Does Walking Make Neuropathy Worse? Here’s What Science Has to Say

Exercise plays a crucial role in preserving muscle mass and improving circulation.

Regular movement leads to a decrease in the intensity and frequency of neuropathy symptoms, but the challenge can seem too daunting to begin. 

When you find the right balance of exercise in establishing a healthy walking routine, you'll find that strength, balance and your range of motion improves.

From endurance to dynamic balance and muscle strengthening, walking correctly after a warmup is a reliable home-based method of training to mitigate the effects of neuropathy.

It lowers pain significantly and holds profound long term benefits to flexibility and a patient’s general mobility.

Here we’ll be showing you how walking can improve your quality of life, the science behind walking as exercise, and what precautions must be taken by those with neuropathic conditions.

Neuropathic Sensitivity and Weight-Bearing Exercise

For many years, walking and other weight-bearing exercises were thought to be a contraindication for those with neuropathy due to the sensitivity of the feet which typically follows this condition.

Diabetic peripheral neuropathy guidelines were adjusted by the American Diabetic Association following new research showing that exercises such as walking are indeed beneficial to improving physical mobility.

Regular physical exercise improves blood glucose levels in type 2 diabetes sufferers, while also drastically lowering the risk of cardiovascular disorders. When one considers the muscle strength gains in combination with the heart health and insulin sensitivity improvements, it becomes clear that exercise is essential.

What many neuropathy sufferers don't realize is that depending on the type of neuropathy, exercise can promote nerve regeneration in some cases. Diabetic peripheral neuropathy is no reversible but weight-bearing exercise and regular stretching will lower pain and promote good healthy nerve growth and functioning.

The Impact of Load-Bearing Exercises on Nerve Health

A startling study published in 2018 changed the way that science views the connection between load-bearing exercises and the body.

Load-Bearing Exercises on Nerve Health

The link between neurological conditions like neuropathy, motor neuron disease, and spinal muscular atrophy was already well known.

However, when these patients cannot do load-bearing exercises, movement declines and the cognitive effects worsen.

What this research concluded is that cellular function and the nervous system are also impacted.

The research also shows that the legs are a critical component of weight-bearing exercise, causing a rise on production of healthy neural cells which are used to produce new nerve cells. Limited physical activity reduced the neural stem cell count to 70% compared to the control group in this breakthrough study.

When we restrict the amount of weight bearing exercise carried out (like walking) we also lower the gene expression of CDK5Rap5, essential to mitochondria. Mitochondria directly supply the energy and gene encoding needed to make nerves grow. Light exercises like walking help replenish the energy supply of our mitochondria, an effective means of treating nerve injuries.

The Effects of Walking on General Neuropathy

A controlled study published in the Oxford Academic Journey of Physical Therapy describes the effects of weight-bearing exercise on a 36-year old male who had been suffering from diabetic peripheral neuropathy for 30 years.

Without any adverse effects and just six minutes of walking on a treadmill a day, the patient displayed massive improvements over a 12-week course. His average daily step count rose from 6,176 to 8,273.

He also experienced less pain in his feet and ankles and had a slightly better dorsiflexor and plantar flexor peak torque. Muscle strength and physical function improved with the bottoms of his feet showing no injury, and no other negative effects diagnosed or reported at all.

Diabetic Peripheral Neuropathy

Ulceration in patients with diabetic peripheral neuropathy is frequently the first sign of a sharp decline in physical impairment potentially leading to amputation. Studies show that the onset of ulceration begins a set of changes including a decreased daily stride count, velocity and peak pressure, as well as the functional capabilities of walking.

The study published in the European peer-review journal Diabetologia confirms a direct link between an increased need for physical fitness. It also noted that while walking exercise will improve gait, balance, and slow the rate of decline of walking, the plantar pressure distribution on the foot must first be considered before it can be deemed safe as a form of physical fitness. 

Protective footwear must be worn, and good foot care needs to be upheld. Most physicians recommend a non-weight-bearing exercises and partial weight-bearing training to increase physical fitness levels and glycemic control.

