Tingling and numbness in the peripheries – could it be Peripheral Neuropathy?
Our hands and feet are essential for daily life, and so it is little wonder that peripheral neuropathy can be so devastating. It can impact daily activities and walking or even holding a cup can be extremely painful. There are many reasons why a person can develop Peripheral Neuropathy and there are things that can be done in a movement class to help.
When working with clients who have had either a permanent interference or dulling of their sensory input system through injury and/or surgery, it is important to ensure that the information is facilitated in their motor planning and coordination. Below is a brief introduction to the causes of Peripheral Neuropathy and some exercise ideas for clients with the condition.
Anatomy of the Peripheral nerves
Small Nerve Fibres are unmyelinated, comprised primarily of microtubules and have slow-acting nerve impulses, they sense both pain and temperature. When a person complains about a hot shower causing pain in their toes you might be thinking about the small nerve fibres.
Large Nerve Fibres are myelinated, composed mainly of neurofilaments that act as a framework for the axon and have fast acting nerve impulses. They sense position, vibration and motor control. It is often these fibres that are affected by diseases such as multiple sclerosis.
Both of these fibres are targeted by chemotherapy drugs, which may explain why patients with Chemotherapy-induced peripheral neuropathy (CIPN) experience a variety of symptoms. The symptoms of Small Nerve Fibre CIPN include sensations of tingling, prickling, burning and decreased pin-prick, temperature and light-touch sensations. The symptoms of Large Nerve Fibre CIPN include decreased vibratory sensation, proprioception, deep tendon reflexes and muscle strength.
As someone loses awareness of their periphery, it can be challenging for them to walk, identify if they are holding something hot or cold and be in a great deal of pain doing things that some people would take for granted.
Causes of Peripheral Neuropathy
There can be many reasons why a person would have dulling of the periphery and these include Peripheral Neuropathy due to:
// Medications (chemotherapy, steroids)
// Vitamin Deficiency (B12)
// Endochrinal Disorders (diabetes, thyroid problems eg Hashimoto’s Disease)
Vascular problems can also result in a loss of sensation in the periphery, particularly the lower limbs. The vascular loss of sensation is different to peripheral neuropathy, but its impact on a person’s balance, control, sleep and pain levels are similar. Accordingly, it is important to know why a person has lost sensation in their limbs and have a correct diagnosis from their neurologist, cardiologist, endocrinologist or oncologist.
Cancers, autoimmune conditions and Peripheral Neuropathy
Once you know the reasoning it is both possible and quite important to be working with these people so that the loss of sensation does not result in permanent deficits. At Body Organics we are fortunate enough to have Dr Janet Schloss working with us. Dr Schloss is a naturopath and clinical nutritionist who undertook her Doctoral studies on the impact of interventions for chemotherapy-induced neuropathies. It is important to remember that chemotherapy is used for a number of autoimmune conditions, not just cancers, and as such there can be many clients who are receiving treatments that can be affecting their peripheral nerves. The topic is considered in detail in the Chronic- Ls online courses (coming soon) taught by Dr Schloss and Carla Mullins. It is also possible to buy our Peripheral Neuropathy course including our ebook
There are different peripheral neuropathy distributions, for example:
// glove and stocking distributions which is common with chemotherapy-induced Peripheral Neuropathy
// proximal motor neuropathy
// pressure palsies – generally an inheritable condition associated with a genetic mutation in PMP22
These distributions of sensory or motor loss will have different causes. It is always important to check with your client to understand the underlying reason for the neuropathy, as there could be over factors affecting the exercise choices eg medications, balance, muscle and nerve degeneration.
Ideas for Peripheral Neuropathies and exercise
Below are some ideas about how sensory input can be incorporated into a movement class setting, so as to assist with neural patterning and recovery. Some exercise considerations are:
// Visual cues, that is the ability for the person to see the distal part of the limb that is required to move. Remember that they may not be aware of the movement in that limb unless they see it. These considerations could include things such as the use of mirrors or placement of the limb at a point that they can see the movement;
// Support structures so that they can move safely, therefore have them near a wall or a bar for them to hold onto.
// Textural and proprioceptive input so that their sensory input system has to adjust and incorporate as much sensory input as they possibly can. This could mean use of different fabrics touching the person’s skin when they are resting their feet on a reformer foot bar or having the person using putty, scarves and all sorts of different textures in their hands whilst they are working.
Check out more about Peripheral Neuropathy at our online course written in conjunction with Dr Janet Schloss.