NEUROPATHY AND BALANCE
20 million Americans suffer from diagnosed peripheral neuropathy including 8% of older populations. Many more are undiagnosed. It displays as numbness, tingling, a burning feeling, aching, cramps or weakness in the extremities. Symptoms often begin in the feet or hands. These symptoms may spread later to the legs or arms.
Peripheral neuropathy occurs when the nerve endings of the peripheral nervous system are damaged. The most common cause of neuropathy is diabetes. 75% of those with diabetes develop neuropathy in the feet and legs. It is progressive and irreversible. Neuropathy can also result from traumatic injuries, infections, metabolic problems, inherited causes or exposure to toxins. It is also a side effect of some chemotherapies where the hands and/or feet may be affected.
Those with neuropathy of the feet have a special challenge in that it affects balance significantly. The complex sense of balance is made up of several simpler ones:
With neuropathy this third sense has deteriorated or declined. The brain has much less information to base awareness of how to balance the body, especially in movement. This leads to a much higher risk of having a fall.
There are a number of ways we can make up for this balance deficit. This article highlights specific ways that balance can be improved if you have neuropathy. The recommendations are very helpful though for anyone wanting to improve their balance.
- The inner ear informs the brain where the head is in space. If you have debris in your inner ear canal then a warped message is sent to the brain. This results in a feeling of dizziness. It often happens when we turn our head quickly
- The eyes inform the brain about the real world outside ourselves: what is actually up and what is down.
- The periphery of the body informs the brain where our limbs are in space, both the hands and especially importantly, the feet. This sense is called proprioception. It gives us the sensation that we can feel our feet on the ground with our eyes closed.
With neuropathy this third sense has deteriorated or declined. The brain has much less information to base awareness of how to balance the body, especially in movement. This leads to a much higher risk of having a fall.
There are a number of ways we can make up for this balance deficit. This article highlights specific ways that balance can be improved if you have neuropathy. The recommendations are very helpful though for anyone wanting to improve their balance.
Tips to improve balance if you have neuropathy of the feet:
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Especially for neuropathy:
To improve stability in general:
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Increase points of contact:
Human beings are designed to have terrible balance. We have only 2 points of contact with the ground, while most mammals have 4. Compare the stability of a 4 legged bar stool to one that has only 2 legs! No wonder balance is a complex and oftentimes difficult issue for us. And if our proprioceptive ability is limited by neuropathy then our challenges are far greater.
One easy way to improve your balance is to add a 3rd point of contact. This becomes even more important if your feet are numb. Here are some interesting ways to do that:
One easy way to improve your balance is to add a 3rd point of contact. This becomes even more important if your feet are numb. Here are some interesting ways to do that:
- Use a cane or hold onto something to stabilize yourself: It in effect is a third leg.
- Use your hands in a more subtle way to add that third point of contact. As you are walking down a hallway, try gently touching the back of your hand against the wall. I often take hot tubs at night in our garden. Sometimes I am light headed getting out of the tub. I will use the back of my hand resting against the side of the hot tub for stability as I maneuver around it.
- Try placing the other foot against the standing leg when practicing standing on one foot. It is an additional point of contact for the brain.
- Place the tip of your tongue against the roof of your mouth: This is a tip shared amongst those pursuing a spiritual path. It closes an energetic circuit and stabilizes the energy of the body.
Much more information on improving proprioception through touch is described in Sense of Touch Improves Balance.
Practice stability exercises:
You would think that good balance comes from the legs and feet. Of course that is true. But an even more important center for balance is the torso. A torso that is engaged produces good balance. Stability exercises are a major help.
Torso stability exercises are any movements you do which force you to keep your torso stable while other activity is going on. Ballet is full of torso stability. (Yoga is as well.) Frankly it is more important than anything else. Keeping the torso in one spot while dramatically moving the limbs is a great way to strengthen the core muscles without actually doing core exercise directly. The field of body building places special importance on this type of work. Here are three wonderful ways to increase torso stability:
- Suitcase carries: This is a group of exercises that direct you to overweight one side of your body to challenge the torso to remain balanced. A very easy suitcase carry is to hold your bottle of water in one hand, relaxed at your side. Walk down a hallway consciously keeping your torso from favoring the weighted side. Try heavier weights as you improve.
- Balancing on one foot: Be sure to do this while holding onto a sturdy chair or countertop with one or both hands. Use your hands as a guide instead of gripping with them. As your balance improves, lightly place your hand on top of the chair or counter until you can lift it up entirely. The challenge of course is to maintain your balance even though on one foot. Concentrate on contracting the muscles on the front and back of your torso as the key to maintaining your balance.
