5 Things You Can Do To Prevent Falls (Even If You Have Neuropathy)

“My balance is bad because I have neuropathy.” 

I hear this from my physical therapy patients a LOT- they state it like a fact, the same way in which they would tell someone they have blue eyes, as if that’s just how it is and how it always will be. 

I teach them (and prove to them!) that this is NOT true! You CAN improve your balance, even if your neuropathy isn’t going anywhere. 

Peripheral neuropathy is the term for nerve damage in peripheral nerves, which means in nerves that are located outside of the brain and spinal cord. Common causes of peripheral neuropathy include diabetes, chemotherapy treatments, infections, and trauma. Symptoms can include pain, numbness or tingling, and weakness in the affected areas, which often is in the hands or feet. 

When peripheral neuropathy affects your feet, it can really wreak havoc on your balance, because it makes it difficult for you to feel your feet on the ground. 

This feeling is important because when you’re standing or walking, the sensation of the ground beneath your feet gives your brain much information about what aspects of your foot are in contact with the ground, and at what time. If you cannot feel the bottoms of your feet, it’s a lot more difficult to sense when your weight shifts to different areas of your foot, which can lead to a lot more losses of balance, twisted ankles, and falls.

Contrary to what many of my physical therapy patients believe (before they met me), having peripheral neuropathy that affects your feet does NOT mean you have to kiss your hopes and dreams of good balance goodbye. Adequate sensation on the bottoms of your feet is - luckily! - only one aspect of your balance. It’s only one piece of the puzzle. Let’s explore 5 other contributors to your balance, and how you can optimize each of these to help make up for what you can’t feel in your feet.

First of all, you can set your environment up for success: inadequate lighting, clutter, and even throw rugs can pose a high risk for falls, especially for those with neuropathy in their feet. Click HERE to read more about how to fully fall-proof your home, or if you’d rather have a streamlined checklist sent straight to you so you can spot-check your home, click HERE. 

Next let’s address your vestibular system: incorporating vestibular exercises help to strengthen this system, which plays a key role in your balance. Our vestibular system is located within our inner ear, and it is responsible for communicating to our brain which direction and how quickly our heads are moving. When this system is not functioning well, you’ll feel dizzy, disoriented, a sense of spinning, or vertigo. One example of a vestibular training exercise is called “VOR x1” (VOR stands for vestibular-ocular reflex), and you can watch a quick video that I made that will show you how to do this easily at home: Click HERE to watch it on Instagram, or click HERE to watch it on Facebook. 

You also want to ensure that you keep your eyes in check: regular visits to the optometrist to keep your prescription updated, as well as actually wearing your glasses or contacts! Your vision provides your brain with a multitude of information about your surroundings as related to your body’s position, so make sure your vision is as good as it can be, so that your eyes can give your brain as much accurate input as they possibly can. 

Fourth, you will want to regularly review all of your medications with your physician - both prescription as well as over the counter drugs. Just because a medication can be bought without a prescription doesn’t mean it’s not powerful, and these drugs still interact with other medications that you may be taking, so it’s important your physician knows about each one. Some medications can throw off your equilibrium or cause dizziness, or there may be certain medications that shouldn’t be taken together. You also want to ensure that you are taking any medications that you need to adequately manage diabetes, for example, as uncontrolled diabetes can cause neuropathy to get worse and worse. 

The final major piece to the balance puzzle? Proprioception, which is your ability to sense what position your body and joints are in. Proprioception is how you can tell me whether your elbow is bent or straight right now- without having to actually look down at your elbow. You can train your proprioception and improve it, even if you also have peripheral neuropathy. In fact, it’s imperative that you do work to train your proprioception, because the research shows that those with peripheral neuropathy are at significantly higher risk for falls. Proprioceptive work will not help you regain the sensation in your skin lost through neuropathy, but it will sharpen the communication between your brain and your joints, which will help you to feel more stable and steady on your feet.

So how do you train proprioception? These types of exercises look like what most people think of when we say “train your balance.” You can practice balancing on one foot, although if you have peripheral neuropathy, this is usually too challenging to start out with. Try starting off simply standing with your feet close together, either looking down at the floor or straight ahead. If that feels easy, see if you can stay standing like this, but while looking up at the ceiling: this will feel a bit harder, because your eyes can’t give your brain as much information about the position of your body relative to the ground when you’re looking up. Again, once this feels easy, then you may even try closing your eyes. Always make sure you’re standing next to a stable surface when doing these types of exercises, such as a sink or counter, and have your hands hovering above that stable surface so that you can easily grab on or hold if you get too wobbly. Depending on your level, it may be a good idea to have someone with you- ideally standing just behind you- when you work on these exercises, especially if it’s your first time. 

I won’t sugarcoat it: if you have peripheral neuropathy, these proprioception exercises can feel extremely difficult, especially when you are just starting out. Don’t be discouraged! The more consistently you work at it, the better you will get, which will help you feel more steady on your feet and decrease your fall risk. 

Although peripheral neuropathy can affect your balance, by sharpening your other contributors to balance (your vision, your vestibular system, and your proprioception) as well as making sure your home environment is set up for success, and regularly reviewing your medications with your physician, you can significantly improve your balance, reduce your fall risk, and minimize the effects that neuropathy can have on your day-to-day life. 

Do you know someone who suffers from peripheral neuropathy? Send them this post! You just may help improve their quality of life and even help them to prevent a fall.