By Rachael Freeland

Restless Legs Syndrome (RLS) is a common condition affecting approximately 10% of the population (www.helpguide.org, 2007). People experiencing this syndrome will often describe a tingly, prickly and/or painful sensation in their legs that creates an overwhelming need to move. Most often the sensations occur in the calf, however they can be felt anywhere in one or both legs (www.postgradmed.com, 2007). It is not uncommon for symptoms to be worse at night and during periods of rest. As a result, many people experiencing RLS have difficulty falling asleep, or are jolted awake by the periodic jerking (also known as Periodic Limb Movements in Sleep or PLMS) thus significantly disturbing their quality of sleep.

Generally, the cause of RLS is unknown. It doesn’t seem to be linked to genetics, increasing a person’s iron, folate and/or magnesium levels can help in some cases, sometimes the symptoms are experienced in conjunction with chronic illness (like kidney failure, rheumatoid arthritis, and diabetes) and symptoms can also be worsened by certain medications (some antidepressant and anticonvulsant medications, some cold and flu tablets etc). In some cases it is believed to be linked to anxiety and nervous tension (and the hyper-arousal this creates within the nervous system). So if a client presents with symptoms akin to RLS it’s important they’ve had a full medical check-up to explore other conditions and to find out what medication they may be taking.

Yoga Therapy Program:

Initially I would encourage a client to keep a “sleep diary” for the period leading up to their first appointment (or between the first and second). This way we can develop a curiosity about what is happening by tracking the client’s experiences and the practises that may help to alleviate the symptoms. The sorts of things I would encourage them record would be: The sensations they experience, and at what Times of day, what Relieves them, whether the symptoms worsen during rest or activity (and what kind of activity), whether the sensations interfere with Sleep in anyway (onset or returning to), what the daytime Consequences may be (fatigue, confusion, lack of attention etc), and lastly, making a note of any changes -whether they be to diet, lifestyle or sleep habits. (Refer Appendix A for sample)

Asana Recommendations
The asanas selected would target the major muscle groups of the legs, gently stretching and strengthening the muscles as well as increasing circulation.

- Calf stretches – in cat pose, alternately lengthening each leg back behind you, gently encouraging the heel to the floor to stretch out the calves.
- From a kneeling lunge position, gently lifting the back foot up and directing it back towards the buttocks. This stretches out the quadriceps muscles
- Then coming back into a cat position and rolling over the toes, gently coming into uttanasana (with the knees bent) to gently stretch out the hamstrings.
- From Uttanasana, bending the knees deeply and lower the tailbone back towards the floor to come into Malasana. This pose simultaneously stretches and strengthens the leg muscles.
- Finally, bring the hands to the floor and release into Child’s pose. A wonderful pose to calm both the body and the mind, whilst the weight of the upper body helps to stretch out the calves.

Pranayama Recommendations
Depending on the client’s level of sleep disruption, a gentle breathing practice like the 4:4:4:4 breath, or focussing on lengthening the exhalation may help ease any tension or frustration (about not being able to get to sleep or being woken up), bringing the mind and body to a greater sense of rest.

Other Advice:
o Creating good sleep habits by doing activities that encourage winding down at the end of the day (including relaxation, elevating the legs on a cushion, using heating pads on the legs, a warm bath), and then listening to those signs that the body is starting to fatigue. Staying awake beyond that, can, for many people trigger RLS once they do go to sleep.
o Ensuring adequate hydration can also help to alleviate RLS symptoms.
o Clients with RLS may be sensitive to soda, caffeine, cigarettes and alcohol, so avoiding these substances may be of benefit – particularly in the evenings.
o Likewise exploring any offending medications and the possibility of discontinuing these (depending on whether the benefits outweigh the negatives – as in the case of antidepressant or anticonvulsant medications).
o For clients with low iron levels or anaemia, increasing their iron intake can alleviate the condition.
o Likewise, for clients who experience high levels of nervous tension or have a highly active lifestyle (both of which lead to muscle fatigue) including a magnesium supplement can be of huge benefit.
o For some people a calcium supplement can be of benefit
o Making a referral for regular massage (acupressure or otherwise)

References:

http://parents.berkeley.edu/advice/health/restless.html. 06/06/2007

http://www.helpguide.org/life/restless_leg_syndrome_rls.htm. 06/06/2007

http://www.postgradmed.com/issues/1999/03_99/evidente.htm. 06/06/2007

www.rls.org 06/06/2007