- Stabilizing your torso while sitting and lifting one leg: Even more effective at torso stabilization than balancing on one foot. Sit upright in a sturdy chair resting your back against the chair. Lift one leg. Lots of muscular activity is necessary to keep your torso on one place. You have to make sure your hips stay even and that you are not tilting toward one side. The solution is to contract the muscles of your torso so much that your body stays in the center no matter what. That muscular contraction is the essence of torso stabilization.
Nervous system health:
Practice, practice, practice: That is not only how you get to Carnegie Hall. It is also how you can train the nervous system. Our nervous system is made up of the brain connected to the spinal cord connected to the peripheral nervous system which runs throughout the entire body. It is the communications system of the body. Over time, nervous system pathways adapt to living conditions and habitual movement. We can train the nervous system to improve those pathways. That is what dance classes are all about.
But training the nervous system is also an essential process in professional sports. For instance, watch how experienced competitive skiers prepare for an event. You may notice them standing off to the side, waiting for their run, with their eyes closed and their body making tiny odd movements. They are visualizing the course and how they ideally want to run it. It has become an established sports training technique. Visualization is an exceptionally effective method for improving nervous system function. It is simply one form of practice.
Practice is extremely helpful in improving balance. And it takes on even more importance if neuropathy has affected the body's proprioceptive abilities.
What is a good thing to practice if you have neuropathy?
But training the nervous system is also an essential process in professional sports. For instance, watch how experienced competitive skiers prepare for an event. You may notice them standing off to the side, waiting for their run, with their eyes closed and their body making tiny odd movements. They are visualizing the course and how they ideally want to run it. It has become an established sports training technique. Visualization is an exceptionally effective method for improving nervous system function. It is simply one form of practice.
Practice is extremely helpful in improving balance. And it takes on even more importance if neuropathy has affected the body's proprioceptive abilities.
What is a good thing to practice if you have neuropathy?
- Practice the right way to walk, including where to look when you walk.
- Practice anything, especially anything rhythmic: Tap your foot to the music. Clap your hands. Work on simple rhythms like right/left/right/hold. (It sounds like a horse galloping.)
- A simple rhythmic exercise: Tap your right hand 8 times, tap your left 8 times, two times (tap your right 4, tap your left 4), four times (tap your right 2, tap your left 2). Repeat but this time tap your foot instead of your hand. Then tap both the foot and hand using the same rhythmic combination.
- Perfect the art of visualization: Close your eyes and concentrate on imagining walking as beautifully and gracefully as you can fantasize. Visualization is most effective when indulging in as much detail as possible. Imagine for example that your heel touches the ground first as you walk. Imagine feeling the weight of your body on your heel. Be specific in exactly which area of the heel.
I once had a devoted elder student who was blind. He attended every class and did every exercise. In class, I always place a lot of emphasis on focusing the eyes to improve balance. I asked him after class one day if that was upsetting for him to hear. His answer was absolutely not. Instead of actually focusing his eyes, he would imagine focusing.
The mind is a powerful thing.
Pay more attention to foot care:
We have a tendency to ignore the parts of our body that are not working well. That's true with neuropathy and also with victims of stroke. What is really need is more attention to those areas, not less.
- Visit your podiatrist regularly: Foot clinics are also available where your toe nails can get trimmed and foot health can be checked.
- Massage your feet regularly: Even better is to get a foot massage once a month. Apply lotion to your feet.
- Check your feet daily for any sores, wounds or infections.
- Practice foot exercises daily, even if you can't feel your feet. If necessary, use your hands to manipulate your feet into a flexed and pointed position. Use a mirror to confirm the foot movement you may not be able to feel.
- Do not avoid walking if you have neuropathy as less activity actually makes the neuropathy worse.
- If movement exacerbates your neuropathy or causes it to flair then use less invasive techniques. Visualization is particularly effective. See the links below.
- Avoid foot soaks if you have diabetes because of the increased risk of infection.
Improve your peripheral vision:
We have two types of vision: central vision and peripheral vision. With central vision we focus on the center of our field of vision. With peripheral vision, we continue to focus on the center of our field of vision but we become aware of movement on the periphery. This is especially important when walking.
To walk correctly, we should be focusing on the direction we are going and be aware of the ground in front of us without looking at it. Practice improves peripheral vision and helps greatly, especially if you have neuropathy. Your peripheral vision can take up some of the role of proprioception.
