From ... in Health Psychology — Dec 5, 2024

Holistic Treatment Options for Restless Legs Syndrome

Restless Legs Syndrome (RLS), or Willis-Ekbom Disease, is a neurological disorder characterized by an irresistible urge to move your legs, often accompanied by unpleasant sensations such as tingling or burning. These symptoms typically appear during periods of rest or inactivity, often worsening at night and significantly disrupting sleep and diminishing quality of life.

With an estimated 7% to 10% of the U.S. population affected — and 3 million new cases each year — finding effective treatments for this lifelong condition is urgent. While medications such as dopamine agonists are often used for symptom management, their long-term use may worsen symptoms or cause side effects. Emerging research, including a recent review of 24 studies, offers promising evidence that holistic, non-pharmacological options may effectively alleviate RLS symptoms.

The study, published in Cureus, focused on non-pharmacological treatments for RLS, revealing the eficacy of various physiotherapeutic modalities. The comprehensive review, which included studies dating from 2006 to 2024, evaluated how different therapeutic interventions, such as exercise, yoga, stretching and refiexology, impact the severity of RLS symptoms. The review's key findings suggest that certain holistic therapies significantly reduce the frequency and intensity of RLS symptoms. The studies revealed that strength training, stretching exercises and yoga helped improve sleep quality and reduce discomfort. Additionally, therapies like refiexology — applying pressure to specific points on the feet to improve circulation and reduce muscle tension — and electrical stimulation were shown to enhance circulation and reduce muscle tension, both of which play a role in mitigating RLS symptoms. The review concluded that these noninvasive treatments could serve as valuable alternatives or complements to conventional pharmaceutical approaches, offering fewer side effects and long-term benefits. The researchers also emphasized the role of magnesium and vitamin D in managing RLS symptoms. Magnesium supports nerve and muscle function, while vitamin D plays a role in dopamine regulation. Individuals with low levels of these nutrients often experience more severe RLS symptoms. Incorporating these nutrients was found to improve overall symptoms and sleep quality.

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Regular physical activity, specifically strength training and stretching, were also effective in reducing the severity of RLS symptoms. Several studies within the review demonstrated that low-impact exercises like walking, swimming and yoga significantly reduced symptoms for individuals with idiopathic RLS (RLS with no clear cause). Yoga and progressive muscle relaxation (PMR) were particularly effective in alleviating muscle tension and improving sleep. The controlled stretching and mindful breathing involved in yoga help reduce both the physical discomfort and the anxiety that often accompany RLS. PMR, which involves systematically tensing and relaxing different muscle groups, was also found to be beneficial in managing restlessness and promoting relaxation. The review also examined the role of physiotherapeutic techniques, such as electrical stimulation and heat therapy, in managing RLS. Electrical stimulation improved blood fiow and reduced muscle tension, offering significant symptom relief without the side effects of medication.

The Cureus review also explored additional alternative therapies, such as acupuncture and refiexology, as potential treatments for RLS. Acupuncture, which involves inserting thin needles into specific points on your body, was shown to reduce symptoms by promoting blood fiow and balancing energy. Refiexology was also found to provide relief by improving circulation and promoting relaxation. One of the most promising findings from the review was the effectiveness of pneumatic compression devices (PCDs), which apply controlled pressure to your legs, enhancing blood fiow and reducing RLS symptoms. PCDs were particularly effective for individuals who experienced nighttime restlessness and dificulty falling asleep.

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The review suggested that this noninvasive therapy could be a valuable addition to an overall treatment plan, particularly for those who prefer to avoid medication. Beyond the physical therapies and nutritional approaches discussed in the review, lifestyle changes were identified as a critical component of long-term RLS management. Several studies emphasized the importance of avoiding triggers such as caffeine, alcohol and nicotine, which exacerbate RLS symptoms. Establishing a consistent sleep schedule and creating a relaxing bedtime routine were also shown to significantly improve sleep quality and reduce nighttime symptoms. For individuals experiencing severe nighttime symptoms, the review suggested additional strategies, such as using weighted blankets or elevating your legs during sleep, which were found to reduce restlessness and improve sleep duration. While these lifestyle adjustments may not completely eliminate symptoms, they complement other treatments and significantly enhance your quality of life.

