Effect of massage with peripheral vascular circulation exercise on neuropathic symptoms of lower legs in type 2 diabetic patients: a pilot study

Abstract

Peripheral neuropathy is usually found in diabetes because a chronic high blood sugar level damages the blood vessels that supply to nerves. This causes sensation impairment and muscle weakness. From literature review, massage and exercise can improve blood circulation and exercise also helps to reduce blood sugar. Therefore, the study aims to determine the effects of massage with exercise for improving peripheral vascular circulation on neuropathic symptoms of lower limbs in Type 2 Diabetes. Thirteen volunteers with diabetic peripheral neuropathy (DPN), mean age 59.92±8.45 yrs, were randomized to 2 groups; 1) massage (n=9), and 2) massage with exercise (n=4).  All participants were assessed neuropathic symptoms by the Michigan Neuropathy Screening Instrument (MNSI) and muscle forces of ankle dorsiflexor (DF) and plantar flexor (PF) by hand-held dynamometer before enrolled in the study. The massage group (M) was taught how to massage their feet and lower legs by themselves (40 min/time). The massage with exercise group (ME) was taught how to massage and exercise by themselves (15 min of massage plus 25 min of exercise, total 40 min/time). Both groups did the intervention as a home-program 3 times a week for 4 weeks. After 4 weeks, the MNSI, DF and PF were re-assessed. The Wilcoxon matched-pairs signed-ranks test was used to compare data within group between pre-post training. The Mann-Whitney U test was used to compare data between groups. At post-training, the MNSI scores were significantly reduced, comparing with pre-training, in both M and ME (p=0.004 and p=0.034 respectively), but there was no difference between groups. An increase in the PF force after training of ME was more than that of M significantly (p=0.045), while a significant increase in the DF force after training was found only in ME group (p=0.034). This pilot study found that massage relieved DPN symptoms in terms of sensory improvement. Whereas, the massage with exercise protocol of this study improved sensation and also forces of DF and PF significantly. However, it should be confirmed the study in a larger sample size for the more reliable results.