011) 111:2633–2651.
2. Exercise for people with peripheral neuropathy.
White CM, Pritchard J, Turner-Stokes L.
Cochrane Database Syst Rev. 2004 Oct 18; Review.
3. Treadmill training in patients affected by Charcot-Marie-Tooth (CMT) neuropathy: results of a multicenter, prospective, randomized, single-blind, controlled study.
Mori L, Prada V, Signori A, Prada V, Pareyson D, Piscosquito G, Padua L, Pazzaglia C, Fabrizi GM, Picelli A, Schenone A; TreSPE Study Group.
Eur J Neurol. 2019 Aug 24.
4. Exercise intervention studies in patients with peripheral neuropathy: a systematic review.
Streckmann F, Zopf EM, Lehmann HC, May K, Rizza J, Zimmer P, Gollhofer A, Bloch W, Baumann FT.
Sports Med. 2014 Sep;44(9):1289-304. Review.