Nerve pain, or neuropathy, affects an estimated 20 million Americans, or about 13.5% of the population. Many personal training certifications barely scratch the surface of this deep-running issue. But the truth is that a little bit of education can go a long way in supporting clients experiencing nerve pain and damage.
There are many different types of neuropathy, but here we’ll focus on peripheral neuropathy, or nerve damage that affects the extremities. This type of neuropathy has many iterations in and of itself and can affect motor, sensory, and autonomic neurons.
Neuropathy that affects motor neurons can result in muscle pain, cramping, and atrophy.
Neuropathy that affects sensory neurons affects balance, coordination, and reflexes. It can also cause pain, tingling, and a loss of feeling to temperature and touch.
Neuropathy that affects autonomic neurons can make it difficult to regulate body temperature, blood pressure, and digestion.
Some types of peripheral neuropathy are inherited, while others are acquired at some point in life.
Exercise programming for those with neuropathy should support blood flow and nerve function, while helping manage pain without placing unnecessary stress on joints and tissues. It might sound like a lot in the beginning, but with some simple guidance, you’ll be on your way to training clients in no time.
As fitness professionals, we can work with our clients who have peripheral neuropathy or other nerve damage to improve sensation, balance, and muscle control. In this article, we’ll walk through strength training, balance, mobility, and aerobic activity as part of a well-rounded, adaptable exercise program for clients with nerve damage. Remember, we’re here to support exercise and healthy movement, not provide medical treatment, though you may have the opportunity to work alongside healthcare providers to better help your clients.
Strength Training Exercises for Neuropathy Relief and Muscle Support
Strength training can benefit those with neuropathy in several ways. It increases muscle strength and size to help counter the atrophy that often accompanies nerve injury. It contributes to joint stability for easier, less painful movement.
Just because you’re helping a client build stability doesn’t mean they should be on an unstable surface, though. Those with neuropathy may have difficulty balancing or safely maneuvering on unstable surfaces. Choose exercises that offer built-in support, such as machines, seated exercises, or activities that can be done near a wall, railing, or chair for assistance if needed.
Focus on proper alignment and offer guidance or help getting into position as needed. Controlled movement will help them stay in alignment and encourage balance and coordination. Perform both coordinated and single-extremity movements to identify and address imbalances. Both bodyweight and resistance training are excellent choices for building strength in those with nerve damage, when done safely.
Exercises that build strength and support joints for those with neuropathy include:
- Seated calf raises and dorsiflexion, also called heel-to-toe rocks, help build lower leg strength, mobilize the ankle, and improve blood flow through the leg and foot.
- Leg raises, seated and standing, can improve hip strength and mobility. Move the leg forward, to the side, and to the back where possible.
- Sit-to-stands or chair squats work both legs simultaneously and improve strength and balance through weight transfer.
Balance Exercises to Improve Stability and Reduce Fall Risk
Peripheral neuropathy and other forms of nerve damage can significantly impact an individual’s balance. Besides making standing and walking uncomfortable, neuropathy can reduce feeling in the legs and feet, making balance and proprioception even more difficult.
Balance exercises for those with nerve damage target coordination deficits and work to reduce the risk of falls and balance losses associated with reduced nerve function.
Before starting balance training, take time to understand how nerve damage really affects your client’s balance. Find out if your client experiences pain, tingling, numbness, or other difficulty while standing. This gives you a baseline to work from and can help you select appropriate exercises.
Start with exercises that keep both feet on a stable surface, and progress to less stable surfaces or more difficult balancing activities if and when they are ready. Focus on controlled transitions and positional awareness. A simple progression of exercises may look like this:
- Standing balance on both legs, starting with both legs hip-width apart. Progress to where the client’s feet are next to each other. When this is comfortable, move on to single-leg stances.
- Single-leg stands can be done near a chair, railing, or wall for added support. Start with short 10-15 second stands, with the option to progress to 1 minute.
- Unstable surface balancing is often a natural progression for those who can safely and easily balance on a stable surface. Try introducing a foam pad, balance board, or uneven surface (like grass) and repeat the first two exercises.
