Safe Exercise Tips for Peripheral Neuropathy

Mar 17, 2020

If you suffer from peripheral neuropathy, you may feel caught in a catch-22 when it comes to exercise:

On the one hand, exercise is absolutely critical if you want to manage both your symptoms and the course of the disease. Exercise will improve blood and nutrient flow to the legs and feet (and the nerves they contain), reduce swelling, and strengthen and stabilize weakened muscles and supporting tissues.

And of course, if your neuropathy is linked to diabetes or high blood sugar, regular exercise will help you keep those exacerbating factors in better control.

This means that exercise will not only make your feet and legs feel better, but can actually keep your neuropathy from progressing to a more severe stage. This can reduce your risk of falls, wounds, and other severe complications.

But on the other hand, exercise (at least in certain forms) can be dangerous for someone who has already lost a lot of feeling, strength, and/or balance in their lower limbs.

If your strength, balance, or coordination have deteriorated due to the disease, obviously your risk of falling, twisting your ankle, or suffering other kinds of accidental injuries is significantly higher than someone unaffected by neuropathy.

Perhaps more dangerous is the lack of force feedback from your feet. You could suffer a cut, injury, perhaps in some cases even a broken bone without really feeling or noticing it right away. The longer it goes unnoticed, the greater your risk of developing severe infections or deformities.

A bad injury would very likely undo all the benefits you had gained from exercise in the first place and then some, making the situation even worse.

So what is a person with neuropathy to do? It comes down to a couple of important things. Number one, you want to stick to exercises that put less weight, pressure, and risk on your feet and ankles. And number two, you want to focus on exercises that specifically counteract some of the most common problems associated with neuropathy.

Let’s break these categories down a bit.

Low-Impact Cardio

Cardiovascular fitness exercises are obviously an important part of overall health and wellbeing for all individuals. Regular cardio helps you manage your weight, improve your blood sugar control, get more oxygen and nutrients to your legs, even get better sleep—all of which can have profoundly positive effects on the course of your neuropathy.

The problem is that many of the types of exercise associated with cardio—running, jump rope, burpees, sports like basketball or tennis, etc.—fall into the category of high-impact. In other words, they place heavy demands on your feet, ankles, and joints. If your lower limbs have been weakened by neuropathy, those demands may be too severe to perform safely.

But there are many alternative cardio exercises that pose much less risk your feet. They include:

Walking. It may be lower intensity than running, but brisk walking is still great cardio exercise—especially if you can go for at least 30 minutes at a time.
Cycling. Both going out for a bike ride or riding the stationary cycle are great forms of cardio that put less stress on feet. The stationary bike may be preferred if your neuropathy is severe, you are unsure of how far you can comfortably ride, or unsure about weather conditions.
Aquatics. The natural buoyancy properties of water allow you get great cardio while putting almost no strain on your joints—plus the water itself is refreshing! Swimming laps is great; so is water aerobics.

Strength and Balance Training

Strength training and balance exercises for your feet and ankles provide many benefits for neuropathy sufferers. Stronger muscles are able to support and balance you better, and are more resistant to injuries overall. Plus, stronger muscles are more efficient at using the oxygen supplied by your blood.

Fortunately, many of these exercises can be performed right at home, with little or no specialized equipment. For example:

Calf raises. Slowly rise up to your tiptoes, hold the position as long as you comfortably can, then slowly lower. For support you can use a wall, kitchen counter, or sturdy piece of furniture. As you get more comfortable, try one foot at a time, with your other foot lifted behind you.
Heel-to-toe walking. A great one for balance! Simply walk in a straight line by placing your heel directly in front of the toes of the other foot with each step. (The shoes should touch.)
Seated dorsiflexion exercises. Sit in a comfy (but not too comfy!) chair with feet flat on the floor. Then, keeping your heels on the floor, flex your feet and toes upward as high as you can, hold, and slowly let them down.

Of course, if you do like to go to the gym, you can hit up the leg extension machine, hamstring curl machines, and other low-impact strength training workouts. On the flipside, you may want to avoid exercises that require heavy weight bearing, such as barbell squats.

Flexibility and Range of Motion Exercises

Flexibility stretches are also a key part of building up resistance to injury. They are foundational to all the other forms of exercise you engage in, since they help warm up your muscles and joints and allow you to safely sustain higher levels of activity. Here are a couple of good examples:

Calf stretches. Face a wall (close enough to put your hands on it for support if needed) with your feet shoulder width a part. Then, step back with one leg as far as you comfortably can, with your back foot flat on the floor and the back knee only slightly bent. (You’ll have to bend your front knee). Lean forward as well as you can, then hold the stretch at least 10-15 seconds. Switch and repeat.
Ankle circles. This one’s really straightforward. Sit in a chair, with one leg crossed over the other knee. Move your ankle in a slow, steady circle at least 10 times in each direction. Alternatively, you can try imagining your big toe as the tip of a pen and writing out the alphabet using only your ankle.

Some Important Caveats

We hope you’re excited to go out and get exercising! That said, before you do, there are a couple of safety checks to keep in mind.

If you have significant signs of peripheral neuropathy, always seek the input of a doctor (whether your PCP or one of the doctors here at Sunshein Podiatry Associates) before putting together a comprehensive workout plan. We’ll help make sure your plan is well tailored to your unique situation and personal needs, from both a safety and an optimal benefit perspective.
Go slow at first, especially if you aren’t used to regular exercise, or are significantly altering your previous routine. It will take your body time to adapt to the new kinds of stresses and challenges you’re throwing at it. Better to start slow and safe, at a pace or intensity you know you can handle, and then increase by no more than 10-15 percent per week.
Always make sure you have the appropriate safety gear, including the right kind of athletic shoes in good repair and fit your feet well. Once again, this is something our team can help you with.

Looking For More Info? Download Our Guide!

Exercise is just one component of living a healthy lifestyle despite your peripheral neuropathy. You also want to make sure you maintain a healthy diet, and of course work closely with your medical team (including the folks here at Sunshein Podiatry Associates) to make sure you get the advanced treatments you need.

To help you with the “at home” component, we’ve written a brief downloadable guide on health and wellness. Keep it on your phone or print it out to keep those diet and exercise guidelines easily accessible and top of mind!