Safe, Natural Strategies to Manage Restless Legs Syndrome
Are your legs constantly moving all the time while you're sitting down? Learn how to manage it properly with these strategies.
STORY AT-A-GLANCE
Restless legs syndrome (RLS) causes an irresistible urge to move your legs, with symptoms worsening at night. The sensations are described as crawling, pulling, aching, and throbbing
RLS is often linked to underlying conditions such as iron deficiency, kidney failure, peripheral neuropathy, spinal cord conditions, or Parkinson's disease
Nutritional approaches like increasing iron, magnesium with B6, and vitamin D intake help manage RLS symptoms without the side effects of pharmaceutical medications
Traditional herbal remedies like Dangguijakyak-san (DS) and Shihogyeji-tang (ST) also help treat RLS by balancing blood flow and dopamine activity
Exercise, stretching, acupuncture, and other holistic approaches like pneumatic compression devices and near-infrared light therapy effectively reduce RLS symptom severity and improve sleep quality
Do you regularly get the urge to move your legs whenever you’re sitting down or staying put in one place? Is your sleep being disrupted because you’re involuntarily moving your legs? If so, then you likely have restless legs syndrome (RLS).
What Is RLS?
The Mayo Clinic defines RLS as the urge to move your legs to ease discomfort. In conjunction with this, it’s common for you to experience:1
Uncomfortable sensations in your legs that begin while resting — This starts when you’ve stayed in bed or sat on a chair for an extended time.
Relief with movement — RLS symptoms lessen when you move your body. Examples include stretching, jiggling legs, pacing, or walking.
Twitching legs at night — RLS is typically linked to another, more common condition, periodic limb movement of sleep (PLMS). It causes your legs to kick during sleep throughout the night.
Patients with RLS note that the symptoms are compelling and unpleasant, and the urge to move affects both sides of the body. You’ll notice that the sensations develop within the legs rather than on the skin, and they’re often described as:
Crawling
Creeping
Pulling
Throbbing
Aching
Itching
Electric
Identifying the Signs and Symptoms of RLS
To arrive at an accurate diagnosis, your doctor will examine you based on the following criteria:2
You have the urge to move your legs, which occurs alongside uncomfortable sensations like aching or pulling.
Symptoms begin or worsen during periods of rest or inactivity.
You experience partial or total relief when stretching, walking, or exercising the affected muscles.
Your symptoms worsen at night.
Another medical condition didn’t cause your symptoms.
RLS is usually a symptom of an underlying disease — not a disease itself. If symptoms manifest, it is likely due to the following:3
Peripheral neuropathy — Nerve damage in your hands and feet is sometimes caused by chronic diseases such as diabetes. Alcohol abuse is also a factor.
Iron deficiency — Low iron levels have been known to cause or worsen RLS, as well as if you have a history of stomach or bowel bleeding.
Kidney failure — In relation to the example above, kidney failure often leads to iron deficiency. When your kidneys don't function well, iron levels in your blood decrease.
Spinal cord conditions — Injuries affecting the spinal cord have been linked to RLS.
Parkinson's disease — People diagnosed with this condition have an increased risk of developing RLS.
Exploring Medical and Herbal Remedies for RLS
The Cleveland Clinic estimates that around 7% to 10% of Americans have RLS, and oftentimes, the first line of treatment is neurotransmitter-altering medications, such as:4
Antiseizure medications (Gabapentin and pregabalin)
Dopamine agonists (Pramipexole and ropinirole)
Dopamine precursors (Levodopa)
Certain medications such as benzodiazepines (clonazepam) and even opioids (methadone and buprenorphine) are given to patients with severe symptoms. However, taking these drugs will cause severe side effects and even lifelong dependence.
