Getting Your Balance Back After Neuropathy

How Chemotherapy Treatments Cause Loss of Balance

Many types of chemotherapy are specifically neurotoxic (for a list, see one of our earlier articles on CIPN).  “Chemotherapy-induced peripheral neuropathy” (CIPN) is a common side effect, affecting over 70% of patients taking platinum drugs or taxanes (source) and remaining as a chronic condition in 30-40% of chemotherapy patients (PubMed).  Many body functions are impacted by chemo-induced neuropathy, but in this article we want to talk about balance.

Neuropathy often results in a loss of balance, which of course increases risk of falling and bone fracture.  (This problem is compounded by the fact that some cancers, radiation therapy and chemotherapy can cause osteoporosis.)  While there are many things you can do to improve nerve health throughout the body—dietary changes, especially—perhaps the key activity for maintaining and regaining your balance is exercise.  Why?  Well, lots of reasons:

“Exercises, including those designed to increase strength and balance, as well as aerobic exercise, may increase the supply of blood, oxygen, and glucose to mitochondria, allowing the mitochondria to produce energy in a more efficient manner. Increasing mitochondrial energy production and blood flow to peripheral nerves may result in fewer neuropathic symptoms, increased strength and balance, and better quality of life.” (PubMed)

So here are (some of) the reasons why exercise is critical:

• It stimulates circulation, bringing oxygen and nutrients to the extremities and the brain to promote healing.
• It boosts mitochondrial activity, creating more energy for the cells of the body.
• It tones and builds muscles.
• It trains the motor nerves and the corresponding brain centers that control them.
• It moves the lymph, draining toxins out of the tissues.

Convinced yet?  We hope so.

However, not every exercise is appropriate during cancer treatment and rehab.  In the first place, as we’ve said, bones can be weaker than they were before treatment.  Inappropriate types of exercise can add to the problems you’re trying to solve!  

What Kinds of Exercises are Best for Recovering Balance from Neuropathy?

Here is a partial list of exercises you might do with one of our physical therapists, and/or at home.  Done correctly, these are safe and effective at improving the strength of muscles and also improving balance. 

Supported exercises (holding on to a chair or counter) – pictures here.

• Calf raises
• Side leg raises
• Hip flexion & extension

Standing exercises (demonstrated on video here).

• Heel raises – keeping your balance against a wall and rising up on your toes, either on both feet or (harder) on one foot.
• Toe raises – keeping one hand on the wall still, rock back to balance on the heels.
• Wall slides – “sitting” against the wall, to strengthen the upper legs.
• Standing on one leg – with a hand ready to grab a balance point if needed.

Keep working towards more repetitions and longer holding times.  Once you have regained some balance, you can add in walking exercises (demo here).

• Walking on toes (i.e., on the balls of the feet)
• Walking on heels
• Slow lunge walks – long lunging steps, holding the opposite foot in the air for a few seconds before taking the next step.

Some of these, especially the lunge walking, require a specific technique to be safe and effective.  This may mean initial oversight/training by a physical therapist.  Doing it right is helpful, doing it wrong is risky.  Get the help you need, at least at the start.

A physical therapist can also provide more intensive balance training with specialized equipment (foam balance pads, balance boards, trampoline to name a few) and teach you specific balance exercises based on your individualized needs.  Your physical therapist will do a comprehensive assessment of your strength and balance as well as determine the severity of your neuropathy  prior to starting a balance program which will help to develop the most effective (and safe) exercise program for you.  

One more note: dealing with balance issues (and with osteoporosis) requires slowing down (initially) and also learning new movement patterns (temporarily, or perhaps permanently).  Take your time, show yourself grace, and get professional training as needed.

If you are heading towards conventional cancer treatment, talk to your oncologist about options for the least neurotoxic treatments, and also review our “Prehab” program.  

If you are already experiencing neuropathy, please schedule an appointment to discuss our neuropathy program.