Restless Legs Syndrome (RLS): Causes, Exercises, Remedies, Treatment

Article by Dr Raghuram Y.S. MD (Ay)
It’s our legs and foot which have carried us so far in the journey of our evolution.
Among many basic instincts and milestones, the infant growing into a child wants to explore the world by standing on his own legs. The little one falls and raises many time until it succeeds standing on its own legs and start moving around. Thus standing on our legs also shows our attitude towards our life. 

Leg and foot are classified into the Karmendriya category by Ayurveda. Karmendriya means the motor organs of utmost importance.
Since our legs are used repeatedly throughout the day, they definitely undergo a lot of stress and strain at the end of the day. That is why we feel better when someone squeezes our legs at the end of the day, while we sleep.
Legs need rest, pampering and good attention if we need to stay healthy and fit enough to carry on the day-to-day activities.

Restless Leg Syndrome, as the name indicates, is pathological and painful conditions which most of us encounter but are unaware of having it. In this discussion, we will try to learn about RLS and Ayurvedic ways of managing this disorder.

What is Restless Leg Syndrome?

It is a nervous disorder, caused due to the disorder of that part of the nervous system which causes an urge to move the legs. It is characterized by an irresistible urge to move one’s body to stop uncomfortable or odd sensations.

RLS usually interferes with sleep and sleep patterns. Insomnia or sleep disturbances are common symptoms of RLS. Therefore it is also considered as a sleep disorder. On the contrary the people having sleeplessness will have varying proportions of RLS.

RLS commonly affects the legs. It can also affect the arms, torso, head and even phantom limbs.
Moving the affected body part modulates the sensations, providing temporary relief

Home remedies, Lifestyle tips

Life style modifications are a must for recovery from RLS. Below mentioned are some of the easy methods which you can follow on a regular basis and get rid of RLS. The same measures are also preventive for RLS:

Move – Keep moving to get relieved from RLS. Easy to moderate exercise can help alleviate RLS. Take care of doing over-exercise. Excessive exercise with lots of sweating and hard muscle contractions can aggravate symptoms.

Morning weight training, walk, jogging or an evening post-dinner brisk walk at a moderate pace can help. If you are an exercise freak and want to work hard on your exercise, make sure to hydrate enough and de-stress yourself after exercise.

Reduce Caffeine consumption – Caffeine is found in coffee, tea, chocolate, energy drinks, sodas and sports supplements and some over-the counter medications. Cut these off from your diet as far as possible. Substitute decaffeinated varieties. Fruit juices and green vegetables are the best.

Avoid smoking – Nicotine in the cigarettes is dangerous for health, they worsen RLS symptoms.

Hydrate – RLS sometimes aggravates due to lack of water. Drink water liberally. Avoid diuretics in the form of caffeine, avoid alcohol.

Hot-cold contrast therapy – Couple of hours before going to bed, take 5 minute shower alternating 20 seconds of cold water followed by 10 seconds of warm water. After that, stand below the shower of warm water for couple of minutes to finish with so as relaxing your nervous system. This increases cardiovascular blood flow, which in turn helps in relieving RLS symptoms.

Beat Stress – Reduce stress by doing breathing techniques, meditation, Yoga, retiring from late night works, keeping home and office affairs distinct from each other etc.

Increase electrolytes – depletion of minerals like calcium, sodium, magnesium, potassium etc crucial for muscle function and relaxation will lead to cramping of muscles and RLS. Try to compensate them. Replace natural electrolytes and minerals such by using trace liquid minerals, Himalayan sea salts, organic fruits and vegetables (grown in organic, mineral rich soil)

Transdermal Magnesium – Use a topical magnesium lotion or do magnesium salts soak. Magnesium can be absorbed through skin. It helps to displace calcium ions that are causing muscle cramping and restlessness in RLS.

Stretch – tight muscles and fascia (connective tissue surrounding group of muscles) cause cramping and RLS. Practice light morning stretch routine, get into Yoga sessions to stretch the muscles and before bed at night stretch your feet and calves by putting your feet against the wall and leaning them with your ankles bent so that your toes are pointing up. Do with one leg at a time for better stretch effect and result.

Compression socks – They are easily available at local medical supplies. Get and wear them before bed.

