Restless legs syndrome: How to manage it? Can exercises help?

What is restless legs syndrome? What causes it and how does it manifest itself?
What should we know about it and how does it affect pregnancy?
Does it occur in children?

Do you know how to manage it and help yourself with it? Are there any exercises for it?

In recent years, restless legs syndrome has again been at the forefront of the public's interest, as well as that of neurological experts. It is a minor neurological disease or neurological syndrome, not a mere invention of an individual.

In the International Classification of Diseases, it is classified as a neurological disease, specifically extrapyramidal syndromes.

It affects up to 10% of the predominantly elderly population.

It affects women more often than men, due to physiological differences (menstruation, pregnancy and breastfeeding). Its incidence increases in direct proportion to age.

The first symptoms may not appear until around the age of 45, but they may be noticeable much earlier, for example around the age of 10. They are very non-specific and restless legs syndrome is not thought of at this time.

Caution:
Restless legs syndrome should be taken seriously, at least until the true cause is clarified.
The causes are thought to be multiple and have a common denominator: the central nervous system.
Especially in younger patients, it may be the first manifestation of a serious neurological disease!

A brief look into the past

Restless legs syndrome is not a modern phenomenon. Its manifestations were already well known to physicians in the 17th century. However, this particular syndrome was more or less considered a myth in the past.

Patients suffering from discomfort in the lower limbs and subsequent compulsive movements were considered to be 'madmen' or hypochondriacs. The cause was attributed to the psyche and instability of the wearer.

It was only later that the disease came to be given its due importance. The symptoms of restless legs were first described by Thomas Willison in 1672.

Later, in 1945, the Swedish neurologist Karl Axel Ekbom made a detailed report on the condition. He called the set of symptoms restless legs syndrome and this is the name still used today. In some literature you can also find the name Ekbom's disease.

In 1995, uniform criteria for this syndrome were established by the International Restless Legs Syndrome Research Group. Today, this still mysterious syndrome is the subject of neurological research. Yet its cause is not fully understood.

Interesting:
The first mention of restless legs syndrome probably occurred in 1580 in an essay by the famous French humanist Michel de Montigne. In his work, he describes a philosopher who was sober when he sat down to wine, except for his legs, which were the only ones that were drunk and had to be moved constantly.

What does it mean when your feet are restless?

Restless legs syndrome, RLS, also known as Willis-Ekbom disease, is a sensorimotor disorder of the central nervous system. It is therefore rightly classified as a neurological, not a psychiatric, disease.

It is characterised by a sensation of discomfort in the lower limbs. These sensations trigger a strong urge to move. The motor symptoms are more intense at rest and therefore most often occur at night. Restless legs syndrome is closely linked to insomnia, which it indirectly triggers.

Table of classification of RLS based on aetiology

Do you also have restless legs syndrome?

The patient's subjective feelings are at the forefront of restless legs syndrome. He experiences discomfort or a sensation of discomfort in the lower limbs.
This sensation is difficult to describe, even the localisation is imprecise. Some patients describe only an unspecified unpleasant sensation.

Patients' descriptions of discomfort ranked by frequency:

• tingling in the limbs
• tingling or tingling in the limbs
• soreness
• cramps, especially in the calves
• feeling of restlessness and nervousness
• internal tension
• a non-specific compulsive feeling
• feeling of being tied down
• sensation of knotting of the toes
• feeling of weakness in the limbs
• feeling of weight on the limbs
• itching
• tickling
• feeling of pressure or pulling
• jerky feeling
• feeling warm or cold
• feeling like they have electricity in their legs
• feeling like they have worms in their bones

Despite the sensory differences in the nature of this sensation, the common feature in all sufferers is the sensation of this discomfort deep down, as if in muscles, bones or blood vessels. It is never a surface sensation but a deep sensation.

These sensations cause the patient to start moving. This movement is also called focal akathisia.

The initiation of movement is volitionally controlled. In some few cases, several involuntary movements (tics, jerks) may occur if the patient has not spontaneously made the movement before.

