Accelerated PN , possibly from PT?

@paul14, My experience has been that exercise helps my neuropathy as long as I don't over do it. I recently went to a physical therapist for some help with new exercises to help with my balance and gait. I've also started wearing thin soled zero drop shoes which really have no padding but do protect the feet from objects. I do like that even with my feet being somewhat numb, I can feel the ground better when walking. Then again, none of the exercises I do are high impact where it can cause trauma to the feet. I also have a pair of OrthoFeet boots that have zippers in the back for easy on/off but I don't wear them much as they seem to make my balance worse with the spongy feeling.

Thanks, do you ever get the tingly feeling and inflammation after walking or even just sitting with shoes on? Is this more nerves being damaged? The increased numbness in both feet from minimal activity is troubling.

I do get a kind of tingly feeling but no pain. I also have swelling in the legs from lymphedema which I have to wear compression socks during the day to help keep the swelling down. Have you looked at the Foundation for Peripheral Neuropathy site for suggestions that might help?
--- https://www.foundationforpn.org/living-well/

You need to identify the cause. I was experiencing the same issues and found out it was coming from my lumbar spine . FYI, my neurologist did not identify the cause and just said it was idiopathic PN, but the MRI taken by the back ortho proved otherwise. Now I can treat accordingly. If you have the same than you will have to adjust your PT protocol.

I’m going to try my best to explain my experience and hope it doesn’t get too confusing: In my case, PT could cause an increase in my neuropathy symptoms…

BUT I don’t believe it causes worsening of my neuropathy, if they makes sense? It didn’t “cause” nerve damage.

@johnbishop mentioned that exercise generally helps, as long as he doesn’t overdo it. I feel strongly that’s the key: not overdoing it.

My PT explained to me that when people have chronic pain, your nervous system gets basically used to communicating a message of pain. That pathway gets worn in, like a habit or a well-worn path through the grass; the brain is more likely to fall into that habit of interpreting a new experience as pain because it’s just done it so many times. She called it sensitization if the central nervous system. Now some people refer to it as “nociplastic pain.”

What was happening to me is that when I did “too much, too soon” of a new exercise, I would get flare-ups of my pain, including my neurological symptoms: tingling in my legs, headaches, dizziness, light sensitivity, etc.

It seemed so weird to me and off the wall, not to mention disturbing—how could a simple and brief standing balance exercises do all that?

I have no idea if that’s what’s happening to you or not, but I wanted to share it, since you asked if something similar had happened to anyone. This has actually happened to me on numerous occasions. It even happened in aqua PT; that was probably the worst neuropathy flare of all, and it’s supposed to be soothing to be in the water!

The way I have to get around it is if I have a flare, I have to take a rest from the exercises that caused it, until I get back to baseline. Relaxing/restorative activities help it go faster to sooth the nervous system.

Then I go back to the exercise and start it with a smaller dose. I have to be careful both with the intensity and number of repetitions. And also if I’m doing too many things all at one time. For example, if I tried 1 minute of a balance exercise and it caused a flare, next time I’ll try 30 seconds.

Then I increase slowly from there to help my body get used to it—both to improve strength and balance, but also to get my nervous system used to it. Eventually I can get to a point where it won’t cause neuropathy symptoms.

Again, not sure if that’s what’s happening, but it’s what regularly happens to me if I overdo it. My PT indicated it’s common, but she sees a lot of chronic pain patients.

You’re so right and it is very, very disconcerting when it happens. She told me that’s exactly what my brain is saying about the new exercise—it’s new and a potential threat and so it’s sending out pain signals to warn me off trying something new even if I know it’s something I want to do.

Thanks John. I am looking at FPN site a lot. Will check it out.

Thanks. I also have lumbar spine issues but neurologist said it wouldn’t affect my symptoms. I’m checking with another neurologist on it.

Right, I think that’s what’s happening except it usually leaves additional numbness in other parts of my feet like pinky toe and side of foot that doesn’t come back. My left foot plantar fascia seems to always flare up just by me flexing the foot while sitting or laying down. As I said, most of both feet are numb now so I don’t know what is causing it or if I will regain the sensation that’s now numb.

For me, I learned that overuse during PT (or any other activity) contributes to fatigue and that my PN requires me extra time to recover. My therapist agreed that we needed to work on eliminating the “day after” effect if PT, as it should be more seamless while helping us build strength and brain/muscle memory. She would modify the activities or reps to help my PN. Open communication is key - we start each session with reviewing how I felt after the prior session. One thing that does not work for me under any terms are exercises that stress my toes. I can stand on heels, but trying to be a ballerina on toes or pushing weights with them leave extra painful and numbing effects for many days, so we’ve had to come up with a different way of helping engage that part of the foot. We’re all different, but if you find that an activity or exercise leaves you worse off vs better, please let your therapist know as there may be a more suitable exercise.

Any pressure on the bottom of my feet such as from walking on hard surfaces or exercising aggravates the nerve pain. Consistent with the other posts above, I'm working with my physical therapist to advance my activity extremely slowly. For example, I started with walking outside only 6 minutes every other day. Even that much aggravated the nerve pain in my feet at night. So, I'm holding at that level until my tolerance improves.