Try Alternative Therapies – Acupuncture, deep tissue massage (that targets the lower body, hips and legs), foam roller etc will work

Healthy diet – Eat a balanced healthy diet of fruits, vegetables and lean proteins. Limit alcohol and caffeine especially at bedtime. Avoid any foods that you know that might keep you awake at night.

Ice – Ice packs and cold showers work wonders in some people

Chamomile tea – Chamomile tea induces sleep and wards off sleeplessness, thus relieves RLS

Create a regular sleep schedule – Sleep disturbances are common complaints of RLS, Sleeplessness also can trigger RLS and its symptoms. Quality and quantity of sleep is a must to get rid of RLS.

Sleep hygiene – RLS disturbs your sleep, so it becomes important that you keep all issues that hinder your sleep away from self. Go to bed at the same time every night to promote sleep. Having a bedtime routine helps you fall asleep. Maintain a sleep journal to figure out what works and what not in providing you a good sleep.
Read related: 20 Simple Ayurveda Sleep Tips On How To Sleep Better

Sleep in a soapy bed – Many people report that putting a bar of soap under their bottom sheet chases away RLS and night time leg cramps. There is no scientific evidence in its proof.

Sleep late – RLS makes it hard to sleep. To get the deep sleep you need, try going to bed a little later and sleeping later in the morning. Those morning hours may be some of your best rest.

Supplements – Studies have shown that RLS symptoms improve when vitamin D supplements are given. RLS has also been associated with low levels of iron or vitamins C and E. they can be supplemented for relief from RLS.

Each day, take 500mg of magnesium, 800-1000 mg of calcium and 800-1000 mg potassium. Shortage of any of these can make your legs twitchy. Drink mineral water rich in magnesium. Bump up your intake of folic acid, a B vitamin (called folate).

Folic acid helps build red blood cells, which in turn helps oxygenate the body. That is an important benefit since RLS is associated with a decrease in oxygen. Food sources of folic acid include leafy green vegetables, orange juice and beans. You’ll also find folate in most multi-vitamins. Eat iron-rich foods such as dark green vegetables, liver, wheat germ, kidney beans, lean beef etc.

Sex – Many people of RLS report that they started feeling better after having sex. Sex can be tried to get relieved from RLS though the inter-relationship could not be established. The relaxation that follows an intimate encounter could be the possible explanation.

Keep mentally busy – Any activity that stimulates the brain can help control RLS and relieve the symptoms. Try playing Sudoku, crossword puzzles, read and write something creative or whatever you love, stimulating conversation etc are shown to be beneficial in RLS

Check your medicines – Check about the medications you are taking with your doctor. Sometimes medications that you take for other conditions can make it difficult for your muscles to relax or can cause insomnia. Make sure to review the medications you are taking with your doctor to see if any of these are contributing to your RLS.

Reduce pain – Symptoms of RLS can range from irritating to very painful. Try alternating hot and cold compresses on your legs to reduce pain. Hot water bath or massage of limbs will also help.

Breathe deeply – Stress makes RLS symptoms worse. Release the tension by taking slow, deep breaths. It also helps to dim the lights and listen to soothing music before you go to bed.

Turn off the TV before bed – Watching television or using computer just before bed can make it harder to fall asleep. Sleep experts say you should make the bedroom a TV – and computer-free zone.

Breaks at office – If you are working for long hours, take intermittent breaks, a 5 minute break every hour will help. When you are on a conference call or watching TV, use that time to give your legs a gentle massage.

Breaks during drive: If you are on long road trips or if your job demands driving for most part of the day, take intermittent breaks, stop for a while, get down, walk around and proceed.

Exercises for RLS

Walking – It is simple to walk. If you are walking, continue, if not, start doing it. It might be a simple exercise but is highly effective for those suffering from or those prone to RLS. It enhances blood supply, works your calf and thigh muscles and improves overall health. It improves oxygenation of the body and provides good sleep.

Stretching – This helps to ease tight muscles and helps increase flexibility. Stretching should be done at night, before bedtime. This relaxes the body and mind. You can try doing the following stretches:

Toe-pull Calf stretch – Sit on the floor with your legs extended out in front of you. Reach forward with both hands and grasp your toes, pulling gently until you feel the stretch in your calves. Hold for 10 to 15 seconds and relax. Repeat several times.
Wall stretch: Stand a few inches from a wall, prop one toe against the wall and lean forward, placing your hands against the wall for balance. Hold for 10-15 seconds and repeat with your other foot.

