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A common complication of elevated blood sugar or diabetes is nerve damage throughout the body. This is known as peripheral neuropathy and can cause debilitating pain, numbness and other distressing symptoms in patients. Usually, the symptoms of diabetic neuropathy begin in the feet and progress to the hands and other parts of the body. The persistently elevated blood sugar found in diabetes causes nerve damage and degeneration through 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 from the symptoms of neuropathy associated with diabetes, current treatment consists of strict control of blood glucose and various drugs that can relieve the symptoms of diabetic neuropathy. Unfortunately, the current state of treatment for most patients suffering from diabetic neuropathy is really inadequate.
There are a number of drugs in the research pipeline that could potentially target some of the metabolic pathways associated with the development of diabetic neuropathy. If these drugs work out, they have the potential to offer the first-ever therapy that tries to address the root cause rather than mask the symptoms of diabetic neuropathy.
Until these new classes of drugs become available for the treatment of diabetic neuropathy, arguably non-pharmaceutical interventions can provide superior relief for diabetic patients suffering from nerve-related complications.
In fact, there are advancements in the physical treatment of neuropathy that may currently benefit diabetic neuropathy patients. Let me tell you about the research results of a team of surgeons from Johns Hopkins and related research results from the physiotherapy profession in Australia. If you or someone you know suffers from diabetic neuropathy, you’ll want to know more about this study.
But first we need a little lesson on how a nerve physically behaves in the body and also some background on what can 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 patients.
What happens to the nerves in your arms and legs when you reach, stretch, bend, walk, or just move from one position or posture to another? It’s probably not something you’ve ever really thought about, but it’s important and relevant, especially for patients with diabetic neuropathy. Think for a moment that nerves are very much like wires that run through your body. Now imagine for a moment if your arm is bent at the elbow. The nerves in your arm are also bent and have little tension in this position. But what do you think happens to these nerves when you reach and stretch to grab something overhead?
The nerve will first stretch and then become taut and ridiculous from the change of position. To prevent overstretching, which can damage a nerve; the nerve must also slide and move. This is the concept I want you to keep in mind; that healthy nerves slide and move with changes in the position of the body parts. This sliding is essential to avoid creating tension in a nerve that can damage it.
In fact, using an imaging technique called high-resolution ultrasound, studies have measured the amount of sliding (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, one of the major nerves in the arm, and the tibial nerve, a major nerve in the leg, move between 2 and 4 mm when the body is placed in different positions. This may not seem like a huge amount of movement or sliding, but chances are if you directly stretched the nerve that much you would tear many of the delicate fibers in it. So the take home point is that this gliding movement of the nerves, while small, is very important for the continued health of the nerve. Anything that would reduce or limit this movement could damage, injure, or irritate the nerve and its individual nerve fibers.
So remember that nerve movement or sliding is healthy for the nerve, nerve fixation or restriction of movement can be harmful.
So how does all this relate to diabetic neuropathy caused by prolonged excess blood sugar? The same researcher who studied nerve movement found that nerve sliding in diabetic patients was significantly less than nerve mobility in non-diabetic control patients. While we don’t know why the nerves are less mobile in diabetic patients, this finding suggests that in addition to the nerve damage caused by high blood sugar, patients with diabetic neuropathy may also have nerve irritation and microtrauma due to constricted nerves. to slide.
These observations led surgeons to develop a surgical procedure designed to decompress and release the pinched nerves in the feet of patients suffering from diabetic neuropathy. The results of a large-scale clinical trial were very encouraging. These results suggest that in addition to treating the symptoms of diabetic neuropathy with drugs, physically clearing the nerves in the feet of these patients could produce a dramatic improvement in burning pain, numb toes, and other symptoms of diabetic nerve complications.
The problem is surgery in general, and foot surgery in diabetic patients in particular can be a risky business.
So the next logical question should be; is it possible to decompress diabetic damaged nerves in the feet without undergoing surgery?
It seems like.
A technique called nerve gliding or sometimes referred to as nerve flossing can do the trick. Essentially, nerve gliding treatment attempts to mobilize fixed and pinched nerves to restore their normal movement. The technique consists of gentle stretches applied over the fixed nerve. While straightening the foot, the patient will bend and straighten the head and neck at the same time. This produces a “flossing” type movement on either side of the nerve fixation. Over time, this reciprocal nerve mobilization can break down adhesions and decompress the nerve. According to nerve slip theory, this type of nerve mobilization can decompress nonsurgically and restore movement of pinched nerves.
Again using high-resolution ultrasound scans to measure nerve excursion and movement, the researcher was able to document that the nerve mobilization and flossing techniques can and indeed do 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 patients with diabetic peripheral neuropathy. In addition, they are non-surgical and relatively safe with very little risk of injury. Nerve mobilization and gliding techniques may offer a potential alternative to foot surgery in patients at high risk of diabetic neuropathy.
What Is Nerve Gliding And Can It Help With Diabetic Neuropathy In The Feet?
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