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Coping with Restless Leg Syndrome | Image Courtesy of Yuris Alhumaydy via Unsplash
Coping with Restless Leg Syndrome | Image Courtesy of Yuris Alhumaydy via Unsplash

Restless Legs Syndrome (or RLS)

Restless legs syndrome (or RLS) is a condition where there are uncontrollable urges to move limbs (mostly in the legs, but sometimes in the arms) that follows a circadian pattern, namely evenings/overnight when resting.

The urges usually come with unpleasant sensations such as tingling, burning, itching, or otherwise pain. Usually, it can be alleviated by movement, but as you can imagine, it can be debilitating and impair sleep, and thus the quality of life. It is common to experience mood swings, anxiety, and depression.

It is estimated that about 3.9-14.3% of the general population suffers from RLS. It is the most common movement disorder in pregnant women. There is either primary (idiopathic) RLS, or secondary (acquired) RLS due to pregnancy, renal pathologies, diabetes, hypertension, and other metabolic conditions. The two most common risk factors for RLS are iron deficiency and kidney disease. 

What Can Help Restless Legs Syndrome?

Restless legs syndrome is thought to arise from a decreased iron deficiency, specifically in the substantia nigra in the brain. There are also other hypotheses including decreased blood flow via impaired vasodilation. Based on the few hypotheses, there are some pharmaceutical options, namely some dopaminergic agents, but unfortunately they do come with side effects.

Luckily, there are non-pharmaceutical treatments that can help decrease the severity of restless legs syndrome symptoms.

  1. Vibration therapy: There is one vibratory counterstimuulation device called Relaxis that has been approved by the FDA as a treatment for RLS. There are also other whole-vibration plates and devices that is thought to help improve blood flow, and decrease symptoms. In our Sherman Oaks office, we feature a whole body vibration system as well.
  2. Exercise/yoga: One study found that at least 30 minutes of aerobic and lower-body resistance exercises 3x/week can help improve symptoms of RLS. Stretching exercises, progressive aerobic strengthening exercises and yoga poses can help improve symptoms. Our physical therapists can prescribe a program for you!
  3. Acupuncture: One study found significant improvement in symptoms after standard acupuncture practices, and with no side effects
  4. Pneumatic compression devices: Compressive devices can help improve blood flow by increasing nitric oxide and act as vasodilators. Studies show improved quality of life scores, measures of daytime sleepiness and fatigue. At our offices we have these devices to assist as a part of the treatment plan.
  5. Near-infrared light: Also improves symptoms through increased nitric oxide through improved blood flow to the region. One study showed 30 minute treatments 3x/week for 4 weeks showed lasting improvements in symptoms. Only side effect is some skin reactions, so make sure to monitor accordingly. We also have red and near infrared devices in all our offices.
  6. Cryotherapy: It can help decrease symptoms through a decreased neuronal activity. However, it is not enough to only localize it to the legs, but participating in whole-body cryotherapy in a cold air chamber is sufficient to help with symptoms.
  7. Massage: Foot reflexology massages 3x/week for 30-40 minutes can help reduce severity of RLS.

Based on the research, walking is extremely beneficial!

Walking 6,000-10,000 steps is helpful to relieve some of the symptoms experienced at night.

Stretches for Restless legs syndrome

Here are a few stretches that can also help with RLS:

  1. Calf stretch: Stand tall facing a wall, stagger your stance, bend the front knee, straighten the back knee, and bring your forearms to the wall. You should feel a gentle stretch on the back of your lower legs. Hold here for 15-30 seconds, repeat 2 times.
    restless legs syndrome exercise 1
  2. Hamstring stretch: Standing tall with a stool or low chair in front of you, bring one foot onto the stool, bend at the ankle (toes up towards you), keep knee straight as you lean your upper body forward. Lean until you feel a gentle stretch in the back of your upper leg. Try to keep a neutral back and hold here 15-30 seconds, repeat 2 times on each leg.
    restless legs syndrome exercise 2
  3. Quadricep stretch: Standing tall with one hand holding onto a counter, bend one knee and use your hand to hold on to the front of your foot until you feel a gentle stretch on the front of the thigh. Hold here 15-30 seconds, repeat 2 times.
    restless legs syndrome exercise 2

None of the above stretches should be painful. If they are, stop and discontinue immediately. Then please reach out to a physical therapist at your earliest convenience for more guidance. 

Restless legs syndrome is more common than we think, and can be a debilitating condition to experience.

Without healthy sleep, we are unable to be our most optimal selves, and experiencing restless legs syndrome can significantly impair our quality of life. While there are pharmaceutical treatments, it is worth trying out some of the non-pharmaceutical approaches listed above.

Don’t know where to start? Contact us to get a head start on your exercise regimen, and ask about infrared light, pneumatic compression and whole-vibration devices! 



References:

Panda AK, Pandey S. Identifying risk factors for restless legs syndrome. Neurol India 2019;67:660-1. 

Tipton PW, Wszolek ZK. Restless legs syndrome and nocturnal leg cramps: a review and guide to diagnosis and treatment. Polish Archive of Internal Medicine 2017;127(12)865-72.

