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  • Writer's pictureRobin R Varghese, PT.

"Restless Leg Syndrome". Have you been troubled not knowing where to seek help from? We can help!!!.

Restless Leg Syndrome(RLS)

  • RLS is considered as a common neurological sensorimotor disorder that manifests as an irresistible urge to move the body to relieve the uncomfortable sensations.

  • The RLS is an underdiagnosed condition, characterized by unpleasant sensations in the legs

  • RLS affects up to 10% of people annually, of both sexes, but is more common in women.

  • There’s a significant circadian rhythm of the RLS, as it commonly worsens at night.

  • RLS is most commonly related to iron deficiency, pregnancy and uremia.

  • Recent studies have suggested an important role of iron decrease of brain in RLS pathophysiology

Symptoms


  • Restless legs syndrome manifests as an overwhelming urge to move the body to relieve the uncomfortable sensations, primarily when resting, sitting, or sleeping.

  • The uncomfortable feelings are always described by the patients as “creeping, crawling tingling, tingling, pulling, or painful” deep inside the limbs, unilaterally or bilaterally occurring with the knees, the ankles or even the whole lower limbs

  • There will be worsening symptoms in the evening leading to disturbed sleep and short remission in the morning after waking up.

  • Difficulty with daily life including job and social activity.

Pathophysiology

  1. Brain iron deficiency occurs in restless leg syndrome (hypoxia and myelin loss model)

  2. Hyperdopaminergic states exist in restless leg syndrome

  3. There are well-defined genetic factors in restless leg syndrome

While the evidence for central iron deficiency is credible, the pathophysiology of the occurrence of this observation is not. We still do not understand how these states of iron deficiency and increased dopamine activity develop. Recently, genetic factors have been identified.

Restless leg syndrome is likely to be more complicated than what has been presented. It is likely to be an interplay of different pathways.


Associated features

1. Circadian rhythm

A study showed the increase in melatonin secretion to be the only changes preceding the sensory and motor symptoms in RLS patients, indicating melatonin might affect the symptoms by its inhibitory effect on dopamine secretion in central nervous system

Also, The intensity of RLS symptoms peaks on the falling phase of the core body temperature, another endogenous marker of circadian rhythm, while it decreases when core temperature increases.

2. Periodic Limb Movement Disorder or PLMS is the involuntary movements of the patient’s limb during awake or sleep which the patient is not aware of, different from the voluntary movement of the limb to relieve the discomfort in RLS patients. But it’s a very common phenomenon in RLS patients

Classification

General classification:

  • Primary RLS

It is considered to be idiopathic when the cause is truly unknown. Genetic factors may be involved.

  • Secondary RLS

They have an onset after 40 years old. Secondary RLS are those associated with a variety of neurological disorders, iron deficiency, pregnancy, or chronic renal failure. In the earliest studies of RLS, some revealed that 25% of RLS patients have iron deficiency condition. There are many other correlated factors too, like Diabetic peripheral neuropathy, migraine, painful neuropathiies, leprosy, Multiple Sclerosis, Guillain-Barre Syndrome, thyroid disease, etc.


Classification based on the onset.

  • Early-onset RLS refers to those who firstly have the symptoms before 45 years old.

  • Late-onset RLS patients have the symptoms from or after 45 years old. A higher familial history rate was found in early-onset RLS comparing to late-onset RLS.

Development risk factors include:

  • Iron deficiency

  • Chronic diseases such as kidney failure, diabetes, Parkinson’s

  • Pregnancy

  • Nerve disease

  • Obesity

  • Certain medications such as anti-nausea, anti-seizure

Treatment

  • There is no known cure for Restless Leg Syndrome.

  • Treatments are used to minimize the symptoms, which in time symptoms may even disappear.

  • There are both medical and physical therapy treatments which can be used minimize symptoms.

  • Another way to minimize restless leg syndrome symptom's is to make lifestyle changes.

  • These include having a regular exercise programme, regular sleep schedule, decreased consumption of caffeine, alcohol and tobacco, along with reducing the amount of stress influences in life.

A General Practitioner will be able to recommend and prescribe a suitable medication should it be needed. In addition, if an individual feels that iron or magnesium deficiency could be the cause of the RLS, a GP can conduct some blood work and prescribe any necessary supplements.

Sleep hygiene should be corrected.


Physical Therapy Management.

  • As mentioned, there is no specific cure for Restless Leg Syndrome, however, Physiotherapy can help control the condition, reduce symptoms and improve sleep through exercise programme that are well planned and can be performed every day.

  • The program will include elevating their legs for at least one hour at night time and they will be advised to do it as often as possible. They will be encouraged to isometrically contract the leg muscles when they are elevated to help move the blood out of the lower extremities and promote a healthy exchange of richly oxygenated blood with blood that has metabolic by products in it.

  • The patient experiencing symptoms of RLS is instructed to perform cardiovascular exercise on a daily basis for at least 30 minutes. Patients might walk, run, bike or use a machine such as an elliptical or rowing machine

  • A physiotherapist may recommend various strengthening and stretching exercises.

  • They may also recommend relaxation exercises or massage for restless leg syndrome

  • Relaxation techniques have been known to relieve restless leg syndrome symptoms.

  • Movement pattern re-education which typically involves neuromuscular re-education of movement, balance, coordination, posture and one’s own sitting and standing activities may be recommended.


At Valley Healing Hands, Brownsville, Texas, we provide the best physical therapy treatment for Restless Leg Syndrome (RLS). We have licensed healthcare providers who can evaluate and treat your condition at ease and with utmost care. Our patients are totally satisfied with the services we provide. You may learn about what they have to say about us here and get connected to us here. Our patients love us and you too will!!!


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