From Numbness to Shooting Nerve Pain – Living with and Managing Neuropathy

Can’t feel your feet or hands, or worse, experiencing shooting pain or clumsiness in your arms and legs that makes moving through life difficult?

You may have neuropathy, a condition where nerves outside of the brain and spinal cord (peripheral nervous system) are damaged or injured, creating problems in your limbs.

You don’t have to settle when it comes to neuropathy. While there is no cure, physical therapy, occupational therapy or a combination of both helps reduce symptoms, improve movement quality and rebuild confidence.

The starting point – What causes neuropathy?

A common misconception of neuropathy is that it only results from diabetes. While diabetes is the most frequent cause, with 60% to 70% of people who have the condition developing neuropathy at some point, there are many reasons why you may be experiencing neuropathy.

Common causes of neuropathy include:

• Alcoholism
• Injuries
• Autoimmune diseases (including lupus, rheumatoid arthritis and Guillain-Barré syndrome)
• Infections (such as shingles, HIV and Lyme disease)
• Cancer and its treatments (chemotherapy, radiation, surgery)
• Vitamin deficiencies (low levels of certain B vitamins, particularly B12, B6 and B1)
• Other systemic diseases (including chronic kidney disease, liver disease and hypothyroidism)
• Toxins and heavy metals (exposure to substances like lead, mercury and certain industrial chemicals)

Nerves operate by sending signals from the brain down our spinal cord and to the rest of our body. If nerve damage is present, it can result in both sensory and motor symptoms.

Sensory symptoms

• Numbness or tingling in hands, fingers, feet and other extremities
• Burning or prickling sensations often described as “pins and needles"
• Sensitivity to touch, heat or cold
• Pain, often described as sharp, shooting or electric
• Loss of balance or coordination

Motor symptoms

• Weakness or clumsiness in the hands, feet or legs
• Difficulty walking or standing
• Dropping objects frequently
• Foot drop (inability to lift the foot)

Why physical and occupational therapy matters for neuropathy

Physical and occupational therapies help improve strength, coordination and adaptation to daily activities. Cognitive behavioral therapy and mirror therapy can help manage neuropathy and phantom limb pain for those who have experienced a limb amputation, retraining the brain in recognizing a prosthetic or absence of your original limb. Other options include transcutaneous electrical nerve stimulation (TENS), nerve gliding exercises, biofeedback and lifestyle adjustments.

Your care plan begins at evaluation

Good care begins with a solid evaluation that goes beyond the numbers. Understanding why you are experiencing neuropathy is a strong starting point and yes, numbers are important when it comes to evaluating range of motion, strength and balance. But in addition to your therapist performing objective measure testing, looking at your medical history and having open conversations to understand your passions helps to develop goals for your care plan that are created especially for you.

When you have something to work toward that you love, doing the work to get there is much easier and more rewarding when you reach the finish line.

For example, if you are a gardener, a good therapy plan will include exercises that may include squatting down or walking on different surfaces, because gardening rarely happens on level surfaces or only in the standing position.

Neuropathy treatment techniques

A strong program blends exercise, manual therapy and addresses limitation in a safe way, especially when sensation is reduced.

Specific rehabilitation techniques include:

• Desensitization – This involves gradually exposing the affected areas to different stimuli like soft fabrics, different textures, hot or cold and gentle tapping to gradually retrain the nerves and restore normal pain perception. Occupational therapists may use vibrations as stimuli.
• Physical and occupational therapy – These therapies can work collaboratively to focus on improving motor skills, posture and functional independence through exercises and adaptive strategies for daily living.
• Mirror therapy and cognitive multisensory rehabilitation (CMR) – Mirror therapy uses a mirror to create the illusion of the phantom limb, while CMR uses exercises to restore normal perception and motor imagery of the limb
• Nerve gliding – Gentle movements of the nerve can help restore normal nerve function by improving mobility of peripheral nerves within their surrounding tissues, helping to relieve neuropathic pain, reduce nerve compression and increase range of motion.
• Biofeedback – This technique helps gain control over involuntary bodily functions like muscle tension or blood flow, which can be a successful strategy in managing phantom pain.

Exercise matters

Structured, progressive exercise is a cornerstone to care. 

• Aerobic conditioning supports cardiovascular health and can positively influence metabolic factors associated with nerve health.
• Resistance training helps combat weakness and muscle deterioration.
• Flexibility exercises preserve joint range of motion and reduce stiffness.
• Balance and proprioceptive training (knowing where your body is in space) address sensory loss, especially in the feet, and improve stability to lower the risk of falls.

Your therapist will work on all of this and more based on your evaluation, and you can expect a personalized home exercise program with clear guidance on frequency, intensity and progression to keep you at your best between appointments.

Choosing a therapy provider who is focused on education and empowerment is vital to sustained progress. Your therapist will teach you strategies to:

• Inspect skin and foot health daily, especially if sensation is reduced or if you have diabetes, to identify unnoticed injuries early.
• Select appropriate footwear and orthotics to improve pressure distribution and stability.
• Pace tasks and plan rest breaks to minimize neuropathy symptom flares and manage fatigue.
• Set up your home for safety with adequate lighting, clutter-free walkways, non-slip surfaces and handrails or grab bars as needed.

Why managing neuropathy is important

Rehabilitation for neuropathy management is often most effective in preserving nerve health when started early. Your therapist is tied into a network of health care providers and can provide appropriate referrals to primary care providers, endocrinologists, chronic pain management providers, nutritionists and podiatrists when they see issues during your sessions.

Many people notice early changes — such as improved balance, reduced fatigue and better tolerance for walking — within a few weeks of consistent therapy and home practice. Even greater gains in strength, endurance and walking stability build over time.

Take the first step in defeating neuropathy symptoms with physical and occupational therapy.

Clinical contribution to this blog provided by Physical Therapist Farris Fakhoury.