Peripheral Neuropathy: The Chiropractic Opportunity Hidden in Plain Sight

What’s Already in Your Practice

For many chiropractors, neuropathy isn’t a condition we go looking for – it shows up as something else. A patient presents with chronic low back pain and casually mentions their feet “tingle at night” or “feel like they’re walking on cotton.” It’s easy to dismiss as spinal referral or age-related changes, but often, this is the clinical start of peripheral neuropathy, and chiropractic is in a prime position to intervene.

With estimates showing over 30 million Americans affected by peripheral neuropathy – and a significant portion underdiagnosed – it’s increasingly likely that chiropractors are already treating these patients.¹ What’s missing is structured recognition, comprehensive management and targeted tools to slow progression, improve function and support systemic health.

More Than a Numb Foot: The Neurology of Early Neuropathy

Neuropathy, particularly in diabetic and idiopathic forms, often begins as a small-fiber neuropathy, affecting unmyelinated C fibers and thinly myelinated Aδ fibers.² These fibers are for pain perception, temperature regulation and autonomic function. Disruption leads to altered signaling, mitochondrial distress and progressive axonal degeneration – prior to motor symptoms.

Recent research also links chronic low-grade inflammation and metabolic dysregulation (especially insulin resistance) as key contributors to this peripheral nerve damage, even in non-diabetic patients.³ This further expands the relevance of neuropathy to chiropractic – not just because of what we treat structurally, but also because of how we treat holistically.

Chiropractic: A Natural Fit for Multisystemic Care

The chiropractic model is uniquely suited to address the biopsychosocial complexity of neuropathy. Mechanical correction through spinal and extremity adjustments can reduce peripheral nerve entrapments and enhance nerve mobility. Lifestyle integration such as exercise, nutrition and glycemic control is central to our wellness framework.

Conservative first intervention aligns with non-pharmacologic best practices for early-stage neuropathy. Unlike fragmented specialty care, chiropractors can combine assessment, education and intervention in one unified approach, and are well-known for multisystem, full-body care.

Modalities That Matter: Laser and Radial Pressure Wave Therapy

Technologies like high-intensity laser therapy (HILT) and radial pressure wave (RPW) therapy are increasingly studied for their ability to modulate symptoms and enhance nerve health. Photobiomodulation (PBM) with class IV lasers has demonstrated effects on:

• Cytochrome c oxidase activation and mitochondrial ATP production⁴
• Superoxide dismutase upregulation and oxidative stress reduction⁵
• Neuropeptide release that aids in nociceptive regulation and inflammation control⁶

For patients with early neuropathy, HILT offers a non-invasive means to stimulate neural repair, improve microcirculation and reduce pain – all without side effects or medication interactions.

Radial pressure wave (rESWT) therapy, though traditionally used for musculoskeletal complaints, stimulates superficial sensory afferents (including Meissner’s corpuscles), improves capillary perfusion and supports local neuroplastic changes – making it useful as a complementary sensory-stimulating modality in cases with tactile deficits or vascular compromise.⁷

Combined-Modality Protocol Snapshot: Use HILT 2-3 times/week in treatments at 4-8 J/cm², targeting dermatomes and distal extremities. RPW can be applied locally 1x/week for 3-5 minutes (2,000-3,000 impulses at a less-than-uncomfortable intensity) at 10-15Hz for additional circulatory stimulation.

Integrating At-Home Care: A Bridge to Compliance and Outcomes

While in-office modalities are effective, neuropathy requires consistency, which can be difficult for patients with mobility or transportation issues. Home-use light therapy, electrostimulation and thermal devices (under appropriate guidance) can extend care into daily routines and improve outcomes through:

• Increased compliance
• More frequent application
• Empowerment and education

Combining this with targeted exercise, nutritional support (e.g., B₁₂, benfotiamine, alpha-lipoic acid), and lifestyle coaching creates a system of care aligned with functional medicine, yet grounded in chiropractic.⁸

Metabolic Health: The Missing Conversation

It’s not just about nerves – it’s about what’s causing their breakdown. Many neuropathy patients are in a state of metabolic inflexibility driven by insulin resistance, mitochondrial dysfunction and systemic inflammation. Chiropractors who incorporate basic metabolic screening (waist circumference, fasting glucose, HbA1c where available) are better positioned to guide comprehensive care.

When patients begin improving both peripheral symptoms and central metabolic drivers, we aren’t just relieving tingling feet – we’re preventing cascade conditions: ulcers, balance deficits, falls, and long-term disability.

Reframing Neuropathy as a Chiropractic Priority

Peripheral neuropathy represents both a pervasive clinical challenge and an underrecognized area of opportunity within chiropractic practice. Neuropathy isn’t just a nerve problem. It’s a systemic signal.

As chiropractors, our strength is in seeing and dealing with the full pattern of mechanical, metabolic and behavioral concerns. Modalities like laser and RPW can accelerate healing, but it’s the systems thinking that creates real change.

As the profession continues to evolve beyond structural care into integrative, systems-based management, chiropractors are well-positioned to assume a leading role in the conservative treatment of this complex condition. Through the convergence of diagnostic acumen, evidence-based modalities and sustainable lifestyle interventions, chiropractic care offers a uniquely comprehensive framework – one capable of addressing the multifactorial nature of neuropathy with both precision and pragmatism.

References

1. Callaghan BC, Cheng HT, Stables CL, et al. Diabetic neuropathy: clinical manifestations and current treatments. Lancet Neurol, 2012;11(6):521-534.
2. Oaklander AL, Nolano M. Scientific advances in and clinical approaches to small-fiber polyneuropathy. JAMA Neurol, 2019;76(10):1240-1251.
3. Pittenger G, Vinik A. Nerve growth factor and diabetic neuropathy. Exp Diabesity Res, 2003;4(3):271-285.
4. Passarella S, Karu T. Absorption of monochromatic and narrow band radiation in the visible and near IR by cytochrome c oxidase. J Photochem Photobiol B, 2014;140:344-358.
5. Rizzi CF, Mauriz JL, Corrêa DS, et al. Effects of low-level laser therapy (LLLT) on the nuclear factor (NF)-КB signaling pathway in traumatized muscle. Lasers Surg Med, 2006;38(7):704-713.
6. Efficacy of low-level laser therapy in the management of neck pain: a systematic review and meta-analysis of randomized placebo or active-treatment controlled trials. Lancet, 2009;374(9705):1897-1908.
7. Notarnicola A, Moretti B. The biological effects of extracorporeal shock wave therapy (ESWT) on tendon tissue. Muscles Ligaments Tendons J, 2012;2(1):33-37.
8. Ziegler D, Ametov A, Barinov A, et al. Efficacy of alpha-lipoic acid in the treatment of diabetic polyneuropathy. Diabetes Care, 2006;29(11):2365-2370.