The Effect of Weight-Bearing Exercise on Muscle Performance

Other hallmarks of peripheral neuropathy include strained muscles due to the decline in ankle mobility, walking speed, patient stance distance, and other regions such as flexion of the ankle and its lower peak dorsiflexion suffering in range and flexibility.

Patients with diabetic neuropathy experience co-contractions of their gate which stresses the muscles leading to a buildup of intermuscular adipose tissue (IMAT).

Internal muscle fat degrades a range of muscle functions including muscular regeneration, neurogenic muscle atrophy, muscle power, and muscle mass. A 5-year follow-up study confirmed that daily walking decreases intermuscular adipose tissue including the IMAT accumulation that accompanies aging.

Endorphins and Pain Control

Walking is a great low-intensity exercise promoting the release of endorphins. These key neurotransmitters are the compounds attributed to the euphoric response of a "runner's high."

They are crucial to modulating pain, stress,  appetite, the release of sexual hormones, and our immune response. As the brain releases endorphins, they interact with opiate receptors. 

The reaction changes the way that we perceive pain, lessening the sensation or mitigating the response. Higher intensity exercise stimulates the release of more endorphins, but as little as a 10-minute light walk will help alleviate the pain and discomfort of neuropathy.

Low-Intensity Walking Exercise Alleviates Neuropathic Nerve Pain

The intensity and type of exercise performed has a definite effect on treating neuropathic pain. Not all exercise delivers the same benefits.

3 women with neuropathy walking for exercise

Low-intensity walking exercise causes a rise in neurite outgrowth. Neurites are essential to nerve growth, regulation, and regeneration.

Peripheral neuropathy sensory degeneration and painful symptoms are due to nerve damage from axon loss, or due to degeneration of the myelin sheath. This makes neurite stimulation essential to stopping nerve pain and repairing the nervous system.

Whereas high-intensity weight-bearing exercises are not as effective as a treatment for neuropathy, the adverse is true for aerobic exercises. Low-intensity aerobic workouts do not lead to quality of life improvements.

One needs to practice moderate-intensity aerobic exercise in combination with low-intensity weight-bearing exercise to see improvements to balance, strength, and lowered pain intensity.

Many physicians recommend water therapy to those who experience too much pain when walking or exercising on land. This shows that weight-bearing exercise can't be ignored due to its widespread benefits to diabetic peripheral neuropathy and other neuropathic pain.

Walking Precautions

All neuropathy sufferers need to take precautions to protect their feet and skin. Research analyzing the risk of skin breakdown in neuropathy sufferers isolated seven areas where the risk of damage is the highest.

The big toe is at the highest risk, then the first toe, the third, then the fifth metatarsal heads, following the medial midfoot, lateral midfoot and finally the heel. Further studies also show that diabetic patients with peripheral neuropathy expend more energy when walking which accounts to the heightened difficulty that most report.

Orthopedic shoes, neuropathy therapy socks for circulation, and arch support inserts protect the feet during walking exercise. While self-care is possible, it is best to request a visual examination by your doctor to identify footwear and a foot care strategy that is best for your unique condition.

Walking Duration and Energy Expenditure

When an irregular gait causes an imbalance of pressure on a foot, the person most often steps on their heel. With the heel taking an increased impact, a slower walking speed is normally experienced.

This leads many to believe that they should increase the duration spent walking to compensate for the speed. However, the increased pressure rather raises the risk of plantar injuries which can lead to long-term complications (even amputation).

Low to moderate intensity weight-bearing exercise must be done without causing discomfort. Formulate an exercise routine over a shorter period which is then repeated two or three times a day in order to accommodate for the increased energy expenditure and other risk factors.  

Walking for Nervous Health

Even though it can be taxing for patients with neuropathic pain to walk, all recent research and recommendations point toward low-intensity weight-bearing exercise as an effective therapy.

Certain doctors even believe that therapy combined with a constant rate of blood circulation over a prolonged period can result in nerve regeneration no matter what neuropathy is in question.

Regardless, sufferers are encouraged to combined stretching, movement, and weight-bearing exercise as well as lifestyle, supplementation and dietary changes. If you are unsteady and have severe problems with your gait, then consider treadmill exercise or walking in a swimming pool. There is always a way to get the benefits of weight-bearing exercise.