On the other hand, “medical remedies” do not necessarily mean pharmaceuticals or complicated inpatient procedures.5 Sometimes, all you need to do is increase your intake of these nutrients:
Iron — Research shows that patients with RLS typically have low iron levels in the brain, and that increasing it helps alleviate symptoms via epigenetic regulation.6
If you decide to follow this route, find out what your iron levels are first — too much iron is linked to cognitive decline that ultimately contributes to Alzheimer's disease. You likely don’t even need to take a supplement at all.
Magnesium and vitamin B6 — A combination of magnesium and vitamin B6 helped reduce severity of RLS symptoms, as well as sleep quality according to a paper published in 2022.7
Vitamin D — A study showed that RLS patients are generally deficient in this nutrient, and that boosting intake will provide relief.8
Aside from these mentioned nutrients, traditional herbal medicines like Dangguijakyak-san (DS) and Shihogyeji-tang (ST) are effective at managing RLS. In a case study published in Medicine, researchers narrated the successful treatment of a 72-year-old woman who suffered from RLS for nearly 60 years.9
RLS disrupts sleep — At the time of the study, the patient was also recovering from a stroke. She experienced severe symptoms, which disrupted her sleep. The only way the symptoms subsided was by moving her legs.
The philosophy behind DS and ST — The patient was given DS and ST to address RLS and other underlying deficiencies defined by the principles of East Asian medicine, namely Xue deficiency (blood deficiency) and Qi stagnation.
Herbal remedies produce safe, positive results — After a week of starting the herbal remedy program, the patient experienced a reduction in symptoms. For the next 47 days, she consistently improved, and no medication was deemed necessary after stopping treatment. In a follow-up after six months, she reported that no symptoms ever returned.
Going deeper into DS and ST, these herbal combinations target the root cause of discomfort and restlessness in RLS by balancing your body’s blood and energy flow:10
The primary ingredient in both formulas — Both DS and ST contain Paeoniae Radix (Peony root). As noted by the research, this compound is rich in paeoniflorin, which activates the adenosine A1 receptor (A1R).
The role of A1R — A key player in brain metabolism, A1R helps stabilize neurotransmitter activity. This effect stabilizes dopamine imbalances — a known factor in RLS.
For context, dopamine is a neurotransmitter that helps regulate movement, and dysfunction is often linked to RLS. By enhancing dopamine activity, Paeoniae Radix helps reduce the urge to move your legs at night.
DS and ST are safe to use — According to the researchers, DS and ST did not produce side effects in the patient, highlighting them as a safe, sustainable way to manage RLS.
Exercise — Another Effective Natural Remedy for RLS
In a study published in Movement Disorders, researchers investigated the effects of different exercise programs on RLS.11 They selected 17 patients between the ages of 22 and 61 and split them into three groups — one was the control group, another did aerobic exercise, and the last did stretching.
The aerobics group underwent 40-minute sessions thrice weekly for a total of eight weeks. As for the stretching group, each session lasted 40 to 45 minutes for the same timeframe.
Exercise significantly helps with RLS — The researchers noted that aerobic exercise, particularly walking, significantly reduced the severity of symptoms by 21%. Moreover, patients reported improvements in their quality of life.
The study theorized that the increased beta-endorphin release, cerebral blood flow, and neuroplasticity contributed to changes. “As a result, exercise has the potential to provide multiple therapeutic benefits that are compatible with the complicated pathophysiology of RLS,” the researchers said.
Stretching improved RLS symptoms — While stretching is not at the same level as exercise when it comes to intensity, researchers noted that it still reduced the severity of symptoms by 18%.
Increased movement promotes better rest — Both exercise and stretching have been noted to help in key aspects of sleep, such as the time it takes to fall asleep and increased duration.
The evidence above reinforces my stance on walking as one of the best exercises you can do to improve your health. It’s accessible and virtually free for most people — just get up, get out, and go for a walk around your community. Not only will this help manage RLS, but evidence shows it reduces all-cause mortality as well.
