While your numbness, tingling, pins and needles, burning pain, aching, and weakness in your arms, legs, hands, or feet may be happening for multiple reasons, neuropathy is the one that I will be focusing on. In fact, you came across this blog more than likely because you searched one of the following: How does neuropathy occur? Will neuropathy go away? Where does neuropathy start? What to do when neuropathy gets worse? What does neuropathy mean? Can neuropathy be reversed? What are neuropathy exercises? and finally the concern about diabetes and neuropathy.
What is Peripheral Neuropathy?
Peripheral neuropathy is a condition that affects the peripheral nerves. Once you break down the vocabulary it’s a little easier to understand:
- Peripheral: to the side of (in this case to the side of the brain and spinal cord)
- Neuro: involving the nervous system
- Pathy: disease
The peripheral nerves are nerves that exit the spine and travel down your arms and legs to your fingers and toes. Given this mini anatomy lesson, it makes sense that symptoms may distribute throughout the arms, legs, hands, and feet following the nerve pathway. These nerves travel a long distance and there are many factors that can lead to problems along the way.
Where does neuropathy start?
The most common cause of peripheral neuropathy is the actual misalignment of the joints where nerves pass through. While this is not a blog about the anatomy of the body, some understanding of the area is crucial but I promise to make it simple.
Vertebra, or spinal bones, sit on top of each other and where they connect to the vertebrae above and below,
there are a set of nerves that come out through holes on each side. In the picture, you see the nerves in yellow, coming through the holes called Intervertebral Foramen. These nerves exit on the right and left side and go to specific parts of your body depending on the level of the vertebrae but follow specific patterns of distribution. If these nerves become irritated anywhere starting from where they exit the spine all the way to their end, there will be issues. These issues are the pins and needles, tingling, burning pain, achiness, and weakness in the arms and legs that are part of neuropathy.
There are many causes of peripheral neuropathy, those involving irritation of the nerves may be due to one or more of the following:
- Joint misalignment
- Spinal stenosis
- Nerve entrapment at the exit of the nerve from the spine or somewhere along the path
- Over-use injuries
Not all neuropathy symptoms stem from misalignment and may include:
- Diabetes
- Alcoholism
In this blog, I will get down to the nitty-gritty of peripheral neuropathy due to alignment/entrapment and in general posture-related causes given that my expertise is Postural Neurology and Functional Movement mostly. The first thing to get out of the way is that the occurrence of neuropathy has nothing to do with age!! Yes, neuropathy is typically seen and treated in older patients because the truth is that generally, most people don’t think about health until they have pain and not even a slight pain!! With that mindset, by the time issues are looked into, quite a bit of damage-related issues exist. Frankly, with the overuse of our digital devices, my patient demographics are changing rapidly and I see more and more people in their late 20’s-30’s with issues that I used to see in a much older patient population. Postural imbalance is no longer ‘ the thing of older age’.
Let me give you an example to see how your postural imbalance leads to wear and tear and what comes in ’that’ package. If you have a door hanging crooked on the frame, after only a short while you will start seeing wear and tear where the door hits the frame. In contrast, an old door that is properly aligned and stable on its frame will show no signs of wear where it meets the frame over time but only the aged wood.
An unbalanced posture is an unstable posture which means unstable joints, bones, muscles, and nerves. In the human body, the ‘wear and tear’ show up with specific presentations such as decrease joint space, calcifications called bone spur or osteophytes, rough joint space, and misaligned joint space to name a few. Imagine the bone spur or Osteophyte forming in that hole where the nerve exits the spine? You can see how that can cause irritation. Now, you don’t have to have a bone spur in a critical place to end up with neuropathy. In fact, the ligaments inside those holes can get thickened as a response to lack of stability; that can cause the narrowing of the hole the nerve exits and cause stenosis which then can lead to neuropathy. The same issue can happen at any joint along the nerve path. I have done a full blog on Stenosis that I invite you to read to better understand how it works.
How Does Neuropathy Occur?
Postural imbalance over time has a cumulative effect potentially ending in peripheral neuropathy; the misalignment due to postural weakness can be extensive and many factors are involved. You may be thinking of injuries such as falls, car accidents, lifting, or being hit by an object. You are correct! These things can definitely be the start of the joint misalignment whether the injury is new or old, especially if an old injury was never treated properly. Although, sedentary work and lifestyle conditions over time can be just as damaging as any injury. How can this be? The simple answer is: we are meant to move and not to sit.
Our bodies are designed to function in movement. You know how when you buy a product it comes with a label that explains what the product was designed for? If you use it outside of what it was designed for and there’s a malfunction, it’s not the manufacture’s fault. It’s yours for using it incorrectly! Sitting for 8 hours a day, staring at our computers or phones is not how our bodies were designed to function! We are using our bodies in ways it was not designed to function, and we see the malfunction!
Your brain has many functions but essentially only 2 goals: for you to live a long life and for your day to be as pleasant as it can be given what you throw at it! A beautiful thing and a true unconditional love if you ask me! When you sit, the brain (our controlling system) has to make the best of what you are throwing at it. Under healthy conditions, which do not include a sedentary lifestyle, the brain is sufficiently activated by your healthy daily activities. The mid-portion of the brain in charge of the upright position (PMRF) and deep breathing (Vagus nerve nuclei) is activated, the body is oxygenated and is in its best and healthiest posture. When sitting for extended lengths of time every day that part of the mid-brain that sends the command to be upright against gravity is not used enough and through time, it starts shrinking; no sense in holding on to something if there is little use for it. Now the command center, the brain, does not even send the command to sit up straight like it was designed to do. This is a great example of what is called negative neuroplasticity. Check out this video to see what I mean.
