Polyneuropathy

Recognising the Common Polyneuropathy Symptoms

The manifestation of polyneuropathy is unique to each individual, with symptoms often starting subtly and worsening gradually. A classic presentation involves symptoms beginning in the longest nerves first, affecting the feet and hands in what is known as a "stocking-glove" pattern. Early detection of these signs is crucial for slowing the condition’s progression and mitigating its impact on daily life. The symptoms are generally categorized based on the type of nerve fiber affected: sensory, motor, or autonomic.

Sensory Nerve Symptoms

Sensory nerves are responsible for transmitting sensations such as touch, temperature, vibration, and pain. Damage to these nerves is often the first indication of polyneuropathy.

• Numbness, Tingling, or Pins and Needles: This is frequently the earliest symptom, a prickling or tingling sensation (paresthesia) that usually starts in the toes and fingers before spreading up the limbs.
• Burning, Sharp, or Jabbing Pain: Many people experience neuropathic pain, which can feel like a deep ache, a shooting electrical shock, or a burning sensation. This pain is often more intense at rest or during the night.
• Loss of Sensation: A progressive numbness can make it difficult to feel pain, pressure, or temperature variations. This raises the risk of unnoticed injuries, such as cuts, burns, or pressure sores on the feet.
• Extreme Sensitivity (Allodynia): In some cases, nerves become hypersensitive, causing severe pain in response to a stimulus that would not normally be painful, like the light touch of a bedsheet or clothing.

Motor Nerve Symptoms

Motor nerves control muscle activity and movement. When they are damaged, it directly affects your strength, dexterity, and coordination.

• Progressive Muscle Weakness: You might first notice difficulty with fine motor tasks like buttoning clothes, writing, or handling keys. This can progress to more significant weakness in the arms and legs, affecting walking and lifting.
• Poor Coordination and Balance: Damage to nerves that help your brain sense the body's position in space (proprioception) can lead to clumsiness, an unsteady gait, and an increased risk of falling.
• Muscle Twitching and Cramps: Spontaneous, involuntary muscle contractions (fasciculations) or painful cramps are common as damaged nerves send faulty signals to the muscles.
• Muscle Atrophy: If motor nerves are severely damaged, the muscles they control may shrink and waste away from lack of use and stimulation.

Autonomic Nerve Symptoms

The autonomic nervous system regulates involuntary bodily functions like heart rate, blood pressure, digestion, and sweating. Autonomic neuropathy can be life-altering.

• Blood Pressure Fluctuations: A common issue is orthostatic hypotension, a sharp drop in blood pressure upon standing that causes dizziness, lightheadedness, or fainting.
• Bowel and Bladder Dysfunction: Symptoms can include incontinence, difficulty fully emptying the bladder, chronic constipation, or alternating bouts of diarrhea.
• Abnormal Sweating: You may experience either excessive sweating (hyperhidrosis) or a reduced ability to sweat (anhidrosis), which can impair the body's ability to regulate its temperature.
• Digestive Difficulties: Nerve damage affecting the digestive tract can lead to gastroparesis (delayed stomach emptying), causing feelings of fullness, bloating, nausea, and vomiting.

Primary Causes of Polyneuropathy

Pinpointing the underlying cause of polyneuropathy is vital, as effective treatment hinges on addressing the root problem. The causes are diverse and can be broadly grouped into several categories.

Systemic Diseases and Conditions

Many chronic illnesses can have a detrimental effect on the peripheral nervous system.

• Diabetes: This is the most prevalent cause of polyneuropathy globally. Persistently high blood sugar levels are toxic to nerves and also damage the small blood vessels that nourish them.
• Chronic Kidney Disease: When the kidneys are unable to filter waste products effectively, the accumulation of toxins in the bloodstream can lead to significant nerve damage.
• Autoimmune Disorders: Conditions where the immune system attacks the body's own tissues, such as rheumatoid arthritis, lupus, and Sjögren's syndrome, can inflame and damage peripheral nerves.

Infections and Toxin Exposure

Direct assault on the nerves can come from external sources, including infections and environmental toxins.

• Infections: Certain viral and bacterial infections are known to cause polyneuropathy, including Lyme disease, shingles (postherpetic neuralgia), Epstein-Barr virus, and HIV/AIDS.
• Toxin Exposure: Exposure to heavy metals (like lead, mercury, and arsenic), industrial solvents, and certain pesticides can be neurotoxic and cause widespread nerve damage.
• Medications: Some prescription drugs, most notably certain chemotherapy agents used to treat cancer and some antibiotics, can have neuropathy as a significant side effect.

Lifestyle and Hereditary Factors

Personal habits, nutritional status, and genetic predispositions also play a crucial role.

• Alcoholism: Chronic, excessive alcohol consumption is directly toxic to nerve tissue. It is also often linked to poor nutrition, specifically vitamin deficiencies that further harm nerve health.
• Vitamin Deficiencies: A lack of essential vitamins, particularly B vitamins (B12, B6, B1, folate) and vitamin E, is a well-established cause of polyneuropathy.
• Inherited Neuropathies: Some forms of polyneuropathy are genetic. The most common is the Charcot-Marie-Tooth (CMT) disease family of disorders, which affects both motor and sensory nerves.
• Physical Trauma: Repetitive stress, injuries, or tumours that compress or crush nerves can lead to neuropathy.

The Role of Physiotherapy in Managing Polyneuropathy

While medical treatment focuses on the underlying cause, physiotherapy is the cornerstone of managing polyneuropathy symptoms, improving function, and enhancing quality of life. A skilled physiotherapist develops a tailored program to address specific impairments.

Improving Strength and Flexibility

A structured exercise program is vital for counteracting muscle weakness and joint stiffness. This includes low-impact strengthening exercises using resistance bands or light weights to build muscle without overstraining nerves, alongside gentle stretching routines to maintain range of motion and reduce painful cramps.

Enhancing Balance and Coordination

To reduce the high risk of falls associated with polyneuropathy, physiotherapy focuses heavily on balance. Gait training helps correct walking abnormalities, while specific proprioceptive exercises (such as standing on uneven surfaces or with eyes closed) help retrain the body's spatial awareness system for better stability.

Pain Relief and Management

Physiotherapists employ several drug-free techniques to manage neuropathic pain. Transcutaneous Electrical Nerve Stimulation (TENS) uses mild electrical currents to disrupt pain signals. Manual therapy, including soft tissue mobilisation, can help desensitise painful areas and improve tissue health.

Patient Education and Adaptive Strategies

Empowerment through knowledge is key. Physiotherapists provide crucial education on proper foot care to prevent injuries, advise on home modifications for safety, and assess the need for assistive devices. This can include anything from custom orthotics and braces (like an AFO) to support weak ankles to a cane or walker to ensure safe mobility.

Rebuilding Strength and Balance in Polyneuropathy With Physiotattva

Living with polyneuropathy requires a proactive and multifaceted management approach. By recognising the early symptoms, working with healthcare providers to identify the root cause, and committing to a comprehensive physiotherapy program, individuals can effectively manage pain, combat muscle weakness, and improve their balance and overall function. The journey may be challenging, but with the right support, it is possible not only to cope with the condition but to maintain an active, independent, and fulfilling life.

At Physiotattva physiotherapy clinics in Bangalore and Hyderabad, you receive personalised care tailored to your specific needs, ensuring effective results and comfort throughout your journey to recovery. 

Don’t wait to start your recovery! Get in touch with Physiotattva for more details! Contact us at +91 89510 47001.