Traditional herbal medicines, like Dangguijakyak-san and Shihogyeji-tang, are also emerging as effective RLS treatments. A recent case report detailed the successful treatment of a 72-year-old woman who had suffered from chronic RLS for nearly 60 years. The patient, who had also been recovering from a stroke, experienced severe RLS symptoms that disrupted her ability to sleep. During the night, she woke up multiple times due to discomfort in her calves and thighs, which only subsided with movement. After being diagnosed with chronic persistent RLS, traditional herbal treatments — Dangguijakyak-san (DS) and Shihogyeji-tang (ST) — were administered to address both her RLS and the underlying deficiencies identified through the principles of East Asian medicine, specifically Xue deficiency (blood deficiency) and Qi stagnation. The results were impressive. Within one week of starting the herbal regimen, the patient noticed a reduction in her RLS symptoms. Over the course of 47 days, her symptoms

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steadily improved, with no need for further medication after discontinuing treatment. Even six months after stopping the herbal remedies, she reported no recurrence of symptoms, demonstrating the lasting benefits of these herbal remedies.

Dangguijakyak-san (DS) and Shihogyeji-tang (ST) are traditional herbal remedies that have long been used in East Asian medicine to address conditions involving blood and energy deficiencies. In the case of RLS, these herbal combinations target the underlying causes of discomfort and restless sensations by balancing your body's blood and energy fiow. The primary ingredient in both formulas, Paeoniae Radix, has demonstrated several pharmacological benefits that align with the needs of RLS patients. Paeoniae Radix, a component rich in the active ingredient paeonifiorin, works by activating the adenosine A1 receptor (A1R), a key player in brain metabolism. The activation of this receptor helps stabilize neurotransmitter activity, which is especially beneficial in addressing dopamine imbalances, a known factor in RLS. Dopamine is a neurotransmitter that helps regulate movement, and its dysfunction is often implicated in RLS. By enhancing dopamine activity, Paeoniae Radix aids in reducing the uncontrollable urges to move your legs at night, thus relieving symptoms of RLS. Unlike pharmaceutical treatments, which lead to withdrawal symptoms or worsening of symptoms with long-term use, DS and ST did not produce such side effects in the patient. Instead, she continued to experience relief even after the herbs were discontinued, suggesting a more sustainable and possibly permanent solution to managing RLS symptoms.

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Another study, published in the journal Movement Disorders, focused on the effects of different exercise programs on RLS. It found that aerobic exercise such as walking , performed three times a week, significantly reduced symptom severity. Participants in the study followed a supervised aerobic exercise routine for eight weeks, which involved walking on a treadmill at increasing intensities based on their heart rate. The severity of RLS symptoms decreased by 21%, and participants also reported improvements in their quality of life. Aerobic exercise enhances blood fiow, releases endorphins and improves dopamine regulation, which are all key factors in managing RLS. Further, aerobic exercise improved sleep quality by reducing the time it takes to fall asleep and increasing overall sleep duration. In the same study, participants who engaged in a stretching exercise routine also experienced notable improvements in RLS symptoms. Stretching exercises, performed three times a week, reduced symptom severity by 18% and significantly improved quality of life. Stretching helps relax muscles, improve fiexibility and reduce the restlessness that often accompanies RLS, making it easier to fall asleep and stay asleep. The stretching routine in the study included exercises that targeted the major muscles and tendons in the legs. Each exercise session lasted about 45 minutes, with multiple repetitions of stretches aimed at relieving muscle tension. The study found that stretching exercises, while not as effective as aerobic exercises in reducing wakefulness after sleep onset, were more beneficial in reducing overall sleep disturbances, making them an excellent option for improving sleep quality without intensive physical activity. In addition to better sleep, exercise had a positive impact on participants' overall well- being. Quality of life, which had been diminished due to the constant discomfort and sleep disturbances of RLS, improved by 46% in the aerobic exercise group and by 63% in the stretching group. This improvement demonstrates that regular exercise, such as walking, has profound effects on both physical and mental health, offering a holistic approach to managing RLS.

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If you've been living with RLS, you know firsthand how disruptive it is to your sleep and overall well-being. The constant urge to move your legs, especially at night, robs you of the restorative rest your body needs, leaving you exhausted and frustrated. But emerging research offers hope. Rather than relying solely on pharmaceuticals that may worsen your symptoms over time, a holistic, noninvasive approach combining exercise, nutrition and traditional therapies offers lasting relief. By addressing the underlying imbalances that contribute to RLS, you take control of your symptoms, improve your sleep and ultimately enhance your quality of life. The power of these natural treatments lies in their ability to work with your body, not against it. Whether through gentle movement, nourishing your body with essential nutrients or embracing traditional herbal remedies, these holistic strategies offer sustainable solutions. You have options beyond conventional medications — options that treat the whole you, not just the symptoms. It's time to rethink how you manage RLS and embrace a more comprehensive, natural approach to healing. With the right balance of care, relief is within reach.

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