Diabetic peripheral neuropathy Part II : Physical therapy
Physical therapy for diabetic peripheral neuropathy:
Physical therapy may help reduce dependency on pain relieving drug therapies. Certain physiotherapy techniques can help alleviate symptoms brought on from diabetic neuropathy such as deep pain in the feet and legs, tingling or burning sensation in extremities, muscle cramps, muscle weakness, sexual dysfunction, and diabetic foot.
Gait training, posture training, and teaching these patients the basic principles of off-loading can help prevent and/or stabilize foot complications such as foot ulcers.Gait is the way that somebody/something walks
किसी व्यक्ति के चलने का तरीक़ा; चाल .Gait is a person's pattern of walking. Walking involves balance and coordination of muscles so that the body is propelled forward in a rhythm, called the stride. There are numerous possibilities that may cause an abnormal gait. Some common causes are:
A degenerative disease such as arthritis.
The definition of a gait is the way that a human walks or runs. An example of a gait is a slow step or a jaunty trot. Jaunty means having or expressing a lively, cheerful, and self-confident manner.
"there was no mistaking that jaunty walk". Jaunty walk means easy and sprightly in manner or bearing to walk with a jaunty step.
Gait training, posture training, and teaching these patients the basic principles of off-loading can help prevent and/or stabilize foot complications such as foot ulcers.Gait is the way that somebody/something walks
किसी व्यक्ति के चलने का तरीक़ा; चाल .Gait is a person's pattern of walking. Walking involves balance and coordination of muscles so that the body is propelled forward in a rhythm, called the stride. There are numerous possibilities that may cause an abnormal gait. Some common causes are degenerative diseases such as arthritis.Gait re-training would also be beneficial for individuals who have lost limbs, due to diabetic neuropathy, and now wear a prosthesis.
Observation of gait can provide early diagnostic clues for a number of disorders, including cerebral palsy, Parkinson's disease, and Rett syndrome.
The causes of gait disorders include neurological conditions e.g. sensory or motor impairments, orthopedic problems e.g. osteoarthritis and skeletal deformities and medical conditions e.g. heart failure, respiratory insufficiency, peripheral arterial occlusive disease and obesity.
The symptoms of gait:
The most common symptoms of gait and balance problems include: Difficulty walking.
Trouble with balance. Unsteadiness.
People can experience:
dizziness.
light headedness.
vertigo.
motion sickness.
double vision.
Gait is evaluated by having the patient walk across the room under observation. Gross gait abnormalities should be noted. Next ask the patient to walk heel to toe across the room, then on their toes only, and finally on their heels only. Normally, these maneuvers possible without too much difficulty.
Gait analysis by doctor can help determine underlying problems such as bone deformities, movement restrictions, muscle weakness, nerve dysfunction, skeletal or joint malalignments, complications from spasticity or contracture, and complications from arthritis.
Off-loading techniques can include the use of mobility aids e.g. crutches or foot splints. Crutch is a type of stick that you put under your arm to help you walk when you have hurt your leg or foot
एक प्रकार की छड़ी जो चलने में सहारा देने के लिए (चोट आदि के कारण) बाज़ू के नीचे रखकर प्रयुक्त होती है; बैसाखी
There are two primary types of crutches:
(1)Underarm Crutches: Underarm crutches are also called axilla crutches and are
two most common type of crutch.
(2)Forearm crutches: Forearm crutches are also called lofstrand or elbow crutches. The forearm support crutches are better in distributing weight equitably to the whole upper body. This makes forearm crutches a more comfortable option as they do not put strain on any part of the body.
Foot splints, also sometimes called "half casts," immobilize your foot or ankle. They provide less support than casts, but they also have fewer complications. Because they're fast and easy to apply, patients can be in and out of their doctor's office faster than if they get a cast.
Exercise programs, along with manual therapy, will help to prevent muscle contractures, spasms and atrophy. These programs may include general muscle stretching to maintain muscle length and a person's range of motion.General muscle strengthening exercises will help to maintain muscle strength and reduce muscle wasting.Aerobic exercise such as swimming and using a stationary bicycle can help peripheral neuropathy, but activities that place excessive pressure on the feet e.g. walking long distances, running may be contraindicated.Exercise therapy has been shown to increase the blood flow to the peripheral nerves, can improve gait function.
Heat, therapeutic ultrasound, hot wax are also useful for treating diabetic neuropathy.
Pelvic floor muscle exercises can improve sexual dysfunction caused by neuropathy.