This happens during periods of physical rest (lying down, sitting), i.e. most often during the night hours when patients are getting ready for a longed-for sleep after a hard day.
The intensity of the difficulty is highest between midnight and 4 a.m. With progression, it can become a problem lasting up to 24 hours a day.

It is a problem not only during sleep but also during the day in patients with sedentary jobs.

Various motor manifestations (walking, straightening, leg movements, uncoordinated movements, twisting) bring only temporary relief, and only for a short time before the movements last.

If the patient stops this activity, the discomfort usually returns. As the condition progresses, even these movements cease to provide relief.

Restless legs syndrome is very closely linked to sleep disturbance. The discomfort makes it significantly more difficult for the patient to fall asleep and also wakes them up from sleep during the night.

Prolonged insomnia brings with it other problems such as exhaustion, fatigue, apathy, impaired concentration, memory, reduced physical and mental activity and even depression. This significantly affects the normal functioning of the person and brings with it problems in everyday and personal life.

Important:
In some cases, we could also talk about restless legs syndrome. In more severe cases, the feeling of discomfort occurs not only in the legs but also in the upper limbs. However, this is an extremely rare example.

Table of criteria for restless legs syndrome

What causes these unpleasant feelings?

We do not know the exact cause of this disorder. It is thought to be a disorder of the central nervous system, specifically the dopaminergic system.

It is the dopaminergic system that is responsible for the activity of the muscles and the transmission of information and impulses within them.

It is probably to some extent on a genetic basis, as there is a very frequent occurrence of this syndrome in the family (up to 50-90%).

It has a role in the etiopathogenesis:

• deficiency of iron, magnesium and some vitamins
• certain drugs (antidepressants, antihistamines, antiemetics)
• toxic influence of some substances (alcohol, nicotine, caffeine)
• diabetes mellitus
• uraemia/uremic syndrome
• kidney disease/failure
• reduced thyroid function
• brain and spinal cord tumours
• neuropathy/polyneuropathy
• neurodegenerative diseases
• m. Parkinson
• extrapyramidal syndrome
• hereditary ataxia
• spinal cord disorders and lesions
• obesity (BMI, especially waist circumference)
• venous disease of the lower limbs - chronic venous insufficiency

The syndrome that exhausts: How do you deal with it?

Correct diagnosis is paramount. Often, patients with restless legs syndrome are diagnosed with another neurological or psychiatric disorder. This is mainly in the early stages of the disease when symptomatology is poor or non-specific.

The nature of the disease itself also has a negative impact on the correct diagnosis. Patients coming to the GP's office usually do not complain of "tingling" in their feet, but primarily of sleep problems or pain. This often confuses the doctor and directs him elsewhere.

The history itself is important in this case, as there is no laboratory marker that can be detected from the blood.

Once we have a clear diagnosis, it remains to determine whether the syndrome is primary or secondary.

Secondary RLS has its cause in another disease, such as neuropathy. In this case, treatment of the causative agent is paramount.

In primary LRS, treatment must be initiated, which takes two forms: medical and nonmedical.

Of the drugs, the most commonly used are dopaminergic agents (dopamine agonists, dopamine precursors), anticonvulsants (gabapentin, carbamazepine), benzodiazepines (diazepam, clonozepam), myorelaxants or opiates. The drugs of first choice vary according to the specific country.

Pharmacological treatment of RLS

Pharmacological treatment is initiated when the patient can no longer manage his or her condition by non-pharmacological means or when indicated by a physician. Most patients with restless legs syndrome describe the severity of their condition as moderate to severe in intensity, at which point medication is necessary.

What else can we do to get relief besides medication?

Non-pharmacological treatment includes the absence of substances that increase the activity of the sympathetic nervous system, such as alcohol, nicotine, caffeine.

If the abusive use of one of these substances is the primary cause of the disease, it is possible to manage the condition permanently without further therapy.

However, the withdrawal must also be permanent. Pharmacological support is often necessary at the beginning of treatment.

