Exercise, mirror therapy and graded motor imagery, alongside treatment of the cause.
Our exercise physiologist, Jessica Coombe (AEP), has both clinical and personal experience of nerve injury — she rehabilitated her own and studied the area closely in doing so.
We commonly see patients with burning, tingling, numbness or pins-and-needles — often in the feet or hands, frequently worse at night — who have been advised to manage it with medication alone.
Many have diabetic peripheral neuropathy and want to take an active role rather than watch and wait. Others present after a peripheral nerve injury, with a limb that feels weak, clumsy or foreign, or with complex regional pain syndrome (CRPS).
A common thread is a limb that has become painful or difficult to move, and pain that medication has only partly controlled.
Nerve pain is usually managed with medication alone — commonly pregabalin (Lyrica), duloxetine (Cymbalta) or amitriptyline. These have a role, but they address the symptom and leave the movement, strength and cause untouched. Treatment here adds the parts medication does not reach.
Exercise for nerve and muscle function. In diabetic peripheral neuropathy, aerobic training improves nerve conduction and neuropathic symptoms, and combined aerobic and resistance training reduces symptoms and improves muscle function — safely, even with reduced sensation. It also rebuilds the strength and balance neuropathy erodes, which is what reduces the risk of falls.
Mirror therapy and graded motor imagery. When a limb is painful or feels foreign, part of the problem lies in the brain’s map of that limb, not only the nerve. Graded motor imagery — a staged sequence of laterality recognition, imagined movement, then mirror therapy — has its strongest evidence in CRPS and phantom limb pain, where it reduces pain and disability (Moseley). Mirror therapy uses a mirror to present the brain with the image of normal, pain-free movement, retraining that map. The sequence is delivered in order, which is what the evidence indicates makes it effective.
Treating the underlying cause. Where diabetes is driving the neuropathy, its progression slows when blood glucose is controlled. Dr Isobelle Smith manages the metabolic driver directly, and exercise itself improves glycaemic control — so the program addresses cause and symptom together.
Balance and falls prevention. Reduced sensation in the feet changes standing and walking, and the main downstream risks are falls and foot injury. Balance and gait are assessed and trained specifically, and foot-care needs flagged early.
Mirror therapy and graded motor imagery are not a cure and do not reverse structural nerve loss. Their evidence is strongest in CRPS, phantom limb pain and post-stroke movement; in diabetic and other peripheral neuropathies they are used as an adjunct, alongside exercise and medical management rather than instead of them. What they can do is reduce pain and improve how a painful or clumsy limb moves. Whether they are likely to help a particular problem is assessed individually.
No. Mirror therapy and graded motor imagery do not reverse structural nerve loss. Their strongest evidence is in CRPS, phantom limb pain and post-stroke movement; in diabetic and other peripheral neuropathies they are an adjunct. What they can do is reduce pain and improve how a painful or clumsy limb moves.
In diabetic peripheral neuropathy, aerobic training improves nerve conduction and neuropathic symptoms, and combined aerobic and resistance training reduces symptoms and improves muscle function. Exercise also improves blood glucose control, which is the underlying driver.
Yes, when it is prescribed and supervised. People with reduced sensation can safely do aerobic and resistance training. We match the exercise to your sensation and check your feet, so you get the benefit without the risk.
No. It works alongside it. Pain medication and exercise do different jobs — we add the movement, strength and cause-management that medication does not reach. Any change to medication is a decision for your GP or specialist.
No referral is required to book. If you have a chronic condition such as diabetes, your GP may be able to refer you under a chronic disease management plan for a Medicare rebate — ask us and we can explain how it works.
The Endocrine & Wellbeing Clinic
Phone: (02) 9870 3256
Locations: Balmain (inner west Sydney) and Telehealth Australia-wide
Affiliated with: ESSA (Exercise and Sports Science Australia), ANZBMS, Endocrine Society of Australia
This page is not a substitute for individual medical advice. Book a consult for assessment specific to your situation.
All future appointments will be at 100 Elliott Street Balmain 2041
