Peripheral Neuropathies.
What is peripheral neuropathy?
Peripheral neuropathy refers to a group of disorders that involve damage to the peripheral nerves — the intricate network of nerve fibres responsible for transmitting signals between the central nervous system (brain and spinal cord) and the rest of the body, including the limbs, organs and muscles. When these nerves are damaged, signal disruption leads to a variety of symptoms: weakness, numbness and pain, typically in the hands and feet.
The peripheral nervous system has three types of nerve fibre, and which type is predominantly affected determines the symptom pattern. Motor nerve damage produces weakness and muscle wasting. Sensory nerve damage produces numbness, tingling, burning pain and loss of proprioception. Autonomic nerve damage affects heart rate, blood pressure, sweating and bowel and bladder function. Many peripheral neuropathies affect all three types — a polyneuropathy — while others affect a single nerve (mononeuropathy) or a specific nerve plexus.
What causes peripheral neuropathy?
Peripheral neuropathy can have various causes. Diabetes is one of the most common — diabetic neuropathy results from high blood sugar levels over an extended period damaging the smallest blood vessels supplying individual nerve fibres. Trauma, injuries or physical trauma can also damage nerves and lead to neuropathy.
Other significant causes include chemotherapy-induced peripheral neuropathy (CIPN) — affecting a substantial proportion of cancer patients receiving neurotoxic chemotherapy agents — alcohol-related neuropathy, vitamin B12 deficiency, hypothyroidism, inflammatory conditions including Guillain-Barré syndrome and chronic inflammatory demyelinating polyneuropathy (CIDP), hereditary neuropathies such as Charcot-Marie-Tooth disease, and nerve compression or entrapment at specific anatomical sites — carpal tunnel syndrome and tarsal tunnel syndrome being the most common focal neuropathies. In a significant proportion of cases — estimated at up to a third — no definitive cause is identified (idiopathic neuropathy).
What are the symptoms?
The classic symptom pattern of peripheral polyneuropathy is a "glove and stocking" distribution — symptoms beginning in the toes and feet and extending progressively upward to the ankles, shins and eventually hands and forearms, reflecting the greater length and therefore greater vulnerability of the longest nerve fibres. Symptoms include tingling, numbness, burning, electric or stabbing pain, hypersensitivity to touch (allodynia — where normally non-painful stimuli cause pain), and weakness of the feet and hands in motor involvement.
Loss of proprioception — the body's sense of position — is one of the most functionally significant features of sensory neuropathy, producing balance impairment and significantly increased fall risk. The combination of foot weakness, numbness and proprioceptive loss creates the characteristic wide-based, high-stepping "steppage" gait of severe peripheral neuropathy.
How is it diagnosed?
Nerve conduction studies (NCS) and electromyography (EMG) are the primary investigations for peripheral neuropathy, assessing the speed and amplitude of nerve conduction and the electrical activity of muscles to localise the site and characterise the type of nerve damage. Blood tests identify treatable causes including diabetes, B12 deficiency and thyroid dysfunction. Skin punch biopsy assesses small fibre neuropathy — a subtype affecting unmyelinated pain fibres that does not appear on standard NCS. In some cases, nerve biopsy or genetic testing is required for diagnosis.
How can physiotherapy and exercise physiology help?
The efficacy and safety of physiotherapy in the management of people with peripheral neuropathies is increasingly recognised, with evidence supporting exercise, manual therapy and neural mobilisation for neuropathic pain and functional improvement.
Physiotherapy addresses several key impairments: strengthening weakened muscles through specific strength-training exercises that improve stability and mobility; balance and coordination training to reduce fall risk; and maintaining joint flexibility and range of motion to prevent contractures and stiffness.
Balance rehabilitation is often the most functionally critical component — the proprioceptive deficits of peripheral neuropathy produce fall risk that is amenable to targeted training even when the underlying nerve damage cannot be reversed. Progressive balance challenges on unstable surfaces, single-leg activities and gait retraining build compensatory strategies that meaningfully reduce fall risk. Our Balance and Bones exercise classes are appropriate for patients with peripheral neuropathy affecting balance and lower limb function.
Neural mobilisation — gentle nerve gliding exercises — reduces nerve mechanosensitivity and can improve both pain and function in entrapment neuropathies and sensitised peripheral nerves. For carpal tunnel syndrome and tarsal tunnel syndrome, these techniques are a core component of conservative management.
Exercise physiology plays a particularly important role in diabetic peripheral neuropathy — structured aerobic and resistance exercise programs improve glycaemic control, reduce cardiovascular risk, build lower limb strength and improve nerve blood flow, all of which contribute to slowing neuropathy progression. Eligible patients may access exercise physiology through a Chronic Disease Management Plan with GP referral.
Real time ultrasound assists in retraining deep foot and lower leg muscle activation where motor neuropathy has disrupted normal neuromuscular patterns. Clinical Pilates provides a controlled, low-impact environment for lower limb strengthening and proprioceptive training appropriate for patients with neuropathic balance impairment.
Our physiotherapists Eliane Machado and Yulia Khasyanova have specialist experience in complex nerve conditions. Exercise Physiologist Ash O'Regan manages chronic disease exercise programming including diabetic neuropathy. All are members of the Australian Physiotherapy Association.
To book or find out more, call us on 07 3706 3407 or book online below. We see patients from across Brisbane's southside including Tarragindi, Coorparoo, Holland Park, Greenslopes and Mt Gravatt.
