PT Classroom - Restless Legs Syndrome: The Unknown Common Condition ׀ by Jennifer Werwie, DPT

 

Jennifer Werwie, DPT, graduated with her Doctor of Physical Therapy degree from the University of Wisconsin-Madison. She received her BS degree in Kinesiology-Exercise Science from UW-Madison in 2008. Jennifer is also a certified personal trainer and fitness instructor. She is a Kenosha native and is an employee with United Hospital System where she primarily works in the outpatient PT setting.



 Restless Legs Syndrome: The Unknown Common Condition

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"Creepy crawly”, “pins and needles”, “tickles”, “itchy”, “numbness”, “tingling”…these are just a few of the sensations that describe a condition that approximately 10-20% of the population suffers from. This condition is Restless Legs Syndrome, or RLS. WebMD defines RLS as “a disorder of the nervous system in which there is an urge or need to move the legs to stop unpleasant sensations” (1). These sensations can often be defined medically as paresthesias and/or dysesthesias in the calves and legs. About 50% of the patients with RLS complain of restlessness in the arms as well (2).

Although it is found to be quite common, there is a lack of awareness about the condition among the general population and medical professionals. As the quote from the Restless Legs Syndrome Organization states, restless legs syndrome is "the most common disorder you've never heard of" (3). It often goes unrecognized or misdiagnosed, with many individuals suffering 10 to 20 years with the disorder until it is properly diagnosed and treated. What is difficult about RLS is that instead of being able to diagnose it through a specific clinical test, doctors must determine its presence through a cluster of symptom characteristics such as the following (1,3-4):

1. An urge to move the legs-- often accompanied or caused by uncomfortable and unpleasant sensations in the legs
2. Occurs during inactivity-- often when sitting or lying down
3. Symptoms partially or totally relieved by movement
4. Onset in the evening-- usually while lying down at night trying to fall asleep
5. Feelings of daytime fatigue and tiredness-- due to difficulty falling asleep and poor sleep patterns
6. Leg twitching during sleep-- RLS can become a sleep disorder when the twitching/jerking also occurs during sleep; then it is called Periodic Limb Movement Disorder (PLMD).


And although there are no specific medical tests to rule in the diagnoses of RLS, many physicians use blood tests and other various examinations to rule out other conditions, such as iron deficiency. It is thought that many chronic diseases, medications, and stages of life are associated with the development or worsening of RLS (1):

Chronic Diseases: iron deficiency, diabetes, peripheral neuropathy, Parkinson’s disease, kidney failure
Medications: anti-nausea drugs, antipsychotic drugs, some antidepressants, cold and allergy medications
Pregnancy: often occurs in the last trimester and usually spontaneously resides approximately one month postpartum
Lifestyle factors: high alcohol and caffeine use, sleep deprivation, sedentary lifestyle
Genetics: Approximately 50% of people with RLS also have a family member with the condition. Research in the past few years has shed new light on the potential influence of genetics on the incidence of RLS. Gene scan studies in Iceland and the US have found a strong association between certain variations in the BTBD9 gene and the incidence of RLS (5,6). In addition, it has been determined that the BTBD9 gene regulates iron levels (and RLS has commonly linked to iron deficiency). RLS is also linked to a lack of dopamine; and individuals with the BTBD9 gene variation were also found positive for dopamine deficiency.

 

The symptoms of Restless Legs Syndrome fall on a spectrum from mild to severe, occasional to frequent, and with many people experiencing major disturbances to quality of life. Patients with RLS often have increased sleep latency, decreased sleep efficiency, and frequent awakenings (4). In addition, patients also report headaches, anxiety, social isolation, reduced libido and mild depression (4). As a result, people suffering from RLS and its symptoms also experience a mean productivity loss of 1 day/week, which results in increased financial burden (7). The symptoms can vary in quality, intensity, onset and duration. Like most conditions, people will respond differently to different treatment approaches. It is important for each individual to take action, and with the guidance of a qualified medical professional, discover the most effective treatment for them. The following are various therapeutic and lifestyle approaches that can be taken to help in ameliorating the symptoms of RLS (1,8):


Elevate and Exercise: Elevate your legs before bedtime. For more severe symptoms, it could take anywhere from one to four hours of elevation. One can add the following exercises to increase blood flow and muscle activity throughout the body (8):
Ankle pumps: Push the ankles down while curling the toes (1 sec), lift ankles up while fanning the toes (1 sec). Aim for 100 repetitions for every hour ankles are elevated.


Quad sets and Glute sets: Tighten the gluteus maximus and quadriceps for 5 second holds. Aim for 40-50 times for every hour elevated.
• After work, perform dynamic, cardiovascular exercise that involves large muscle groups such as walking, bicycling, swimming or running for approximately 30 minutes in the evening.

Massage your feet and legs every night (better yet, have someone else massage them if you can!). Perform circulation massage technique, always massaging upwards towards the heart (preventing fluid accumulation and irritation at your feet and lower legs).

Practice deep breathing: Stress has been known to aggravate RLS symptoms. Take 10 slow, controlled, deep breathes in and out.

Engage in brain exercise: Distraction has been found to ease RLS symptoms. Crossword puzzles, reading a book, or playing a board game can be effective ways to exercise and distract the mind.

Try Yoga: Because it combines exercise, deep breathing and relaxation, yoga combines three remedies known to reduce RLS symptoms. Sign-up for a class or try an at-home video to learn the proper postures and pace for you.

Turn off the TV before bedtime: Although sometimes relaxing, the visual stimulation before bedtime has been known to aggravate RLS symptoms.

Avoid alcohol and cigarettes: Although immediately relaxing, alcohol and cigarettes can have triggering effects of RLS, and can lead to overall poorer quality of sleep.

Review your medications: It is always a good idea to review with your doctor to ensure none of your medications or supplements are aggravating or causing your Restless Legs Syndrome.

Last revised: November, 18 2012
by Jennifer Werwie, DPT

References:
1) WebMD: Restless Legs Syndrome Center: http://www.webmd.com/brain/restless-legs-syndrome/restless-legs-syndrome-rls.
2) Michaud, et al. Arm Restlessness in Patient with Restless Legs Syndrome. (2000) Movement Disorders. Mar;15(2):289-93.
3) Restless Leg Foundation. Website: http://www.rls.org/.
4) Agarwal P, Vaish N. Restless Legs Syndrome: Clinical Manifestations. (2011) MedMerits. http://www.medmerits.com/index.php/article/restless_legs_syndrome/P2
5) Freeman, et al. Sleep Fragmentation and Motor Restlessness in a Drosophila Model of Restless Legs Syndrome. (2012) Current Biology. (22) 12:1142-1148.
6) Stefansson, H., David, B, et al. A Genetic Risk Factor for Periodic Limb Movements in Sleep. (2007) New England Journal of Medicine. 357:639-647.
7) Allen RP, et al. Prevalence and Disease Burden of Primary Restless Legs Syndrome: Results of the General Populations Survey in the United States. (2011) Movement Disorders. (26):114-120.
8) Linder, Bruce. “Restless Legs Syndrome and Physical Therapy.” AllThingsPT.com: http://allthingspt.com/contact-us/#contact-form-81.

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