Electric stimulation of the plantar aspect of the foot showed improved balance and sensation when performed daily.
Focused Ultrasound Therapy
Focused ultrasound is an early-stage, non-invasive, therapeutic technology with the potential to improve the quality of life and decrease the cost of care for patients with neuropathy.
The therapeutic ultrasound can influence the regeneration of peripheral nerves.It was concluded that low intensity therapeutic ultrasound enhances nerve regeneration, as demonstrated with significance on the 21st postoperative day.
Manner of walking or stepping; bearing .Gait: A manner of walking. Observation of gait can provide early diagnostic clues for a number of disorders, including cerebral palsy, Parkinson's disease, and Rett syndrome.
The causes of gait disorders include neurological conditions e.g. sensory or motor impairments, orthopedic problems e.g. osteoarthritis and skeletal deformities and medical conditions e.g. heart failure, respiratory insufficiency, peripheral arterial occlusive disease and obesity.
The symptoms of gait:
The most common symptoms of gait and balance problems include: difficulty walking. trouble with balance. unsteadiness.
People can experience:
dizziness.
light headedness.
vertigo.
motion sickness.
double vision.
Gait is evaluated by having the patient walk across the room under observation. Gross gait abnormalities should be noted. Next ask the patient to walk heel to toe across the room, then on their toes only, and finally on their heels only. Normally, these maneuvers possible without too much difficulty.
Gait analysis can help determine underlying problems such as bone deformities, movement restrictions, muscle weakness, nerve dysfunction, skeletal or joint malalignments, complications from spasticity or contracture, and complications from arthritis.
Off-loading techniques can include the use of mobility aids e.g. crutches or foot splints.
Gait re-training would also be beneficial for individuals who have lost limbs, due to diabetic neuropathy, and now wear a prosthesis.
Exercise programs, along with manual therapy, will help to prevent muscle contractures, spasms and atrophy. These programs may include general muscle stretching to maintain muscle length and a person's range of motion.General muscle strengthening exercises will help to maintain muscle strength and reduce muscle wasting.[Aerobic exercise such as swimming and using a stationary bicycle can help peripheral neuropathy, but activities that place excessive pressure on the feet e.g. walking long distances, running may be contraindicated.Exercise therapy has been shown to increase the blood flow to the peripheral nerves, can improve gait function.
Crutch is a type of stick that you put under your arm to help you walk when you have hurt your leg or foot
एक प्रकार की छड़ी जो चलने में सहारा देने के लिए (चोट आदि के कारण) बाज़ू के नीचे रखकर प्रयुक्त होती है; बैसाखी
There are two primary types of crutches:
Underarm Crutches. Underarm crutches are also called axilla crutches and are the most common type of crutch.
.Forearm crutches. Forearm crutches are also called lofstrand or elbow crutches.
The forearm support crutches are better in distributing weight equitably to the whole upper body. This makes forearm crutches a more comfortable option as they do not put strain on any part of the body.
Foot splints, also sometimes called "half casts," immobilize your foot or ankle. They provide less support than casts, but they also have fewer complications. Because they're fast and easy to apply, patients can be in and out of their doctor's office faster than if they get a cast.
Heat, therapeutic ultrasound, hot wax are also useful for treating diabetic neuropathy.
Pelvic floor muscle exercises can improve sexual dysfunction caused by neuropathy.
Hot Wax therapy:It uses a bath of molten paraffin wax, is one of the most effective ways of applying heat to improve mobility by warming the connective tissues. Wax therapy is mainly used on your hands and is often used by hand therapists in a hospital setting along with an exercise programme.
As it has a very low melting temperature (48°C-90C). It is not going to cause any burns or blisters, and does not get stuck to the skin as well. Warm wax has several benefits. It helps to bring down the aches and pains of the body, relaxes sore and tired muscles and hydrates the skin making it soft and smooth.
Electric stimulation of the plantar aspect of the foot showed improved balance and sensation when performed daily.
Focused Ultrasound Therapy
Focused ultrasound is an early-stage, non-invasive, therapeutic technology with the potential to improve the quality of life and decrease the cost of care for patients with neuropathy.The therapeutic ultrasound can influence the regeneration of peripheral nerves.It was concluded that low intensity therapeutic ultrasound enhances nerve regeneration, as demonstrated with significance on the 21st postoperative day.
Conclusion:The Various methods of physical therapy may help to reduce the pain of diabetic peripheral neuropathy in hands,legs and feet.
Author:Dr.Bhairavsinh Raol
