Tuesday, July 12, 2011

The Case of the Jumping Legs: Restless Legs Syndrome

Do you have jumpy legs or legs that just need to move? Well, you may have a syndrome called restless legs (RLS). These are marked by a spontaneous movement of the legs. This usually only occurs at rest and are relieved by movement.  Sleep disturbance, such as sleep apneas, is commonly associated.  This is not the same as leg cramps.

Who has this?  This is a very common problem, as up to 15% of Americans have it. More women than men have it; the prevalence of RLS increases with age.  Sometimes it may occur in children and at times is misdiagnosed as growing pains.

What is the cause?  The cause is usually unknown; however, there appears to be a genetic link, in other words a family history. There is a hypothesis that the neurotransmitter called dopamine is associated with this disorder. In fact, this hypothesis is the basis of how we treat it with medicine. There is also an increased incidence of restless legs in patients with Parkinson’s disease.

RLS may also be associated with iron deficiency, chronic kidney disease, pregnancy, movement disorders, diabetes, varicose veins, and rheumatism. There is some association with low thyroid and obesity.

What are some of the symptoms?  Clinically, patients describe a sensation of crawling, creeping, pulling, itching, or stretching all deep in the leg rather than the skin. Pain is usually absent. Symptoms typically worsen at the end of the day and are maximal at night, usually within 15 minutes of getting into bed. In severe cases, symptoms may occur earlier in the day while the patient is seated. This makes sitting at a desk or meetings or in a movie theatre difficult. In milder cases, one  may be fidgety.

So, how do you diagnose RLS? Here are the criteria by the International Restless Leg Study Group: an urge to move when in bed or periods of inactivity( sometimes other body parts are involved as well such as the arms or even the entire body); the urge is partially or totally relieved by movement such as walking or stretching. Supportive criteria include family history or a positive response to RLS medication.

What is the treatment?  Some cases require the use of meds, but before that here are some these simple measures to try: stretching exercises of the posterior leg muscles before going to bed; use of iron replacement ( have your iron checked first); stop mental activating activities such as video games before going to bed; avoid caffeine; and lose weight. If these don’t work, there are some pretty successful medications your doctor can discuss with you.
Below is an example of stretching exercise to try:

Stand facing the wall, feet together, about two feet from the wall. Heels on the floor, lean forward to the wall, stretching the posterior leg muscles. Hold for 10-30 seconds. Repeat x5. Twice daily. 


Dr. Frank Marinkovich owns and operates Eastside Family Health Center in Kirkland, WA. Serving Kirkland and the Eastside, Seattle, Bellevue, Renton and the surrounding local communities. Specializing in Primary Care, Automobile Accidents and FAA physicals. Visit them online at Eastside Family Health Center or call them at (425) 899-2525.
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