A common complication of elevated blood sugar or diabetes is damage to the nerves throughout the body. This is known as peripheral neuropathy and can produce debilitating pain, numbness and other distressing symptoms in patients. Typically the symptoms of diabetic neuropathy start in the feet and progress to the hands and other parts of the body. The sustained elevated blood sugar found in diabetes causes damage and degeneration to the nerves via a number of different metabolic pathways. Our knowledge about the deranged metabolism that is the actual cause of diabetic nerve damage has increased dramatically, unfortunately there are currently few, if any, medications specifically designed to treat the underlying cause of the condition. For patients suffering with the symptoms of neuropathy associated with diabetes, current treatment consists of strict blood glucose control and several drugs that may relieve the symptoms of diabetic neuropathy. Regrettably the current state of treatment for most patients suffering from diabetic neuropathy is truly inadequate.
There are a number of drugs in the research pipeline that may potentially address some of the metabolic pathways associated with the development of diabetic neuropathy. If these drugs pan out, they have the potential to offer the first-ever therapy that seeks to address the cause rather than mask the symptoms of diabetic neuropathy.
Until these new classes of medications become available for the treatment of diabetic neuropathy, arguably non-pharmaceutical interventions may offer superior relieve for diabetic patients suffering with nerve related complications.
There are, in fact, advances in the realm of physical treatment of neuropathy that may potentially benefit diabetic neuropathy patients right now. Let me tell you about the research findings of a team of surgeons from Johns Hopkins and related research findings from the physiotherapy profession in Australia. If you or someone you know is suffering from diabetic neuropathy, you are going to want to know about this research.
But first we need a little lesson on how a nerve behaves physically in the body and also a little background on what may happen to nerves in diabetic patients. Once we understand these fundamental properties of the peripheral nerves, we can talk about the specific research findings of these two groups and how they may benefit diabetic nerve pain sufferers.
What happens to the nerves in your arms and legs when you reach, stretch, bend, walk or simply move from one position or posture to another? It is probably not something you have ever really considered, but it is important and relevant especially to patients with diabetic neuropathy. Consider for a minute that nerves are very much like wires running through your body. Now picture for a moment if your arm is bent at the elbow. The nerves in your arm are also bent and have very little tension on them in this posture. But what do you suppose happens to these nerves when you reach and stretch to grab something overhead?
The nerve will first straighten and then become tight and taunt due to the change in position. To prevent overstretching, which can damage a nerve; the nerve must also glide and move. This is the concept I want you to keep in mind; that healthy nerves glide and move with changes in the position of the parts of the body. This gliding is essential to prevent the build up of tension in a nerve which can cause damage to it.
In fact using an imaging technique called high resolution ultrasound, researches have actually measured the amount of gliding (they call it excursion) that occurs in a nerve when the body is placed in different positions. What we know from these studies is that the median nerve which is one of the main nerves in the arm and the tibial nerve, a major nerve in the leg, move between 2-4 mm when the body is placed in different positions. Now this might not seem like a huge amount of movement or gliding, but chances are that if you would directly stretch the nerve this amount, you would rupture many of the delicate fibers within it. So the take home point is that this gliding movement of the nerves while small is very important for the ongoing health of the nerve. Anything that would reduce or restrict this movement has the potential to damage, injure or irritate the nerve and its individual nerve fibers.
So remember that nerve movement or gliding is healthy for the nerve, nerve fixation or restriction of movement can be harmful.
So how does all this relate to diabetic neuropathy which is caused by prolonged excessive blood sugar? The same researcher that were studying nerve motion discovered that nerve gliding in diabetic patients was substantially less than nerve mobility in control patient without diabetes. Although we don’t know why the nerves are less mobile in diabetic patients, this finding suggests that in additional to the damage to the nerves caused by high blood sugar, patients with diabetic neuropathy may also have nerve irritation and micro trauma due to restricted nerve gliding.
These observations lead surgeons to develop a surgical procedure designed to decompress and release the trapped nerves in the feet of patients suffering with diabetic neuropathy. The results of a large clinical trial were very encouraging. These results suggest that in addition to treating the symptoms of diabetic neuropathy with medications, physical release of the nerves in feet of these patients could produce dramatic improvement in burning pain, numb toes and other symptoms of diabetic nerve complications.
The problem is surgery in general and especially foot surgery in diabetic patients can be risky business.
So the next logical question should be; is it possible to decompress diabetic damaged nerves in the feet without resorting to surgery?
It appears so.
A technique called nerve gliding or sometimes called nerve flossing may do the trick. Basically nerve gliding treatment seeks to mobilize fixed and entrapped nerves to restore their normal motion. The technique consists of gentle stretches applied across the fixated nerve. While the foot is stretched the patient simultaneously will flex and extend the head and neck. This produces a “flossing” type motion on either side of the nerve fixation. Over time this reciprocal nerve mobilization may break down adhesions and decompress the nerve. According to the theory of nerve gliding this type of nerve mobilization may non-surgically decompress and restore motion to entrapped nerves.
Once again using high resolution ultrasound scanning to measure nerve excursion and movement, researcher were able to document that the nerve mobilization and flossing techniques can and do indeed cause the nerves in the arms and legs to move and glide in response to this non-surgical procedure.
This means that, at least in theory, patients suffering from diabetic neuropathy could benefit from nerve flossing or nerve gliding techniques applied to the feet and legs. Because these techniques can mobilize the nerve with gentle stretches and foot positioning they appear to be an exciting potential new treatment option for diabetic peripheral neuropathy patients. What is more they are non-surgical and relatively safe with very little potential for injury. Nerve mobilization and gliding techniques may offer a potential alternative to foot surgery in high risk diabetic neuropathy patients.
George Kukurin D.C.