Peripheral neuropathy refers to a group of disorders that involve damage to the peripheral nerves — the intricate network of nerve fibres responsible for transmitting signals between the central nervous system (brain and spinal cord) and the rest of the body, including the limbs, organs and muscles. When these nerves are damaged, signal disruption leads to a variety of symptoms: weakness, numbness and pain, typically in the hands and feet.
The peripheral nervous system has three types of nerve fibre, and which type is predominantly affected determines the symptom pattern. Motor nerve damage produces weakness and muscle wasting. Sensory nerve damage produces numbness, tingling, burning pain and loss of proprioception. Autonomic nerve damage affects heart rate, blood pressure, sweating and bowel and bladder function. Many peripheral neuropathies affect all three types — a polyneuropathy — while others affect a single nerve (mononeuropathy) or a specific nerve plexus.
What causes peripheral neuropathy?
Peripheral neuropathy can have various causes. Diabetes is one of the most common — diabetic neuropathy results from high blood sugar levels over an extended period damaging the smallest blood vessels supplying individual nerve fibres. Trauma, injuries or physical trauma can also damage nerves and lead to neuropathy.
Other significant causes include chemotherapy-induced peripheral neuropathy (CIPN) — affecting a substantial proportion of cancer patients receiving neurotoxic chemotherapy agents — alcohol-related neuropathy, vitamin B12 deficiency, hypothyroidism, inflammatory conditions including Guillain-Barré syndrome and chronic inflammatory demyelinating polyneuropathy (CIDP), hereditary neuropathies such as Charcot-Marie-Tooth disease, and nerve compression or entrapment at specific anatomical sites — carpal tunnel syndrome and tarsal tunnel syndrome being the most common focal neuropathies. In a significant proportion of cases — estimated at up to a third — no definitive cause is identified (idiopathic neuropathy).
What are the symptoms?
The classic symptom pattern of peripheral polyneuropathy is a "glove and stocking" distribution — symptoms beginning in the toes and feet and extending progressively upward to the ankles, shins and eventually hands and forearms, reflecting the greater length and therefore greater vulnerability of the longest nerve fibres. Symptoms include tingling, numbness, burning, electric or stabbing pain, hypersensitivity to touch (allodynia — where normally non-painful stimuli cause pain), and weakness of the feet and hands in motor involvement.
Loss of proprioception — the body's sense of position — is one of the most functionally significant features of sensory neuropathy, producing balance impairment and significantly increased fall risk. The combination of foot weakness, numbness and proprioceptive loss creates the characteristic wide-based, high-stepping "steppage" gait of severe peripheral neuropathy.
How is it diagnosed?
Nerve conduction studies (NCS) and electromyography (EMG) are the primary investigations for peripheral neuropathy, assessing the speed and amplitude of nerve conduction and the electrical activity of muscles to localise the site and characterise the type of nerve damage. Blood tests identify treatable causes including diabetes, B12 deficiency and thyroid dysfunction. Skin punch biopsy assesses small fibre neuropathy — a subtype affecting unmyelinated pain fibres that does not appear on standard NCS. In some cases, nerve biopsy or genetic testing is required for diagnosis.
How can physiotherapy and exercise physiology help?
The efficacy and safety of physiotherapy in the management of people with peripheral neuropathies is increasingly recognised, with evidence supporting exercise, manual therapy and neural mobilisation for neuropathic pain and functional improvement.
Physiotherapy addresses several key impairments: strengthening weakened muscles through specific strength-training exercises that improve stability and mobility; balance and coordination training to reduce fall risk; and maintaining joint flexibility and range of motion to prevent contractures and stiffness.
Balance rehabilitation is often the most functionally critical component — the proprioceptive deficits of peripheral neuropathy produce fall risk that is amenable to targeted training even when the underlying nerve damage cannot be reversed. Progressive balance challenges on unstable surfaces, single-leg activities and gait retraining build compensatory strategies that meaningfully reduce fall risk. Our Balance and Bones exercise classes are appropriate for patients with peripheral neuropathy affecting balance and lower limb function.
Neural mobilisation — gentle nerve gliding exercises — reduces nerve mechanosensitivity and can improve both pain and function in entrapment neuropathies and sensitised peripheral nerves. For carpal tunnel syndrome and tarsal tunnel syndrome, these techniques are a core component of conservative management.
Exercise physiology plays a particularly important role in diabetic peripheral neuropathy — structured aerobic and resistance exercise programs improve glycaemic control, reduce cardiovascular risk, build lower limb strength and improve nerve blood flow, all of which contribute to slowing neuropathy progression. Eligible patients may access exercise physiology through a Chronic Disease Management Plan with GP referral.
Real time ultrasound assists in retraining deep foot and lower leg muscle activation where motor neuropathy has disrupted normal neuromuscular patterns. Clinical Pilates provides a controlled, low-impact environment for lower limb strengthening and proprioceptive training appropriate for patients with neuropathic balance impairment.
Our physiotherapists Eliane Machado and Yulia Khasyanova have specialist experience in complex nerve conditions. Exercise Physiologist Ash O'Regan manages chronic disease exercise programming including diabetic neuropathy. All are members of the Australian Physiotherapy Association.
To book or find out more, call us on 07 3706 3407 or book online below. We see patients from across Brisbane's southside including Tarragindi, Coorparoo, Holland Park, Greenslopes and Mt Gravatt.
