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October 14, 2020

How does physiotherapy and gentle exercise help manage pain?

Reviewed by the Transitional Pain Service team at the Toronto General Hospital
The contents of this website are for informational purposes only and do not constitute medical advice. Always seek the advice of a physician or other qualified health provider with any questions you may have regarding a medical condition.
Neuropathic pain is a complex type of pain caused by an abnormality in the nervous system. The pain caused by the damaged nerves can be due to any number of things—it can be a result of an infection, an illness, an injury, and even surgery. The pain occurs whenever there is an increased release of neurotransmitters combined with the inability of the nervous system to regulate these signals.

Medication is usually the first form of treatment for neuropathic pain. However, more and more doctors are now suggesting a multidisciplinary approach to their patients. Many medical professionals will suggest that physiotherapy be included in the treatment plan to make the ongoing medication even more effective. Physiotherapy helps the patient restore and maintain functional movement as well as reduce and manage their pain effectively.
Medication for Neuropathic pain treatment
Benefits of physiotherapy
Since neuropathic pain can be a long-term condition, you can turn to other alternatives to reduce the impact of pain on the overall quality of your life. Once you have the go-signal from your primary care physician, you can consult with a licensed physiotherapist to help you come up with a pain management plan that will take into account your current lifestyle, physical activities, and general health.

Your physiotherapist will assess your needs and study your medical history before giving you a short- and long-term treatment plan. Aside from receiving physical therapy, you will also receive self-management recommendations that you need to follow at home. The specialist can also advise you on the proper equipment to use such as canes, crutches, or any other assistive device to help you function even in pain.

With physiotherapy, no medication is involved; the focus will instead be on improving muscular movement. The physical therapy may be implemented in isolation or in combination with other treatments. Here are some therapies that may be recommended by the physiotherapist for your nerve pain:
Joint mobilization
This therapy involves the process of moving a joint to a desired direction. With this form of therapy, you may experience decreased muscle spasms and increase your joints' mobility. The physiotherapist will use their hands and apply force if necessary to move the joint in the appropriate direction.
Myofascial release
This form of therapy is done by applying gentle pressure in the affected areas. It keeps the joints warm and loose and provides relief for people who are already experiencing restricted movements due to pain.
Heat and cold therapy
Heat therapy can improve blood circulation due to the sudden increase in temperature. Heating pads and warm water bottles may be used to apply the heat. Cold therapy, on the other hand, will reduce the blood flow on the applied area as well as reduce the nerve activity. It also numbs down the affected body part, causing the pain to subside. This can be done by applying ice packs on the affected area or by taking a cold shower. Note that there is a risk involved when applying heat or cold therapy to the body, and prolonged exposure can lead to further damage.
Transcutaneous electrical nerve stimulation (TENS)
TENS is a non-invasive peripheral stimulation technique used to treat and manage pain. In this method, electrodes are placed on the skin near the source of pain and a small, battery-operated device delivers low-voltage electric currents to the affected area. The currents will prevent the nerve receptors from sending messages to the brain. One known side effect of TENS is an allergic reaction or rash that can develop on the skin where the electrodes have been placed.
Benefits of gentle exercise
Living with neuropathic pain can make even the simplest of activities such as making the bed or reaching for an item on a top shelf painful. Most people suffering from neuropathy are afraid to move because they believe it will only make the pain worse. The truth of the matter is, moving in an appropriate way and under supervision of a physical therapist can be helpful and avoiding all movement can lead to more pain.

Having a consistent exercise routine combined with passive stretching will help control your pain. It will help maintain your ability to move, instead of being completely disabled by the pain you are feeling. It will also give stability to your muscles and joints, and will make normal daily activities easier to do.

Aside from alleviating the pain through exercise and manipulation, physiotherapy also encourages the body to heal itself through the production of natural pain-relieving chemicals. The physical activities you do in physiotherapy will allow you to release endorphins, which is a naturally-occurring hormone that acts as the body's painkillers.

Below are the four main types of exercises that are ideal for people with neuropathic pain. Consult your doctor to get the "all clear" for these various forms of exercise:
Aerobic exercise
This is a type of exercise that increases your heart and breathing rates. Doing aerobic exercises will improve your body's utilization of oxygen. Brisk walking, running, hiking, biking, and swimming are some examples of aerobic exercise.
Flexibility exercise
Also known as gentle stretching, this can be done to get the body all warmed up for a more vigorous form of activity. This will keep your joints flexible and reduce your chances of injury.
Balance training
Some kinds of neuropathic pain can leave your joints feeling sore and stiff. It can also leave your body weak, making you prone to fall-related injuries. Doing exercises to improve your balance will help strengthen your core, improve your coordination skills, build stronger muscles, and prevent falls from happening.
Strength training
Once your body gets used to being active, you can also implement a weight training program to build mass and strengthen those weakened muscles.
With physiotherapy, you don't have to go through life with pain and immobility. When pain becomes a constant feature in your daily life and prevents you from performing ordinary activities, physiotherapy can help you manage the pain and improve your physical health.

The role of physiotherapy in pain rehabilitation is very important. Many people suffering from neuropathic pain have improved their ability to function by doing physiotherapy. This field of medicine has allowed people to overcome their pain, regain their strength, and lead active lives.