Based on my interview with Dr. James O’Keefe, a cardiologist based in Kansas City, I recommend you strive for 10,000 number of steps per day (with a maximum of 12,000). He explains:
“Clearly, more is better. You get the big gains going from sedentary lifestyles — 2,000 to 3,000 steps a day — up to 7,000 or 8,000. [Here] you have this very steep reduction in mortality, improvement in survival. It continues to about 12,000 steps a day. Most of the studies show that it plateaus at 12,000.”
Consider These Holistic Alternatives to Manage RLS
In addition to exercise and stretching, a meta-analysis published in Cureus investigated other alternatives to manage RLS better:12
Acupuncture — An ancient healing method falling under Traditional Chinese Medicine (TCM), acupuncture involves inserting needles into specific points in your body, thereby promoting blood flow and balancing energy.
Reflexology — Applying pressure at specific points on the soles of your feet will promote circulation and relaxation.
Pneumatic compression devices (PCDs) — These gadgets apply pressure to your legs, which enhances blood flow while also reducing RLS symptoms. According to the researchers, this method is one of the most promising alternatives:
“PCDs represent a highly promising supplementary or alternative therapy for RLS since they are practical and appear to be successful in enhancing the intensity of RLS symptoms and all quality-of-life aspects.”
Yoga — The researchers noted that yoga is especially helpful for stabilizing mood and reducing sleeplessness, “making it a viable option for postmenopausal women with RLS.”
Near-infrared light therapy — Previously published literature cited by the study noted that light exposure helped relieve discomfort. The benefits even extended to four weeks after stopping treatment.
Progressive muscle relaxation (PMR) — One study cited in the meta-analysis noted that within six PMR sessions, severity of symptoms reduced by 38.89%. By the 12th session, that number climbed to 61.11%.
For those unfamiliar, PMR is a method that helps reduce muscle tension by consciously tensing up and relaxing certain muscle groups. To give PMR a try, here’s a relaxation sequence by the Centre for Clinical Interventions.
Frequently Asked Questions (FAQs) About Restless Legs Syndrome
Q: What is restless legs syndrome (RLS) and what are its symptoms?
A: RLS is a neurological condition characterized by an uncontrollable urge to move the legs, often accompanied by uncomfortable sensations like crawling, throbbing, or itching. Symptoms typically occur during periods of rest or inactivity, worsen in the evening, and are temporarily relieved by movement. Many with RLS also experience periodic limb movement of sleep (PLMS), leading to sleep disruption.
Q: How is RLS diagnosed?
A: Diagnosis is based on several criteria, including the presence of an urge to move the legs, onset or worsening of symptoms during rest, relief through movement, evening or nighttime occurrence, and the exclusion of other medical conditions. RLS often indicates underlying issues such as iron deficiency, peripheral neuropathy, or kidney problems.
Q: What are the treatments available for RLS?
A: Medications like dopamine agonists, antiseizure drugs, and opioids are commonly prescribed, but these are strongly discouraged because they carry risks of side effects and dependency. Safe, nutritional approaches include supplementation with iron, magnesium, vitamin B6, and vitamin D, all of which have shown promise in reducing RLS severity and improving sleep.
Q: Are there effective natural or herbal remedies for RLS?
A: Yes. Traditional East Asian herbal formulations like Dangguijakyak-san (DS) and Shihogyeji-tang (ST), which contain Paeoniae Radix, have shown effectiveness in alleviating RLS symptoms by balancing neurotransmitter activity and improving blood flow, without reported side effects. These remedies also offer a sustainable, long-term solution.
Q: What lifestyle and holistic alternatives are available to help manage RLS?
A: Exercise, particularly walking and stretching, has been shown to significantly reduce RLS symptoms and improve sleep quality. Other holistic therapies include acupuncture, reflexology, yoga, progressive muscle relaxation (PMR), pneumatic compression devices, and near-infrared light therapy. These alternatives improve circulation, reduce stress, and enhance sleep.
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