10/07/2020
Exercise and Neuropathy
March 8, 2020
Barry Landreth
Exercise and Neuropathy: How to Keep your Nerves structurally healthy and optimally functioning for Optimal Physical Activity
Neuropathy is defined as an abnormal or unusual degenerative state of nerves. One must not misunderstand the importance of healthy and compliant nervous interventions to ones overall state of health. We hear in laymen’s terms things like, “I’m so nervous.” Or “I pinched a nerve.” These are statements that scientifically relate to structure and function of the nerve squalae.
When dealing with neuropathic conditions especially when related to physical activity, one must balance the health of the structure of the nerve complex with the amount of stimulation needed to create regeneration-like recovery for continued healthy and safe human performances. This stimulation can come from Physical Activity which is defined by the Centers for Disease Control and Prevention in a 2011 publication as any bodily movement produced by the contraction of skeletal muscles that increases energy expenditure above basal level.
Why are the nerves so important to our bodies? It takes stimulation by nerves to get muscle to contract. This could be conscious thought creating the pull on our bones to create movement and/or balance, and unconscious stimulations for breathing, heart beats, blood flow etc.
For us today, we are going to focus on how to stimulate damaged or non-optimally performing nerves so they will adapt and become more efficient at delivering signals for a more coordinated and rapid recruitment of muscle fibers leading to greater power and function in your physical activities be they activities of daily living, enhancing your metabolic health or athletic endeavors like walking a 5k, running half-marathon, or competing in tennis tournament, etc).
Let’s take a snapshot of nerve stimulation. First of all, our sensory nerves receive a message or signal from one of our 5 senses (sight, smell, taste, touch, hear) and send it to our brain which sends a message to our central nervous system down our spinal cord to our peripheral nerves (arms, legs, core mainly) which stimulates the needed muscles to react. These messages are carried via chemicals known as neurotransmitters with Acetylcholine being the most prominent in this process. If at any point in this feedback loop of delivery there is a lack of efficiency, the needed signals to recruit muscle is impaired or even completely blocked. These retardations of signal efficiency are known as nerve impingement.
Research has shown that a damaged nerve can regenerate at approximately one millimeter per day. This is quite slow. So, we need to make sure that as we try to achieve optimal nerve health, we don’t create damage to the nerves required for movement and balance primarily at the sites of the numerous neuromuscular junctions.
How do we enhance our nervous system’s delivery of messages? In the practice of exercise science we have a set of guidelines to enhance neuromotor skills. These include exercises for balance, hand-eye coordination, gait, agility and proprioception. The American College of Sports Medicine (ACSM) and fitness industry generally lavels these types of exercises as Functional Fitness Training. For optimal functional fitness, which means, in part, optimal neural message delivery for optimal muscle recruitment for optimal muscle performance, one must include resistance and flexibility training to enhance muscle strength and pliability to reduce the potential nervous impingements discussed above. These combinations are why Yoga, Pilates and Tai Chi are popular modes of training for neuropathic clients.
The ACSM has adopted an exercise prescription protocol to promote standardized presentation for exercise components in general. The FITT-VP Model, as its known, details the Frequency, Intensity, Time, Type, Volume and Progression for each exercise category. The ACSM has also categorized exercise as Health-Related Physical Fitness and Skill-Related Physical Fitness. Health-Related uses Cardiorespiratory Fitness, Muscle Strength and Endurance, Body Composition (fat distribution) and Flexibility Exercises. Skill-Related uses Speed, Power, Agility, Reaction Time, Coordination and Balance Exercises. Thus to enhance optimal physical performance, especially for nerve health, a combination of the health and skill related protocols should be used.
The goals of an exercise program for those with neuropathies is to maintain or improve strength and aerobic capacities which prevents functional decline, minimize pain and joint stiffness, aid weight control for a healthy body composition, reduce chronic diseases (like hypertension, Cardiovascular Diseases, Type 2 Diabetes, etc), improve bone mineral densities to help minimize osteoporosis, etc, as well as, improve mental health, all summing to a better quality of life.
Depending on the levels of neuropathy at the muscles needing rehabilitation, one may need to make some special training considerations inside the exercise prescription. Weight-Bearing Aerobic activities must be carefully managed. The amount of running, stair-climbing, and agility-type jumping with stop and go actions needs to be minimized at first to allow the nerve to regenerate., Likewise, resistance activities that require higher intensity movement and impact should also at first be significantly controlled. This does not mean to avoid these activities. But, we must be careful in their administration so as to not create a more damaged nerve or nerve components.
To help achieve positive physical adaptations, the warm-up and cool down protocols are critical so as to minimize the pain sensations. Activity should be 5 to 10 minutes of controlled movement of joints through their full range of motion and light intensity aerobic actions. As an example, walk for 5 minutes then perform light static stretches of calves, hamstrings and quadriceps muscles, followed by dynamic lateral lunging into a body squat a few times on each lead before beginning your Aerobic Exercise plan for today. This type of warm up and cool down will signal for additional oxygenated blood flow which will bring needed nutrients and chemicals to the working muscles, thereby enhancing your initial performance over someone who just starts their exercise program with tight, “cold” muscle.
Another special training consideration is appropriate footwear. For higher-impact activities, it is imperative the shoes provide good shock absorption and stability. With nerve issues, one might seek a shoe specialist for appropriate fit and recommendations for a more biomechanical correcting support (pronation vs supination for example).
Lastly, care must be taken to minimize pain and functional limitations. Therefore, initially one might need to utilize an interval protocol of shorter work followed immediately by non-weight bearing rest. This way one can repeat this work/rest series enough times to accumulate a sufficient amount of physical activity all geared toward stimulation, response and adaptive neurological recovery. As you progress and improve the work interval should increase and the rest interval may decrease. Pain sensations in and around the joints along with any physical limitations like poor balance are the keys to the amounts of activity one should complete per session and determine program progressions.
For Charts and Graphs with Sample Training Programs contact barrylandreth@gmail.com.
***As always, this exercise prescription is prepared as a general knowledge program for those with self-diagnosed nerve deficiencies. Always seek your Doctor’s advice prior to implementing any exercise program. Find a quality Exercise Physiologist to help you implement these types of programs***
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