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Exercises to help avoid hand and foot problems

By Benjamin Sewell

Associate Physiotherapist, The Headache, Neck & Jaw Clinic

 

While lower limb management in diabetes needs no introduction, the upper limb often gets overlooked as a key area of maintenance in diabetes treatment. In fact, diabetes (both type 1 and 2) can actually lead to increased rates of many upper limb conditions.

 

Inclusive of this is peripheral neuropathy. Through chronic high blood glucose levels, the nerves which carry messages from your brain to your body can become damaged and lose their effectiveness over time, causing numbness.

 

It is believed that between 60 to 70 percent of people living with diabetes will eventually develop peripheral neuropathy.

 

This damage often occurs in the feet but can also occur in the upper limb and other areas of the body. The phenomenon is called Stocking-Glove Syndrome. Clients can develop numbness or weakness in their toes which then slowly progresses up the leg. Eventually the finger tips become involved, resulting in nerve damage in areas that could be covered by "stockings and gloves".

 

The damage to the nerves and blood vessels then increases the risk of developing other musculoskeletal conditions. As can be seen in the table below, people living with diabetes are more likely to experience conditions such as Frozen Shoulder and Carpal Tunnel Syndrome than the average person.

 

Upper limb disorders

With diabetes

Without diabetes

Frozen Shoulder

11-30%

2-10%

Limited joint mobility

8-50%

0-26%

Dupuytren's contracture

20-63%

13%

Carpal Tunnel Syndrome

11-16%

0.125%

Flexor tenosynovitis

11%

<1%

Diffuse idiopathic skeletal hyperostosis

13-49%

1.6-13%

Brukner and Khan (2007)

 

The maintenance of blood glucose levels in the healthy range is key to decreasing the risk of developing peripheral neuropathy.

 

As a result, there are also several easy exercises you can perform on a daily basis which will reduce the likelihood of developing any of these conditions.

 

Tendon and nerve gliding stretches

Hand -  make a fist and move in and out of that fist as shown below

  • 10 times, 3 times a day

 

Shoulder -  gently stretching your shoulder in and out of the positions shown below. Note do not hold this stretch, slowly move back and forth into the stretch. Stop if there is any burning pain or numbness.

  • 5 times, 3 times a day

  

Hand Exercises _abc

Hand Exercises _def

Hand Exercises _123

Hand Exercises _45

Totten and Hunter (1991)

 

Shoulder Exercises

Coppieters and Alshami (2007)

 

Upper body strengthening

  • Specifically focus on shoulder, elbow and wrist exercises
  • 2-3 times a week

 

General neck stretches

  • Ear to shoulder
  • Nose to armpit
  • Left and right, up and down
  • 6 times a day
  • 10-15 second holds

 

Posture work

  • all the time
  • Shoulders back, chest forward, head up, nice and tall. 

 

Lower limb peripheral neuropathy has long been considered a common ailment when addressing diabetes management.

 

However, the upper limb should not be ignored when discussing treatment options with your medical practitioner.

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