Restless Legs at Night: Why Your Legs Won’t Switch Off
You’ve finally sat down for the evening. Or perhaps you’ve climbed into bed, found the perfect position and are ready to sleep.
Then your legs decide they have other plans.
There’s an uncomfortable sensation deep inside them. Tingling, crawling, buzzing, pulling, aching, or simply an overwhelming feeling that you need to move.
You stretch. You rub your calves. You get up and walk around.
It settles.
You climb back into bed…
…and there it is again.
Welcome to the frustrating world of Restless Legs Syndrome (RLS).
What Is Restless Legs Syndrome?
Restless Legs Syndrome, also known as Willis-Ekbom disease, is a neurological condition that creates a strong urge to move the legs, usually accompanied by uncomfortable sensations.
The important word here is neurological.
Although you feel the symptoms in your legs, RLS isn’t simply caused by tight muscles.
Symptoms typically become worse when you’re resting, particularly while sitting or lying down, and are usually more noticeable during the evening or at night.
Movement often provides temporary relief.
People describe sensations such as crawling, fizzing, tingling, pulling, buzzing, throbbing or aching. Sometimes the description is much simpler:
“I just can’t keep my legs still.”
Four Clues That Suggest Restless Legs
RLS tends to have a recognisable pattern:
You have an urge to move your legs. This may be accompanied by strange or uncomfortable sensations.
It starts or becomes worse when you stop moving. Sitting watching television, travelling or lying in bed can trigger symptoms.
Movement makes it feel better. Walking, stretching, changing position or massaging the legs may temporarily reduce the sensations.
Evenings and nights are usually worse. You might feel relatively comfortable during the day, only for your legs to become increasingly restless as bedtime approaches.
Unfortunately, bedtime provides exactly what restless legs seem to dislike most: being still.
Are My Calves Just Tight?
Possibly, but that doesn’t necessarily explain the restless legs.
Someone experiencing RLS may understandably think:
“My calves feel uncomfortable, therefore my calf muscles must be tight.”
They stretch them, foam roll them, massage them or introduce them to a massage gun with enough horsepower to start a small lawnmower.
And their legs may genuinely feel better afterwards.
But muscular tension can sometimes be secondary to the constant movement rather than the original cause.
Repeatedly flexing the ankles, moving the legs, stretching or pacing around the bedroom can leave the muscles tired and tense.
Treating that muscular tension may improve comfort, but it doesn’t necessarily mean we’ve treated the underlying RLS.
What Causes Restless Legs?
In many people there isn’t one obvious cause.
RLS appears to involve how the nervous system regulates iron and dopamine within the brain, although the underlying biology is complex.
There can also be a genetic component, with RLS sometimes running in families.
Other recognised associations include pregnancy, kidney disease, certain medications and iron deficiency.
Iron is particularly interesting.
Someone can have insufficient iron stores without necessarily assuming they are iron deficient. If restless legs are frequent or disrupting sleep, it may be worth speaking to your GP about whether your iron status should be investigated.
Don’t simply start taking iron supplements because your legs have been performing Riverdance at 2am. Too much iron can be harmful.
Is It the Same as Night Cramps?
No, although the two are easily confused.
A night-time calf cramp usually involves a sudden and painful involuntary contraction. The muscle may become extremely hard and painful.
RLS tends to produce an urge to move, often accompanied by unusual sensations rather than one particular muscle suddenly going into spasm.
Other problems can also produce uncomfortable leg sensations, including nerve irritation, peripheral neuropathy, muscular problems and some circulatory conditions.
So not every twitchy, uncomfortable leg should automatically be labelled RLS.
Can Massage or Myotherapy Help?
This is where an important distinction needs to be made.
Myotherapy doesn’t cure Restless Legs Syndrome.
However, that doesn’t mean hands-on treatment can’t be useful.
Someone repeatedly moving, stretching and tensing their legs may develop considerable muscular tension through the calves, hamstrings, thighs and hips.
Soft-tissue treatment may help reduce this associated muscular tension and make the legs feel more comfortable.
Interestingly, NHS self-help advice for RLS includes walking, stretching and massaging the legs, along with using warmth such as a bath or heat pad.
So massage can certainly form part of managing the discomfort.
The important distinction is between helping the uncomfortable muscles and claiming to treat the neurological condition causing the restless sensation.
What Can You Try at Home?
A few simple changes are worth experimenting with.
Regular moderate exercise during the day can help, particularly if you spend long periods sitting. Gentle calf, hamstring and hip mobility during the evening may also make the legs feel more comfortable.
A warm bath or shower before bed can help some people settle.
Gentle self-massage may reduce muscular tension and temporarily relieve symptoms.
It’s also worth looking at caffeine and alcohol. Coffee, tea, cola and energy drinks can aggravate symptoms in some people, particularly later in the day.
And although it sounds rather unexciting, maintaining a reasonably consistent sleep routine may help too.
Bodies have an irritating habit of liking sensible and boring.
When Should You Speak to Your GP?
Occasional restless legs don’t necessarily mean you have Restless Legs Syndrome.
But speak to your GP if symptoms are:
happening regularly
getting progressively worse
repeatedly disturbing your sleep
significantly affecting your quality of life
not improving with sensible self-care
Your GP can consider possible underlying causes, review medications and decide whether blood tests, including assessment of your iron status, would be appropriate.
The Bottom Line
If your legs become uncomfortable primarily when you’re sitting or lying down, improve when you move and become particularly troublesome during the evening or at night, Restless Legs Syndrome is worth considering.
But don’t automatically assume it’s simply a pair of tight calves desperately needing to be stretched.
Sometimes the muscles are part of the story.
Sometimes the nervous system is writing most of the plot.
At Myotherapy Clinic in Horsham, my role is to assess the muscular and mechanical side of your symptoms, treat soft-tissue tension that may be contributing to your discomfort and recognise when symptoms don’t behave like an ordinary muscular problem.
Because good treatment isn’t simply about finding somewhere that hurts and pressing it.
It’s about understanding why it might hurt in the first place.
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