What is Restless Legs Syndrome?

Restless Leg Syndrome (RLS) is an uncomfortable condition of the legs that often causes an annoying and unpleasant sensation, creating an irresistible urge to move while relaxing, falling asleep or during periods of rest. Most often, the discomfort is centered deep inside the calves, but can also occur in the thighs, feet, or anywhere in between.  In many cases, both legs are equally affected.

RLS is common.  The intensity of RLS ranges from mild to moderate to severe.  RLS becomes more common as people get older, but it can begin early in life.  In all age groups, RLS is more common in females than males.

Symptoms of RLS are usually most bothersome at night.  Often there is involuntary leg movement during sleep and a person may have to extend the legs or get up and walk around in an attempt to relieve the discomfort during the night.  RLS sufferers have difficulty falling asleep and staying asleep.  Symptoms may vary from day to day, and in severity and frequency from person to person.  RLS has a profound effect on the duration of quality sleep for most people.  Individuals with mild RLS may have some disruption of sleep onset and minor interference in daytime activities due to drowsiness.  In moderately severe cases, symptoms occur only once or twice a week but result in significant delay of sleep onset, with some disruption of daytime function.  In severe cases of RLS, the symptoms occur more than twice a week and result in burdensome interruption of sleep and impairment of daytime function.

The most distinctive aspect of RLS is that lying down and trying to relax activates the symptoms.  RLS characteristically flares up at bedtime, but it can also take place during long stretches of inactivity, such as sitting in a meeting, settling down into a chair or recliner at the end of the day, riding in a car, traveling in an airplane, or simply sitting in a movie theater.

RLS is described as an aching, gnawing, tingling, throbbing, itching, bubbling, burning, creeping, tugging or crawling sensation like “ants crawling up my legs” or “soda pop in my veins.”   Sometimes the sensations seem to defy description.  Affected people usually don’t describe the condition as a muscle cramp or numbness.  To combat the sensation they fidget, jiggle their legs, pace the floor, do stretches or exercises, and toss and turn.  The urge to move is overwhelming and the only way people with RLS can stop the discomfort is to move about.  This compelling desire to move is what gives Restless Legs Syndrome its name.

What causes RLS?

 Although a single cause for Restless Legs Syndrome has not been recognized, this disorder has been linked with several conditions.  Pregnancy, obesity, neurological conditions and nutritional insufficiencies are implicated in creating RLS.  Often it happens to pregnant women, especially in their last trimester.  In most cases, symptoms usually disappear within 4 weeks after delivery.                                          

Frequently RLS will occur in conjunction with other chronic diseases such as kidney failure, diabetes, peripheral neuropathy and rheumatoid arthritis.  Sometimes it is associated with an iron or magnesium deficiency.  Certain medications may aggravate symptoms.  These medications include anti-nausea drugs (prochlorperazine or metoclopramide), anti-psychotic drugs (haloperidol or phenothiazine derivatives), anti-depressants that increase serotonin, and some cold and allergy medications that contain sedating antihistamines. Environmental and other toxins including alcohol, cigarette smoke, and caffeine can also bring about or exacerbate RLS symptoms.

Managing RLS

 There is a lot you can do to take care of restless legs yourself.  Assessment of your musculoskeletal health is a great first step. From a Chiropractic perspective, RLS is often considered to have its origins in the pelvic area of the lumbar and sacral regions of the lower back. Chiropractors recognize that structural issues may be a major contributing factor.  Pelvic instability can place additional stress on the sacral base and cause anterior (forward) pressure from the spine toward the abdomen.  The result is an increased lumbo-sacral lordosis (a forward curvature of the spine toward the abdomen), causing symptoms identical with RLS.

Dr. Bruce recommends the following to help manage and relax restless legs:

• Correct extremity instability in the feet, ankles, legs, knees and hip and adjust any pelvic and lumbo-sacral instability.

• Follow a regular exercise program which includes leg stretching, and exercises specifically to improve the pelvis and the lumbo-sacral area; however, do not overdo it or exercise late in the day.

• Massage will increase circulation and help relax and soothe restless leg sensations.
• Increase your intake of magnesium and iron supplements if levels are low.
• Practice relaxation techniques such as meditation, yoga or deep breathing.
• Reduce caffeine, alcohol and tobacco use.
• Soak feet in hot water or apply a heating pad or cold compress to the affected area.
• Maintain a regular sleep schedule. When resting or sleeping, lie on your side with a pillow between your knees.

Simple stretching can help stop the symptoms of RLS in their tracks.  Here’s a few to help you get started.

Calf Stretch – Stretch out arms so that palms are flat against a wall and elbows are nearly straight.  Keep right knee slightly bent and step back a foot or two with left leg, positioning the heel and foot flat on the floor.  Hold for 20 to 30 seconds.  Now bend left knee while still keeping the heel and foot flat on the floor.  For a deeper stretch, move foot back a bit farther.  Switch legs and repeat.

Front Thigh Stretch – Stand parallel to a wall for balance.  Keep right leg straight and bend other knee and hold ankle with your right hand to pull your heel up toward your buttock. (Same side ankle to hand causes undue stress on your knee joint and quad muscles.)  Hold for 20 to 30 seconds.  Switch legs and repeat.

Hip Stretch – Stand facing a chair, with the back of the chair against a wall for support.  Raise left foot up and rest it flat on the chair, with knee bent.  (Or try placing your foot on a stair while holding the railing for balance.)  Keeping spine as neutral as possible, press pelvis forward gently until you feel a stretch at the top of the right thigh.  Your pelvis will move forward only a little.  Hold for 20 to 30 seconds.  Switch legs and repeat.

Living well with RLS means knowing how to manage your symptoms so you control Restless Legs Syndrome so it doesn’t control you.