Peripheral neuropathy can significantly impact balance and mobility, often increasing the risk of falls. By disrupting the connection between sensory input and motor output, this condition challenges the body’s ability to stay stable and respond effectively to its environment.
Through targeted balance training, physiotherapy can help individuals improve stability, reduce falls, and regain confidence in their movements. In this blog, we explore the causes of peripheral neuropathy, the components of balance and how balance training can help improve mobility and falls risk for those living with this condition.
Table of Contents:
- What is peripheral neuropathy?
- Anatomy of the Peripheral Nervous System
- Causes of peripheral neuropathy
- Components of balance
- Balance Training in Peripheral Neuropathy
What is Peripheral Neuropathy?
Peripheral neuropathy refers to damage of the nerves outside of the central nervous system (brain and spinal cord). While peripheral neuropathy can be caused by a variety of conditions, the symptoms commonly include numbness, weakness and sometimes pain in the feet and hands.
Peripheral Nervous System Anatomy
Peripheral nerves consist of bundles of nerves supported by connective tissue and are classified based on their function. Sensory (Afferent) nerves transmit sensory signals (e.g., touch, pain, temperature) from receptors in the skin and muscles to the central nervous system, while motor (efferent) nerves carry information from the brain and spinal cord to muscles and glands.
The peripheral nervous system’s intricate design ensures seamless communication between the body and the brain, enabling complex interactions with the environment.
Causes of Peripheral Neuropathy
There are many causes of peripheral neuropathy including:[i]
- Diabetes mellitus
- Chronic alcoholism
- Nutritional deficiencies (e.g., B1, B6, B12, and vitamin E)
- Inflammatory conditions (e.g., vasculitis)
- Hypothyroidism
- Autoimmune disease (e.g., Sjögren syndrome, lupus, rheumatoid arthritis)
- Infections (e.g., Lyme disease, Epstein-Barr virus, hepatitis C, shingles, leprosy, HIV)
- Guillain-Barre syndrome
- Toxins (heavy metals, chemicals)
- Chemotherapy agents
- Medications (antibiotics, cardiovascular medications)
- Inherited conditions (e.g., Charcot-Marie-Tooth disease, familial amyloidosis)
- Trauma or injury
Components of Balance
From a physiotherapy perspective, balance is a complex interplay of multiple systems working together to maintain stability and control during static and dynamic activities. Understanding these systems helps physiotherapists develop effective strategies to improve balance and prevent falls.
1. Musculoskeletal System
Muscles strength, flexibility, joint stability and postural alignment all provide the structural framework and strength needed to maintain posture and perform movements.
2. Sensory Systems
Balance relies on three primary sensory systems to detect changes in position and environment:
The visual system provides information about the environment, orientation, and motion.
The vestibular system detects head motion and position changes through the inner ear’s semicircular canals and otolith organs.
The somatosensory system provides proprioceptive feedback from the skin, muscles, and joints about body position relative to the ground.
3. Cognitive and Psychological Systems
Cognitive functions like attention and executive planning influence safe navigation, especially in complex environments. Anxiety, fear of falling, or dual-tasking can impair balance control.
Balance Training in Peripheral Neuropathy
Due to the damage of nerves with peripheral neuropathy, connections between how information is taken in by the central nervous system, as well as the motor output to the muscles is compromised. Balance training is crucial in mitigating the negative effects of peripheral neuropathy that lead to postural and gait instability, and potentially falls.
A recent systematic review of the literature found that balance training in those with diabetic peripheral neuropathy improved balance outcomes such as one legged stance time, timed up and go test, and Berg Balance Scale scores.[ii] Another study looking specifically at older adults with peripheral neuropathy found that balance training reduced their risk of falls.[iii]
Research has also found similarly positive results in those with chemotherapy induced peripheral neuropathy. One systematic review looking at the effects of exercise, including balance training, on peripheral neuropathy found improvements in symptoms, quality of life and balance measures.[iv]
Balance Training consists of:
- Sensory/Proprioception Training – training can consist performing single leg stance exercises or using uneven surfaces or balance boards
- Vestibular training – training involving head movements, gaze stabilization, and habituation exercises
- Strength training – Core, hip, and lower limb muscles are critical for stability and movement control
- Flexibility – ensuring muscles and joints are at optimal length will allow muscles to respond better to changes in stability
- Postural Training – allows for improved distribution of weight allowing for greater control and efficiency during static and dynamic movements
- Education – Cognitive training/multitasking balance exercises, mindfulness techniques to reduce anxiety and improve focus, and fall-prevention strategies
Conclusion
While many people used to resign themselves with the effects of peripheral neuropathy, we now know that balance training is a cornerstone of physiotherapy for individuals with peripheral neuropathy. This treatment can improve stability, confidence, and independence.
By addressing the challenges caused by impaired sensation, physiotherapy helps retrain the body to rely on alternative systems, such as vision and strength, while enhancing proprioception and coordination. Whether through tailored exercises, gait training, or fall-prevention strategies, balance training empowers individuals to regain control of their movements and reduce the risk of falls.
For those living with peripheral neuropathy, physiotherapy provides not just physical support, but also a renewed sense of freedom and safety in everyday life.
References
[i] Hammi C, Yeung B. Neuropathy. [Updated 2022 Oct 15]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK542220/
[ii] Køhler, E., Dalgas, U., Buhl, C. S., & Brincks, J. (2024). Content and effects of balance training in people with diabetic peripheral neuropathy – a systematic review and meta-analysis. Physiotherapy Theory and Practice, 1–12. https://doi.org/10.1080/09593985.2024.2391823
[iii] Xi Pan, Jiao-jiao Bai,
Balance training in the intervention of fall risk in elderly with diabetic peripheral neuropathy: A review, International Journal of Nursing Sciences, Volume 1, Issue 4, 2014, pages 441-445, ISSN 2352-0132, https://doi.org/10.1016/j.ijnss.2014.09.001.
[iv] Huang Yingjie , Tan Tian , Liu Lu , Yan Zijian , Deng Yuexia , Li Guangyao , Li Min , Xiong Jia. Exercise for reducing chemotherapy-induced peripheral neuropathy: a systematic review and meta-analysis of randomized controlled trials, Frontiers in Neurology, volume 14, 2024. doi:10.3389/fneur.2023.1252259
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