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.
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