Seated inner thigh stretch: Sit on the floor. Bring the soles of your feet together in front of you. Hold your feet and press your knees gently towards the floor. Don’t worry if they don’t touch the floor. You just want to feel the stretch in your inner thighs. Hold for 10-15 seconds and release.

Lying Hamstring Stretch – Lie flat on your back with one leg extended above you and your toes pointed. Lace your fingers behind your knee and pull gently until you feel the stretch along the back of your thigh. Hold for 10-15 seconds and release. Repeat with your other foot.
Stretch – When you get the urge to move your legs, start rubbing them or stretch them to their full length and point your toes. These intentional movements send signals to your brain that can override the strange tingling sensations of RLS. Stop if the stretching produces leg cramps.

Those are strong indications of magnesium deficiency and can’t be alleviated by stretching. Sit on the edge of the bed and firmly massage your calves to give the muscles deeper stimulation. If those treatments don’t calm your legs, get up and go for a brief walk around your home. Take long steps and bend your legs to stretch the muscles.

Progressive muscle relaxation – It is a calming ritual which you have to practice after you go to the bed. Breathe deeply for a few minutes. Then tense the muscles in your feet. Hold the tension for a few seconds, then relax. Next, tense your calf muscles, hold, and relax. Then do the same with your thigh muscles. Repeat the tensing and relaxing pattern, working all the way up your body to your neck and face muscles. When you are finished, your whole body should feel relaxed.

Yoga for RLS

Don’t Miss This
Yoga – It is much more beyond exercise. It is a holistic approach towards effective body-mind healing. It is part work-out, part-stress reliever. Try Yoga after getting guidance from your Yoga instructor. The below mentioned Yoga postures when practiced regularly works wonder in relieving RLS.

Uttanasana (Forward fold Yoga Pose) –

Paschimottanasana (Deep Forward Fold) –

Janu Sirsasana (Head to knee pose) –

Setu Bandhanasana (Bridge pose) –

Balasana (Child pose) –

Shavasana (Corpse pose) –

Pranayama for RLS

Pranayama (Deep Breathing) –
This is essentially a breathing exercise which moves the breath in unique ways allowing for different effects on the nervous system. At night, practicing calm breathing, even breathing in a 1:1 ratio and then eventually building up to 1:2 allowing the exhale to lengthen more than the inhale. You can also try inhaling while blocking one nostril and alternating nostrils with each breathe, which can help calm the nervous system.

Modern perspective

Restless Legs Syndrome, Disease review, Modern perspective –

Causes

Causes of RLS –
Causes of RLS is not known in most cases
Genes are said to have a role in causation of RLS
Nearly half of people with RLS will have a family member with the condition

Other factors associated with onset, development or exacerbation of RLS include –
Most common associated medical condition is iron deficiency (20% of all cases of RLS).
A study published in 2007 – RLS features were seen in 34% patients having iron deficiency as against 6% of controls. Conversely 75% of individuals with RLS symptoms may have increased iron stores.

Other associated conditions –
Varicose veins or venous reflex
Folate deficiency
Magnesium deficiency
Fibromyalgia
Sleep apnoea
Uraemia
Diabetes mellitus
Thyroid disease
Peripheral neuropathy
Parkinson’s disease
POTS
Sjogren’s syndrome
Celiac disease
Rheumatoid arthritis
Attention Deficit Hyperactivity Disorder (ADHD)

The above mentioned chronic conditions often include symptoms of Restless legs syndrome. In these conditions RLS will be secondary to the main disease. Effective treatment of the primary disease or diseases will take care of RLS.

Treatment

Medications – Some medicines are seen to cause, worsen or trigger RLS and its symptoms.
Medications which cause or worsen RLS are –
Antiemetics
Antihistamines
Antidepressants
Antipsychotics
Anticonvulsants
Benzodiazepine withdrawal (sedative-hypnotic drugs)
Hypoglycaemia also worsens RLS symptoms
Opioid withdrawal

Surgery – Surgery of any kind, back surgery or injury can be associated with causing RLS
Association of RLS with excessive body weight, lack of exercise, depression or other mental illnesses are documented but not established

Pregnancy – Some women experience RLS during pregnancy, especially in the last trimester. RLS and its symptoms will usually go away within a month or so after the delivery of the child.

