Restless legs syndrome (RLS) describes the condition where leg sensations cause an almost irresistible urge to move the lower limbs, usually right before sleep. According to the National Institutes of Health National Center for Sleep Disorder Research, RLS affects as many as 10 percent of Americans. For the projected millions of people struggling with restless legs, bodywork is one of the favored approaches to lessen this disruptive, potentially painful, sleep-depriving condition.
Typically characterized by creeping, crawling, burning, tingling or aching, a person living with this syndrome feels a need to move their legs to relieve these sensations. Considered a central nervous system disorder, RLS often interferes with resting or falling asleep. Partial or complete relief of the sensations occurs with leg motion, and the symptoms often return upon cessation of these movements. It is easy to see why many RLS sufferers fall into an unhealthful cycle of sleeplessness.
Although the symptoms can be different for each person affected, most people with RLS experience the following:
- Irritation – Leg sensations are often irritating, typically described along the scale from painful to uncomfortable. Although sensations are often in the calf area, some experience them in the upper leg, feet, arms or even the hands.
- Need to Move – People with RLS often have an overwhelming urge to move. Typically, getting up and moving around can relieve the discomfort.
- Position and Time Variables – The discomfort of RLS tends to increase when a person is in a sitting or lying down position. The intensity usually escalates in the evening or at night.
- Visible Movement – When a person with RLS sits or lies down, the movement or jerking of their feet or toes may be witnessed by others.
Although family history and high caffeine ingestion may cause RLS, the etiology is unknown in most cases. Restless legs syndrome can also be a secondary problem, brought on by other conditions. Examples include:
- Chronic Disease – An underlying medical problem, such as diabetes mellitus, kidney disease, Parkinson’s disease or rheumatoid arthritis could precipitate RLS.
- Pregnancy – Many women experience RLS in the last months of pregnancy. This may be related to an iron deficiency. Left untreated, the symptoms often go away after delivery.
- Iron Deficiency Anemia – A lack of iron in the blood may not allow a muscle to rest.
- Neurologic Lesions – People with spinal cord tumors, peripheral nerve lesions or spinal cord injury often report symptoms of RLS.
- Drug Side Effects – Medications including tricyclic antidepressants, anti-nausea and anti-seizure drugs, selective serotonin reuptake inhibitors (SSRIs), lithium, and some cold and allergy drugs may increase or trigger RLS symptoms. In addition, withdrawal from sedatives may trigger RLS.
Other conditions suspected of contributing to RLS include sleep apnea, narcolepsy, varicose veins, thyroid problems or problems with hand or feet nerves.
The medical community regards restless legs syndrome as a condition that can be managed, but not necessarily cured. In general, the therapeutic approach is dependent on improvement of the primary condition and the severity of the RLS.
For those with extreme pain and total sleep deprivation, medications are prescribed. The medications used for RLS are frequently “off-label” uses of the drugs, meaning they are not specifically intended for RLS, but have been found to help with symptoms. The following are the medications most prescribed for RLS and how they might impact bodywork:
- Benzodiazepines – These medications are depressants that artificially promote sleep. Unfortunately, the sensations of RLS are usually not suppressed with this class of drugs. Of concern to bodyworkers, hypotension (low blood pressure) is a typical side effect of benzodiazepines. Any client at increased risk of hypotension requires extra attention during a position change or when rising from a massage table.
- Dopaminergic Agents – Used to treat Parkinson’s disease, these drugs reduce motion by affecting the level of dopamine in the brain. Common examples include pramipexole (Mirapex), pergolide (Permax), ropinirole (Requip), and a combination of carbidopa and levodopa (Sinemet). Hypotension is also a typical side effect of dopaminergic agents. Again, any client at increased risk of hypotension requires extra attention during a position change or when rising from a massage table.
- Opioids – These narcotic drugs are used as painkillers to reduce severe RLS symptoms. Examples of these drugs include the combination of oxycodone and acetaminophen (Percocet, Roxicet) and the combination of hydrocodone and acetaminophen (Vicodin, Duocet). Because clients taking opiods are likely to have decreased pain sensation, bodyworkers must be extra careful with their depth and pressure.
If medications are not used, most healthcare providers advise one or more of the following approaches:
- Massage – Habitual leg massage has been reported to ease RLS.
- Hydrotherapy – Advising clients to take a warm bath often demonstrates favorable results. On the other hand, some people find relief with the application of cold packs.
- Moderate Exercise – While moderate exercise early in the day benefits leg circulation and therefore leg pain, strenuous exercise could potentially aggravate RLS.
- Avoid Alcohol, Caffeine and Nicotine – Refraining from these substances, especially in the evening, can help reduce RLS severity.
- Compression – Wrapping the legs in ace bandages, or wearing compression stockings or tight pantyhose can reduce RLS sensations.
Five Bodywork Tips for RLS
Massage therapy is one of the most well known approaches for helping RLS. While concentrating on bodywork for the lower half of the body is the general rule, below are five specific tips for the administering therapist:
- When treating RLS, it is always advisable to first seek the client’s physician’s approval.
- Releasing the piriformis muscle typically yields dramatic improvement in RLS symptoms.
- Some favored modalities for preventing the energetic accumulation common with RLS are myofascial release, trigger point therapy, deep tissue massage and sports massage techniques.
- Increasing circulation in the hamstrings can relieve uncomfortable sensations in the legs.
- Bodyworkers should be aware that in some cases, deep relaxation may aggravate RLS.
Although there is no surefire way to get rid of RLS, bodywork is one of the most effective ways to deliver relief and reinstate a healthy sleep schedule. Being familiar with the symptoms, possible causes and treatment options for this condition will help bodyworkers deliver topnotch care to the many suffering from restless legs syndrome.
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