Guay A, Houle M, O’Shaughnessy J, Descarreaux M. Current Evidence on Diagnostic Criteria, Relevant Outcome Measures, and Efficacy of Nonpharmacologic Therapy in the Management of Restless Legs Syndrome (RLS): A Scoping Review. J Manipulative Physiol Ther 2020; 43(9)930-41. 

What Our Patients Have to Say

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Testimonial by Jackie W.

I was in multiple car accidents a decade ago, and I have been to many physical therapists through the years without success. They found the root of my lower back pain problems and after nearly a decade of barely being able to walk I finally can again without pain. They are also the best pelvic floor pts and the only ones who found the connection between my pelvic floor and lower back problems. If you need help with physical pain, they are your answer.

-- Jackie W., 1/19/17 via Yelp!

Testimonial by Alexandra B.

Heather is without exaggerating AMAZING! After years of trouble with a certain part of my body, in no time, she made everything change back to equilibrium and to what would be considered normal. She explains everything in detail and therefore gives you a better understanding of why things are the way they are, and how you can work towards turning things around. I would highly recommend Heather for any type of Physical Therapy. She has created her own "Method/Therapy" through years of studying (with some of the greatest practitioners), practice and breaking down the issues of her past patients, enabling her to fine tune her own system. I'm so thankful to have found her, and I'm especially grateful for the quick recovery I've achieved, after years of distress. If you cannot afford her, I recommend you purchase her book. Although it may not be Heather in person, it can still help you to get on the right path to recovery!

-- Alexandra B., 5/20/2015 via Yelp!

Testimonial by A.B.

Before I was referred to Heather Jeffcoat I was living in a nightmare. I had been married to my husband for three years and I was suffering from Vaginismus. That all changed when I visited my OBGYN and she said she knew of someone with a great success rate. To be honest I was hesitant at first because my first doctor had already told me that all I needed to do was order dilators from the internet and I should overcome my problem. She was wrong because I had followed the book on how to use the dilators with absolutely no advancements in my condition. However, that all changed when I went in for my first visit and Heather took the time to explain my condition and how we were going to work together to overcome it.

I remember leaving her office with a glimmer of hope that I could live a normal life. As my sessions continued I began to see immediate results. With only four sessions and a strict dedication to my home programs I was cured of Vaginismus. In the beginning of this process I was made aware that my health insurance company might not cover the costs, which was disappointing but today I can say one hundred percent that it was the best money I ever spent. Now thanks to Heather I am finally enjoying my life to the fullest with my husband. Thank you Heather, I can’t begin to tell you how much I appreciate all that you have done for me. I will never forget it. Those who are suffering from these types of conditions don’t be afraid because she makes you feel so comfortable and the end result is worth it. Good luck to you all and I hope you experience the success I have.
-- A.B.

Testimonial by J.B.

My husband and I were having problems with painful intercourse. My therapist recommended that I go and get a pelvic floor evaluation from a physical therapist. Having never been treated by a physical therapist, I wondered how this really was going to help me. My husband who is a physician was very supportive and agreed that a PT evaluation would be a great idea. So i made the appointment and was blown away by what I learned. I had no idea that pelvic floor muscles could get tight and have trigger points just like any other muscle in the body. I'm a massage therapist and very familiar with tight muscles, and this new thought really amazed me. Heather's program to help relax and strengthen these muscles made such a difference. I can say that I am 100% pain free during intercourse now. Yippee! Going to the PT appointments and doing the at-home exercises was definitely a discipline, but it's 100% worth it! The rewards are amazing.

-- J.B.

Testimonial by Amanda W.

Heather's unique physical therapy program literally changed my life! After years of struggling with vaginismus, a condition that made it impossible for me to have intercourse and very difficult to use tampons without pain, a gynecologist referred me to Heather. I was nervous for my first appointment, but Heather's professional and friendly demeanor put me at ease. She did a great job explaining each technique she was using to help my muscles relax. Heather uses a combination of internal and external stretches and exercises to relax the pelvic floor and build muscle strength. Her specially developed home program helped me quickly recover from an issue that seemed insurmountable before meeting Heather. She was optimistic about my progress and incredibly encouraging. Less than 6 months after my first session, I was able to have pain-free sex for the first time in my life! If you are suffering from vaginismus or any other pelvic floor issues, I highly recommend making an appointment with Heather and reading her book!

-- Amanda W., 2/15/16 via Yelp!

Testimonial by Jamie M.

I have been going to see Heather for a while now, and I can't tell you enough how much she has improved my quality of life. Heather specializes in issues like pelvic floor, but I see her for other orthopedic issues.

I have a lot of chronic joint pain and dysfunction issues (back, hips, neck) that require that have ongoing physical therapy maintenance. The effects of my problem joints/areas overlap and interconnect with each other in complex ways, so helping me requires really having a complete understanding of the entire skeletal and muscular system. Pain does not always appear where the problem actually is, the human body is a twisty, many-layered puzzle. I have an exercise program I do at home and I am very functional, but there are just something things I need a PT to help me out with.

Read more: Testimonial by Jamie M.

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