Alcohol – it may trigger symptoms of RLS or make the condition worse. Withdrawing alcohol usage may relieve symptoms of RLS.

Sleep deprivation – it also triggers symptoms of RLS. Improving quality and quantity of sleep will take care of RLS and its symptoms.

Genetics –
More than 60% RLS are familial, they are inherited in an autosomal dominant fashion
Research works backed by brain autopsies have shown both dopaminergic system and iron insufficiency in the substantia nigra. Iron insufficiency is an essential co-factor for the formation of L-dopa, the precursor of dopamine.
3 genes, MEISI, BTBD9 and MAP2K5 were found to be associated to RLS. Their role in RLS pathogenesis is still unclear. Most recently a 4th gene PTPRD was found to be associated to RLS.
The presence of a positive family history suggests that there may be a genetic involvement in the aetiology of RLS.

Mechanism

Most research links are oriented towards the involvement of dopamine and iron system. The hypotheses are based on the observation that iron and levodopa (pro-drug of dopamine) can be used to treat RLS and also on findings from functional brain imaging (PET, functional MRI), autopsy and animal experiments. A connection between dopamine and iron related markers are demonstrated by the finding of low iron levels in the substantia nigra of RLS patients.

Symptoms

Uncomfortable sensations in the legs (sometimes arms or other parts of the body also), ‘itchy’, ‘pins and needles’ or ‘creepy crawly’ feelings are felt in the legs
These sensations are usually worse at rest, especially in lying or sitting positions
Irresistible urge to move legs to get relieved from these uncomfortable sensations. This happens due to uncomfortable sensations that occur primarily in the legs (can occur elsewhere also).
Severity of symptoms ranges from mild to intolerable
Symptoms are not constant, there may be days in which the person has not felt these weird sensations, they come and go on a regular basis, regular enough for the patient to remember, regular enough to cause discomfort and sleeplessness in the patient
The symptoms are usually worse in the evening and night times. Patient usually does not suffer during day times.
In some people, the symptoms may cause severe night sleep disruption that can significantly impair their quality of life.

Different sensations in RLS (as explained by the patient) –
Most often it is difficult for the patient to name or explain the nature of sensation they are feeling.
They describe it as –
Discomfort in the legs
Pain
Aching in the muscles
An itch you can’t scratch
Antsy
Electrical
Creeping
Pins and needles
Pulling
Crawling
Numbness
Limb ‘falling asleep’
Buzzing sensation
Unpleasant ‘tickle’ that won’t stop
Crawling feeling (something is crawling over the body or limbs)
Limbs jerking while awake etc

The awkward sensations either begin or intensify while relaxing or reading or studying or trying to sleep.
Most individuals with RLS have ‘periodic limb movement disorder’ i.e. limbs jerking while at sleep. This is associated with sleep disruption.

Relieving factors – Movement usually brings immediate relief. The relief many times may be temporary and partial. The common movements bringing relief in RLS are –
Walking
Stretching
Biking
Yoga
Running
Continuous fast up-and-down movements of the leg
Rapidly moving the legs toward then away from each other etc
Worsening of symptoms take place by –
Relaxation
Sitting or lying down (reading, plane ride, watching TV) etc

Some experience RLS only at bedtime, while others experience it throughout the day and night. Most people experience the worst symptoms in the evening and the least in the morning.
Individuals with RLS have higher rates of depression and anxiety

Classification

RLS can be categorized as –
Primary RLS (idiopathic) – This type will have no known cause. It usually begins slowly before approximately 40-45 years of age. It may later disappear for months or even years. It is often progressive and gets worse with age. In children RLS is often misdiagnosed as growing pains.

Secondary RLS – It often has a sudden onset after 40 years of age. It may occur daily from the beginning. It is most associated with specific medical conditions or the use of certain drugs.