Exercise to improve peripheral vision:
To walk correctly, we should be focusing on the direction we are going and be aware of the ground in front of us without looking at it. Practice improves peripheral vision and helps greatly, especially if you have neuropathy. Your peripheral vision can take up some of the role of proprioception.
Exercise to improve peripheral vision:
- Take your arms and bring them up and overhead. The area your arms are describing is your field of vision. Place your hands in your lap.
- Focus on an object in the center of your field of vision.
- Try to see your hands in your lap while looking straight ahead.
- Move your hands out and up. Be aware of the movement without looking at your hands directly.
- Focus straight ahead and "see" everything on the floor that is in front and around you. Try placing some objects on the floor for you to "see" and practice locating them without actually looking at them. Practice from a seated position first.
Practice walking the "right" way:
The ability to walk is extremely important to cultivate and maintain as we age. Any problems with walking limits our ability to be active. Activity level is a better gauge of elder age than anything else so if we are less able to walk we end up aging faster. Since we are already at a significant deficit because of neuropathy, we should practice the correct way to walk and practice it well and often.
The correct way to walk:
At first, this technique should be practiced while sitting to train the foot and ankle muscles to be able to smoothly roll. Using a mirror will really help, especially when practicing walking standing.
- While looking ahead in the direction you are going,
- Place your heel down first.
- Roll through your foot as you place your weight on it.
- Push off with the back foot.
At first, this technique should be practiced while sitting to train the foot and ankle muscles to be able to smoothly roll. Using a mirror will really help, especially when practicing walking standing.
Focus your eyes in the direction you are facing:
An excellent general rule of thumb is to focus your eyes in the direction your are facing whenever you feel unstable or disoriented. Basically, increase your vision skills to make up for a deficit in your proprioceptive sense.
Here are the fundamentals:
Some further thoughts:
Eye exercises are highly recommended:
Here are the fundamentals:
- If you feel disoriented, stop what you are doing and stay still.
- Do not move your head at all if possible. That will only make you dizzier.
- Focus your eyes on a small inanimate object in the center of your field of vision, where your field of vision is the view of whatever you are facing right now.
- This should immediately stabilize you.
Some further thoughts:
- Practice conscious looking: We get into the habit of not really seeing what's around us. Take notice.
- See the horizontal lines in your view: Horizontal lines which have a clear definition improve balance the most effectively. It is a great "trick" to give clear shapes extra notice.
- Avoid focusing on curves or fuzzily outlined objects.
- Do not focus on something that moves. That means do not focus on another person or even yourself in a mirror.
Eye exercises are highly recommended:
- Without moving your head, focus your eyes on your upper right and down on your lower left. Then focus on your upper left and your lower right. Repeat.
- Without moving your head, circle your eyes all the way around in both directions.
- Keep your eyes focused on one spot in front of you and turn your head to the right and left while you keep focusing straight ahead. Do the same once more, this time moving your head up and down.
- It is best to practice eye exercise with your glasses off so you get a full range of motion. Think of seeing beyond the frames of your glasses. This is especially important with peripheral vision.
Learn to move your head less:
Since moving the head can increase disorientation it is advisable to reduce head motion, especially when feeling out of sorts. A symptom of BPPV (benign paroxysmal positional vertigo), dizziness turning the head is quite common for those older.
A stable head position makes strong physical orientation
far easier, along with use of eye focus.
far easier, along with use of eye focus.
Where you look when you walk is an essential part of balance. With neuropathy, the temptation is to look down at the floor. This increases fall risk substantially. We should instead look in the direction we are going. This requires practice. For much more on this important subject see the links below.
Diet can affect neuropathy: The following foods have the potential to increase pain in neuropathy: dairy products, wheat, citrus fruits, corn, caffeine, meat of all kinds, nuts and eggs.
Berries, almonds and tomatoes have properties that naturally ease the inflammation that's often linked to chronic pain. Whole foods and vegetables are also loaded with nutrients that can minimize discomfort from nerve damage.
Bananas, lentils and beans may help prevent or treat neuropathy.
Balance Techniques that Help Neuropathy
Exercise to Improve Proprioception
Sense of Touch Improves Balance
Exercise for Foot Neuropathy
Feeling Unsteady
Getting Suddenly Dizzy
Nervous System Health
Where to Look When You Walk
Beware of Head Movement
Foot Help For Those Older
Visualizing Foot Health
Exercise to Improve Proprioception
Sense of Touch Improves Balance
Exercise for Foot Neuropathy
Feeling Unsteady
Getting Suddenly Dizzy
Nervous System Health
Where to Look When You Walk
Beware of Head Movement
Foot Help For Those Older
Visualizing Foot Health
Published November 22, 2023.