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Restless Leg Syndrome

A few years ago a Trini, now turned German national came to us with a condition that we had never treated before. She had already spent loads to strip her veins with no real relief. Open, yet pessimistic, she gave us a try and to both our pleasures, she got great results. A few months ago this client was visiting Trinidad and on seeing her, she was able to give a positive progress report.

So what is it really? Restless Leg Syndrome (RLS) is a condition where pain is experienced mainly when sitting or lying on evenings sometimes, but more so at night. A person’s natural reaction would be to get up and walk around to exercise the area, and try to see if this helps, and it actually does.

Symptoms

It is an unpleasant sensation and typically occurs in the feet, calves, thighs, and in some instances the arms. At times, the symptoms don’t match the condition’s name; however, the desire is there to move the legs. The symptoms do disappear or fluctuate in intensity, and the sensations generally felt are as follows:

• Crawling
• Tingling
• Cramping
• Creeping
• Pulling
• Painful
• Electric
• Tense
• Uncomfortable
• Itchy
• Tugging
• Aching
• Burning

Causes

In many cases, no known cause for RLS exists. Researchers suspect that the condition may be due to an imbalance of the brain chemical dopamine. This chemical sends messages to control muscle movement.

Heredity Factor

RLS runs in families in up to 50% of the people affected, especially if the condition started at an early age. Researchers have identified sites on the chromosomes where genes for RLS may be present.

Pregnancy

Pregnancy or hormonal changes may temporarily worsen RLS signs and symptoms. Some women experience it for the first time during pregnancy, especially during their last trimester. However, for most of these women, signs and symptoms usually disappear quickly after delivery.

Related conditions

For the most part, restless legs syndrome isn’t related to a serious underlying medical problem. However, it sometimes accompanies other conditions, such as:

• Peripheral neuropathy. This damage to the nerves in your hands and feet is sometimes due to chronic diseases such as diabetes and alcoholism.

• Iron deficiency. Even without anemia, iron deficiency can cause or worsen RLS. If you have a history of bleeding from your stomach or bowels, experience heavy menstrual periods, or repeatedly donate blood, you may have iron deficiency.

• Kidney failure. If you have kidney failure, you may also have iron deficiency, often with anemia. When kidneys fail to function properly, iron stores in your blood can decrease. This, along with other changes in body chemistry, may cause or worsen RLS.

How is it diagnosed?

Four criteria must be met for the diagnosis of RLS in a person (adult or child):

• A strong urge to move your legs – This sometimes irresistible urge often, but not always, occurs with unpleasant feelings in your legs. When the disorder is severe, you also may have the urge to move your arms.

• Symptoms that start or get worse when you’re inactive – The urge to move increases when you’re sitting still or lying down and resting.

• Relief from movement – Your symptoms are partially or temporarily relieved by activity, such as walking or stretching, for as long as you keep moving.

• Worsening symptoms – It starts or get worse in the evening or at night.
Blood tests or muscle or nerve studies may be done to exclude other possible causes for your symptoms.

Other Conditions that Mimic Restless Leg Syndrome

There are many conditions which can mimic restless leg syndrome including:

• Parkinson’s disease
• Fibromyalgia
• Periodic leg/limb movement disorder
• Muscle diseases
• Joint conditions
• Nerve problems such as peripheral neuropathy
• Circulatory problems

In children, RLS is sometimes referred to as growing pains.

Treatment Options

Treatment is usually directed toward any underlying illness, if known. For example:

• Blood testing to reveal underlying iron deficiency anemia may reveal the underlying cause.
• If varicose veins are thought to be the cause, sometimes surgery to strip the veins is considered to repair the circulation. Like with most things, let surgery be a last option.
• Reduction or elimination of caffeine, nicotine, and alcohol from a person’s diet.
• Getting better sleep like with pregnant women who do not sleep well at night, and other persons with sleep disorders.
• Exercise, to assist with circulation.

Alternative Remedies

Other treatments that can be helpful for some persons are:

• Electrical nerve stimulation
• Physical therapy
• Acupuncture

Anxiety may trigger or increase RLS symptoms according to some medical specialists. However, there is no known cure for it, and in most people, any underlying cause should be ruled out by medical tests.

Lifestyle and Home Remedies

Making simple lifestyle changes can play an important role in alleviating symptoms. These steps may help reduce the extra activity in your legs:

• Taking pain relievers. For very mild symptoms, taking an over-the-counter pain reliever when symptoms begin may relieve the twitching and the sensations.

• Trying baths and massages. Soaking in a warm bath and massaging your legs can relax your muscles.

• Applying warm or cold packs. You may find that the use of heat or cold, or alternating use of the two lessens the sensations in your limbs.

• Trying relaxation techniques, such as meditation or yoga. Stress can aggravate RLS. So learn to relax, especially before going to bed at night.

• Establishing good sleep hygiene. Fatigue tends to worsen symptoms of RLS, so it’s important that you practise good sleep hygiene. Ideally, sleep hygiene involves having a cool, quiet and comfortable sleeping environment, going to bed at the same time, rising at the same time, and getting enough sleep to feel well rested. Some people with RLS find that going to bed later and rising later in the day helps in getting enough sleep.

• Exercising. Getting moderate, regular exercise may be beneficial, but overdoing it at the gym or working out too late in the day may intensify symptoms.

• Avoiding caffeine. It’s worth trying to avoid caffeine-containing products, including chocolate, coffee, tea and soft drinks for a few weeks to see if it helps.

• Cutting back/eliminating alcohol and tobacco. These substances also may aggravate or trigger symptoms. Test to see whether avoiding them helps.

• Staying mentally alert in the evening. Boredom and drowsiness before bedtime may worsen RLS. Mentally stimulating activities such as video games or crossword puzzles can help you stay alert and may even reduce symptoms.

Your feet mirror your general health . . . cherish them!

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