Diagnosis

Diagnosis –
There are actually no medical tests to diagnose RLS
Blood tests and other tests may be advised to rule out other conditions which resemble RLS
The diagnosis most of the time is based on patient’s case history. The signs and symptoms will help in diagnosis. The history related to patient’s family history, medication use, the presence of other symptoms or medical conditions, or problems with daytime sleepiness will also help in diagnosis.

Diagnostic Criteria –
According to National Institutes of Health’s National Institute of Neurological Disorders and Stroke, the below mentioned 4 symptoms confirm the diagnosis of RLS –
The symptoms are more severe at night and do not occur, or are negligible in the morning (although in extreme cases, symptoms may occur in the day time)
An irresistible urge to move the legs and or arms, often associated with an sensation of pain, burning, pricking, tingling, numbness or other unpleasant or unusual sensations
The sensations begin following relaxation or a period of staying still and during sleep
Temporary relief from these sensations during movement of the affected legs and or arms

NIH criteria of diagnosis –
In 2003, a US National Institutes of Health (NIH) panel modified their criteria to include the following:
An urge to move the limbs with or without sensations
Improvement with activity, Many patients find relief when moving and the relief continues while they are moving. In more severe RLS this relief of symptoms may not be complete or the symptoms may reappear when the movement ceases.

Worsening at rest – Patients may describe being the most affected when sitting for a long period of time, such as when travelling in a car or airplane, attending a meeting or watching a performance. An increased level of mental awareness may help reduce these symptoms.

Worsening in the evening or night – Patients with mild or moderate RLS show clear circadian rhythm to their symptoms, with an increase in sensory symptoms and restlessness in the evening and into the night

Ayurveda concept and management

Restless Legs Syndrome (RLS) cannot be compared to any disease explained in Ayurvedic texts in its real sense. But we can try to compare RLS to a few conditions due to their close resemblance. In this section let me try to do that part of work of bringing close-in comparisons of conditions explained in Ayurveda wrt RLS.

RLS – A Vata Vyadhi,
RLS, as we have seen is categorized under neurological disorders. We generally discuss neurological and degenerative diseases under the topic of Vata Vyadhi. Thus it is not wrong to consider RLS as a Vata Vyadhi. Vata Vyadhi means an extraordinary disease or symptom complex or syndrome which manifests due to vitiation of Vata.

Most of the symptoms like pain, numbness, feel of pins and needles, urge to move, weakness etc as explained in RLS are available in most of the Vata Vyadhi’s. We can find the involvement of Pitta and or Kapha in the later context of the disease process, but primarily this condition is manifested due to morbid Vata.

Vaa gati gandhanayoho vaataha (Ref – Madhava Nidana)
‘That which carries out the Gati (motor activities) and Gandhana (sensory activities) uninterruptedly in the body is called Vata’

RLS is all about awkward and weird sensations and feel which get better with movements or calls for some movements. Sensation is a sensory thing (Gandhana) and movement is a motor thing (Gati) which comes in response to a sensory thing.

In RLS some sensory change and a responsive motor change is taking place constantly. This is due to unpredictability of Vata behaviour. According to Ayurveda both the sensory and motor skills are managed and governed by Vata, a balanced and healthy one. But the same Vata when imbalanced can cause disturbances related to both ‘sensations’ and ‘motor responses’ to the same.

Mechanism – Vata, owing to its properties like dryness, roughness, intense, deep piercing, coldness, mobility etc will cause excessive dryness of the protective layers of the nerves which are basically made up of Kapha elements (watery elements) like meda (fat tissue). This loss of insulation and protection will disturb the anatomy and physiology of nerves and nerve conduction.

When this happens at a more aggressive pace, severe neurological diseases are manifested. But on the other hand if the damage is slow and in a less proportion diseases like RLS are manifested. When the nerves of the lower limb are disturbed by Vata the symptoms are predominantly seen in the legs (typical or classical RLS), but the same mechanism can happen anywhere in the body.