Changing certain medications that have been shown to worsen RLS or its symptoms is also essential. These include some medications for depression, psychosis and anti-emetics.

If the cause is a mineral or vitamin deficiency, on the other hand, regular supplementation of the missing substances is needed. Most often this is iron deficiency(sideropenic anaemia), which can be obtained from the diet but also in the form of nutritional supplements.

Hot baths will soothe your feet, body and soul

Some patients experience longer-lasting relief after a nice, hot bath. The bath should be taken just before bedtime. The hot water relaxes the muscles, dilates the blood vessels and circulates the blood, thus preparing the patient for a restful sleep. Alternating hot and cold showers is also recommended.

Various aromatic salts or oils added to the bath also revitalise the mind and completely relax and soothe. They have a positive effect not only on the discomfort in the legs but also on insomnia.

Applying dry heat to specific parts of the body has a similar effect. This is achieved, for example, by using an electric heating pad or a blanket on the lower limbs. The heat dilates the blood vessels, circulates the muscles and relaxes them.

Massages and exercises: they are pleasant and effective

Massages and various stretching exercises, which stimulate the muscles, have proved to be very beneficial. They are designed to relax (loosen) the muscles. Massage can be full-body, but you can also focus on targeted areas (thighs, calves, feet). They have a similar effect to a spa, but much more intense.

Meditation exercises can also be used, during which patients alternately tense and relax the muscles of the whole body, along with controlled breathing. The body is not only blooded, relaxed, but also oxygenated. After meditation exercises, patients feel as if they have been reborn and relaxed.

Incorporating these or at least one of these techniques into a regular schedule bears fruit.

Electrotherapy

Electrical stimulation of the nerve and muscle fibres in the lower limbs is also suitable. It is possible to make an appointment with a massage therapist or physiotherapist for such therapy. This is one of the most popular treatment methods not only for RLS but also for other neuromuscular diseases or painful conditions due to various causes.

There are also simple electrostimulation devices that can be purchased in e-shops, and are not that expensive. These are devices that consist of a main controller and several electrodes. These are glued to the incriminated part of the body that we want to stimulate. The device is then used to set the method and intensity of massage and electrical stimulation (the number of functions depends on the type of device and the patient's demand). Their use is simple, and most importantly, they can be practiced in the home environment.

The principle of electrical stimulation is to send the body's own impulses via diodes, i.e. the aforementioned electrodes.
The impulses pass through the skin and muscles to the nerve endings.
The patient may therefore feel a slight tingling or tensing and relaxation of the individual muscle parts. The treatment is not painful.
The effect is individual for each person. But it should be remembered that several of these massages must be carried out to achieve the desired success.

Table with methods of electrical stimulation

Restless legs syndrome and pregnancy

The connection between restless legs syndrome and pregnancy was already noticed by Karl Alex Ekbon.

Some cases of restless legs syndrome are closely linked to pregnancy, especially in the last trimester. In the third trimester, women are more tense, more stressed, suffer from sleep disturbances, are exhausted and even depressed.

It is not uncommon for restless legs syndrome to occur in pregnancy. Expectant mothers also very often suffer from iron and magnesium deficiencies, which are the likely causes of this condition. They also have lower haemoglobin, haematocrit and red blood cell counts.

The problems usually end after childbirth, when the patient and the levels of some substances return to normal.

Do you have restless legs syndrome and are expecting a baby?

If the condition is present before pregnancy, it is expected and highly likely that symptoms will intensify during pregnancy. After delivery, there is a 70% chance that symptoms will ease again, and for some, restless legs syndrome may even worsen.

The limited treatment options for pregnant women are also a problem. Although dopaminergic drugs have been approved for the treatment of pregnant patients, there is not much information about their effect on the fetus. Therefore, therapy in pregnancy should be considered by each mother individually, evaluating the pros and cons, of course in consultation with her attending physician.

The risk is also increased:

• Complications during pregnancy
• prenatal depression
• prolongation of the birth itself
• complications during childbirth
• the need for a section
• postnatal depression
• generalised anxiety disorder