It is obvious that collapsed posture and weakness in the muscles leads to failed joints and compression of the spinal joints. Remember the nerves exit the spine through those sets of holes that are on the side of the vertebra. What do you think happens to the integrity of those holes over time given the lifestyle I just talked about? It’s called Stenosis!
Over-use injuries are injuries by which you perform the same motions over and over again throughout the workday. Sitting behind a desk, looking at a monitor that is not at the correct height, and using a keyboard that stresses the elbows are examples of things in life that can be considered overuse injuries. Eliminating poor work environments plays a huge role in preventing peripheral nerve symptoms and plenty of other things such as neck pain, back pain, and carpal tunnel syndrome.
This Ergonomic checklist will help you self-evaluate and customize your work environment in less than 5 minutes. Making the necessary changes is a step in the right direction but if you’re already experiencing symptoms this is not enough to achieve relief and overall health.
Neuropathy Pain Relief and Neuropathy Treatment
Unfortunately, most people are fully happy knowing that their pain went away on its own or with the minimal amount of work (medication); not me! I know that the pain did not come in just because and never goes away just because. Unless I know what happened, I am on the search to find the answer. The issue with neuropathy is when the subtle signs and symptoms are either ignored or minimized by the patient or the provider. THAT is not what health care should be and frankly, you only have one body to take care of and that way of attention is more damaging than you realize.
Neuropathy is the end result of improper balance and movement over time. The ‘blue print’ of movement and sensation in the brain, called Homunculus, changes based on our use of the body. So if movement is a concert, our brain is the conductor, the homunculus is the musical notes, and the body parts are the musicians. If the concert is not a good one, all of those ingredients are to be assessed for fault. Frankly, going after let’s say the pianist to expect an improvement in the concert performance is a waste of time because when it comes to a good concert, when each musician chimes in and phases out is a huge player in how pleasant the concert will be. When we focus on shutting out the pain with meds, we do NOTHING in the right direction. When we isolate the area and do physical therapy of that area, we don’t address the cause either, why? Because the issue is not in isolation but in movement. When you get adjusted by a chiropractor, you feel better but you are only stimulating the nervous system with the hope that this controlling system will do its part. That’s like a teacher coming in announcing that she has something important to say but not say anything exciting or important after that statement. Adjustment of the spine does stimulate the nervous system; nervous system does control every function of your body. That is a fact BUT over time, with repetitive wrong movements, that blue print, the homunculus is impacted as well. The ‘how-to’ of movement has changed; what is being done about that? That is why Postural Neurology (the neurology behind movement and posture) as well as Functional Movement is critical in the treatment of peripheral neuropathy. Here are a couple of videos explaining it!
The benefits of Postural Neurology are heightened when paired with Developmental Kinesiology or Functional Movement. Watch this video to understand why!
With the lifestyle changes in terms of ergonomics that we previously mentioned, pain relief using modalities such as Active Release Technique (ART), and the addition of posture and movement correction, you have everything you need to get out of pain and stay out of pain. Have you ever cut off or seen a tree that is cut off at the trunk only to see new shoots coming out the following year? Addressing neuropathy with Postural Neurology and Functional Movement is what is needed for the symptoms to not only go away now but for the future and there is no other way to look at it. Bear in mind that the principles behind them are to be followed for a lifetime. The wrong answer is always wrong no matter when you look at it so don’t make the mistake of thinking that if you address anything related to health once, it should go away for life.Attending your health is a lifetime pursuit and not an event.
Diabetes and Neuropathy
One of the health conditions that is commonly associated with neuropathy is Diabetes. Unless you are a type 1 diabetic meaning your body from birth did not produce enough insulin, you have a solution to your problem. Diabetes is not a disease of insulin deficiency!! It is the lack of insulin and leptin working together to signal hunger vs. feeling full. It is more common than ever before because our diet is worse than ever before. The peaks and valleys in blood sugar make us more susceptible to diabetes than ever before. Diabetic Neuropathy occurs when the level of diabetes if off for quite a long time so the solution is to control the level as soon as possible. That means diet and activity.
This is not the subject of the blog but I strongly encourage you to check out Metabolic Typing where I fully explore what it is and why it is crucial to find out what yours is. I don’t want to guess what food is good for me, I want to KNOW what the right fuel is for me. Sheesh, how many times did we hear “wine is good… wine is bad”, “high protein/low carb is good…high protein/low carb is bad” or, “Coffee is good/coffee is bad.” Come on!!! The truth is for some people they are good and for others, it is not. What category you belong to is only determined by doing your own Metabolic Typing.
Alcoholism is another element related to neuropathy. Alcohol robs your body of vital B vitamins that your nerves need to stay healthy and to heal. The lack of B vitamins irritates and damages the nerves giving you peripheral neuropathy.
If you have neuropathy, have been taking medication for it and still feel the pain and limitation, if you feel there is no hope, think again. You are the Designer and the Director of your own life so design and direct it the way you wish to live it.
Dr. Shakib