Causes

Causes – All the causative factors which cause or aggravate Vata are the causes of RLS.
The causes are as enlisted below:
Vyayama – Excessive exercises
Vyavaya – Excessive indulgence in sexual activities
Apatarpana – Fasting in excess
Prapatana – Fall, injury
Bhanga – Fractures
Kshaya – Depletion of tissues
Jaagarat – Excessive vigil (awakening all night)
Veganam cha vidharanat – Suppression of natural body urges (reflexes)
Ati shuchi – Excessive administration of cleansing procedures (Panchakarma)
Shaityadi – Excessive consumption of cold foods and activities
Traasaat – Fear
Ruksha – Excessive consumption of dry foods
Kshobha – Irritation
Kashaya – Excessive consumption of astringent foods
Tikta – Excessive consumption of bitter foods
Katu – Excessive consumption of pungent foods
Vari-ghanagame – cloudy and rainy season
Parinate anne – After the digestion of food
Aparahne – Evening
Vega dharana and Udeerana – Vata also gets increased due to avoiding the natural urges (vega) created in the body such as reflexes for hunger, thirst, sleep, voiding urine and stools, sneeze etc. Similarly, Vata gets vitiated when these reflexes are forcibly created when they are not naturally impending. This leads to a condition called Udavarta in which the Vata moves in a haphazard way in the body disturbing all the other governing factors and produces various psychosomatic illnesses.

Thus one should not make a habit of forcibly withholding the natural body urges and reflexes and also not to force them out of the body. This when holistically practised, will keep Vata in control and prevent many diseases from manifesting. This is true with any Vata disorder including RLS.

Pain, numbness, feeling of needles and pins, feel of awkward sensations etc symptoms are directly proportional to the quantity of disturbance of Vata in the body. Pain cannot be produced without the involvement of Vata. Thus Vata alleviating medicines and treatments are mandatory for combating Vata Vyadhi, RLS in this case.

Thus effective treatments and medications mentioned for combating vitiated Vata can also be incorporated for treating Restless Legs Syndrome.

Sarvanga Vata

This is one pathological manifestation of vitiated Vata in which the whole body is afflicted by the mischievous activities of morbid Vata. (Sarvanga=full body).

Sarvanga kupite vaate gaatra sphurana bhanjane
Vedanaabhihi pareetascha sphutanti iva asya sandhayaha (Ref – Charaka Chikitsa 28/25)
The symptoms of Sarvanga Vata (Vata vitiated in the whole body) are – Gatra sphurana (tremors all over the body), bhanjanam (crushing pain), severe splitting or blasting type of pain all over the body, especially in the joints.

This condition though is different from RLS in its outer look and presentation, we can see that RLS would manifest in other parts of the body like upper limb etc other than in lower limbs.

If we consider this condition as Vata vitiation in many places at a time, it would resemble Sarvanga Vata which means Vata vitiatied in the whole body. Thus RLS can also be treated on the lines of Sarvanga Vata.

Twak Gata Vata

Gatavata is a condition wherein the vitiated Vata gets lodged in some tissue and disturbs the qualitative and quantitative integrity of that particular dhatu (tissue) or organ leading to either depletion or destruction (partial or whole) of the target tissue / organ.

Twak rookshaa sphutitaa suptaa krushaa krushnaa cha tudhyate
Aatanyate saraagaa cha parva ruk twak sthite anile (Ref – Charaka Chikitsa 28/30)
When the vitiated Vata gets located in the Twak (skin) it produces the following symptoms –
Ruksha – dryness of the skin
Sphutita – cracks and fissures in the skin
Suptaa – Numbness or lack of sensation
Krushaa – emaciation
Krushna – blackish discolouration
Toda – pricking sensation (pins and needles)
Aatanyate – feeling of bulge below the skin
Saraagaa – reddish discolouration
Parva ruk – pain in the inter-phalangeal joints (small joints of the hands and foot)
This condition clearly resembles RLS. RLS thus can be treated on the lines of Twak Gata Vata.

Gridhrasi

RLS resembles Gridhrasi (Sciatic pain) –
Sciatica is the nerve pain which occurs in the lower limb due to the irritation of sciatic nerve, the largest nerve in the body. The pain is typically felt along the course of the irritated nerve. The pain starts from the lower back and travels down the back of thigh, knee and legs to the foot.

Gridhrasi is a condition explained in Ayurveda which is often compared to Sciatica due to the close resemblance of their signs and symptoms.

Though Sciatica and RLS are totally different neurological conditions they can be treated on similar lines according to Ayurveda principles. Because, the site of manifestation of symptoms is lower limb in both cases and the causative dosha is also Vata.