Mobility and Stretching Exercises for Improved Joint Function
Mobility is undertrained in almost all populations, and those with nerve damage are no exception. Neuropathy can greatly affect mobility in several ways. Because it can cause pain, numbness, or tingling, it can dissuade individuals from moving the affected joint(s), causing atrophy and reduced mobility around the joint. It may also change the ability to feel or move the joint through its full range of motion.
Doing mobility work with your clients supports their joints’ ranges of motion and reduces stiffness and pain that limit movement quality. When you begin mobility training with your clients, start with testing that not only determines the actual range of motion but also the feeling at each endpoint and throughout the joint’s movement.
Start with gentle, dynamic movements and make sure your clients are warmed up before jumping into static stretches:
- Ankle circles support joint movement and circulation in the lower legs and feet. Encourage movement in all directions where possible. For an added element, have your client trace the ABCs in the air with their foot.
- Calf stretches can ease tight muscles that accompany an unnatural gait pattern, sometimes caused by pain or tenderness in the feet.
- Seated hamstring stretches help lengthen and stretch the posterior side of the body, improve blood flow, and release nerve tension, especially on the sciatic nerve.
Aerobic Exercises to Support Blood Flow and Nerve Function
Aerobic exercise has been shown to be one of the most helpful non-medicated forms of help for those with neuropathy. It increases circulation, releases natural painkillers, and may help regenerate peripheral nerves.
Because weightbearing activities may be uncomfortable or inaccessible, choose activities that cause lesser amounts of pain and stress on joints or affected limbs, such as:
- Water aerobics or swimming both promote circulation and healthy ranges of motion for all joints, without placing unnecessary weight or strain on them.
- Stationary bikes and other seated cardio machines like seated steppers can build cardiovascular endurance, making other daily activities easier.
- Brisk walking can be a great option for some. Walking on a treadmill or a surface with supports or handrails can assist with balance and stability as needed.
Safe Programming Strategies for Clients With Nerve Damage
Programming for those with nerve damage begins the same way other programs do. Simple exercise programs that focus on training the whole body allow your clients’ bodies to adjust to the new exercise. Programs should progress gradually, with options for low- and high-symptom days.
During your sessions, monitor their symptoms, including pain, numbness, and tingling. Adjust your workouts based on your client’s response rather than a fixed progression. Avoid high-impact or highly unstable movements early in their program, and move toward them only when and if they will be beneficial.
Coordinating care and sessions with a healthcare provider can help you choose the safest and most effective exercises for your clients. Know when to refer a client to a medical professional and stay within your scope of practice.
Professional Responsibility and Real-World Risk
Nerve damage introduces variability that affects how your clients respond to exercise. Adhering to safe practices alongside having a comprehensive insurance policy can reduce risks to your business and professional practice.
Remember a few key tips to keep your clients safe and your business protected:
- Clients with reduced sensation from nerve damage have an increased risk of injury. Take extra safety precautions where possible to reduce this risk.
- Clients with neuropathy may not notice strain, pressure, or improper positioning during exercises. Help guide them safely through each exercise. Use cues that do not rely on sensation or tactile input. Using a mirror can help clients visually see and check their form during exercises.
- Your client’s symptoms can and likely will vary session to session. In addition to your regular training program, have alternative activities available for days when their symptoms may not allow them to safely or comfortably complete their regular workout. This encourages them to stay in the habit of moving.
Before, during, and after, take a moment to check in with your clients and assess how they’re doing. Keep in mind that your risk increases when exercise begins to resemble treatment. If you notice that a client may benefit from medical care or physical therapy, don’t be afraid to make a referral.
Why Liability Insurance Matters When Working With Neuropathy and Nerve Damage
Working with clients who have nerve damage can compound the complexity and unpredictability of training sessions and outcomes. Common claims in the fitness industry include injury from balance exercises, strength training, and mobility work. But all this doesn’t need to compound your stress. Look for an insurance policy that offers coverage for instruction and supervision anywhere your clients will be exercising, whether at home, online, or at the gym.
Exercise for nerve damage supports mobility, balance, and daily function. It also requires structured programming and attention to client response. When guiding clients through exercises for nerve damage, your responsibility extends beyond good programming.
Working with neuropathy and nerve-related conditions introduces variability, even with well-planned sessions. If you work with clients experiencing nerve damage, having an insurance policy is part of responsible practice. Get covered with an insurance policy for fitness professionals through Insure Fitness Group.
