This very specific problem should not be approached by the novice trainer. Any personal trainer who works with diabetic clients should have advanced education and/or certifications for training this special population.
Diabetes can cause damage to the nerves through their prolonged exposure to high glucose levels in the blood. Symptoms of this damage may include loss of strength, muscle wasting and numbness in the arms, hands, legs and/or feet.
To work with a client with neuropathy, the trainer should first assess the client's footwear. The shoes should be stable and provide proper support. I recommend referring the client to a podiatrist or other qualified professional who can evaluate foot mechanics and the need for orthotics. Furthermore, the trainer should consult with the client's doctor to see if any of the client's medications are causing or contributing to the peripheral neuropathy.
A thorough neuromuscular and musculoskeletal assessment is also recommended. This assessment will help identify any imbalances that may be exacerbating the condition. For example, soft-tissue adhesions or restrictions in the fasciae or muscles might be placing further stress on the major nerve sites of the body, such as the brachial and lumbar plexus. Any lower-back, hip or neck-and-shoulder dysfunction should be evaluated to rule out the possibility that soft-tissue structures in these areas could be causing referred pain or dysfunction in the extremities.
Guided by the assessment results, the trainer should do specific muscle testing of all the major muscles, including (but not limited to) the flexors and extenders of the foot; the hip flexors; the gluteus maximus, minimus and medius; the tensor fascia latae; the adductors, quadriceps and hamstrings; the lats and pecs; the rotator cuff muscles (internal and external rotators); the flexors and extensors of the wrist and fingers; and the biceps and triceps. This muscle testing will help create an understanding of which specific muscle and/or nerves have been affected.
Guided further by these results, the trainer can develop a myofascial release program to help release and align the soft tissue. Then an isometric strengthening program can be added to help facilitate a "reawakening" of those muscles and nerves that have been damaged. As progress is made with single-joint movements, weight-bearing exercises that address the entire kinetic chain can be added.
The trainer must not overtax the client's nervous system; that is the key. Constant trainer-client feedback is imperative to ensure that the right muscles are firing during movements and that the client does not become too fatigued.
The choice of specific exercises will depend entirely on the individual client and his degree of dysfunction and neuropathy.
Justin Price, MA
Owner, The BioMechanics
2006 IDEA Personal Trainer of the Year
San Diego, California
Diabetic neuropathies can impact multiple areas...