Thus Gridhrasi in its earliest and most feeble form of manifestation wherein pain is not too evident but other symptoms like weakness, numbness and weird sensations are available can be considered as RLS. Even in clinical experience I have seen the medicines prescribed and advised for Sciatica would work dramatically in relieving the symptoms of RLS.

Brief introduction of Gridhrasi –
Sphik poorvaa kati prushta uru jaany jangaa paadam kramaat
Grudhrasee stambha ruk todaihi gruhnaati spandate muhuhu
Vaataat vaata kaphaat tandraa gaurava arochakaanvitaa (Ref – Charaka Chikitsa Stanam, 28/55,56)
Explaining the nature of the disease Gridhrasi, Charaka tells that – ‘The disease in which the pain starts from the buttocks and travels along the back of pelvic and hip areas, thigh, knee, legs and ends at the foot is called Gridhrasi’. This Gridhrasi is of 2 types.

Vataja Gridhrasi – This type of Gridhrasi is manifested due to the vitiation of only Vata. Along with the pain in the above said regions of the lower limb, Vataja Gridhrasi also presents with gripping and pricking pain and intermittent (regular) twitching.

Vata-Kaphaja Gridhrasi – This type of Gridhrasi is caused due to joint vitiation of Vata and Kapha. The pain is present in a lesser intensity along the regions of the lower limb explained in Vataja Gridhrasi. Along with this the patient will also suffer from Tandra (sleepiness), Gourava (heaviness in the limbs) and Arochaka (tastelessness).

Vaatajaayaam bhavet todo dehasya api pravakrataa
Jaanu kati uru sandheenaam sphuranam stabdhataa bhrusham
Vaata shleshma udbhavaanaam tu nimittam vahni maardavam
Tandraa mukha prasekaha cha bhakta dvesham tathaa eva cha (Ref – Madhava Nidanam 22/55, 56)

Symptoms of Gridhrasi or Sciatica manifested due to vitiation of Vata include –
Toda (pricking pain in the limbs),
Deha pravakrata (deformity of the limbs and body, disturbed gait),
Sphurana (twitching, pulsations) and Stabdhata (stiffness, catch) in the Janu (knee joints),
Sphurana and Stabdhata in Kati (pelvis, hips) and
Sphurana and Stabdhata in Uru (thigh)

Symptoms of Gridhrasi or Sciatica manifested due to vitiation of Vata-Kapha include –
Vahni maardavam – Low metabolism
Tandra – Slepiness
Mukha praseka – Watering in mouth, water brash
Bhakta dwesham – Aversion to food, Anorexia

Paarshneem prati anguleenaam tu kandaraa yaa anila arditaa
Sakthnaha kshepam nigruhneeyaat grudhrasee iti saa smrutaa (Ref – Sushruta Nidana 1)
Sushruta tells that when the kandara or nadi (nerve) located near the heels and toes (sciatic nerve?) gets afflicted by vitiated Vata, it leads to the manifestation of a painful disease in the lower limbs and is called by the name Gridhrasi (Sciatica or Sciatic pain). It causes severe gripping pain in the legs and thighs along with twitching.

Mamsagata Vata

RLS resembles Mamsagata Vata –
Here vitiated Vata getting lodged in Mamsa (muscle / flesh) tissue causes painful symptoms. When this vitiated Vata afflicts the muscles of the butt and legs (thigh, legs) it produces symptoms which almost resemble sciatica and RLS.

Acharya Sushruta has explained the same context that Gridhrasi is caused due to the affliction of the Kandara (nerve) supplying the foot, toes, leg and thigh by vitiated Vata which further causes pain in the lower limb along with twitching, catches and inability to walk (loss of movements). We have already discussed this aspect in the earlier passages. Therefore Restless Legs Syndrome shall be treated on the lines of Mamsagata Vata

Prevention of RLS

Restless Legs Syndrome – Prevention, Ayurvedic concept:
We have learnt that Restless legs syndrome is a disturbing neurological condition wherein the sensations are disturbed. These symptoms of RLS are essentially associated with Vata vitiation. RLS can be prevented by keeping away all the causative and triggering factors which tend to vitiate Vata in the body.

Avoiding food and life style activities which aggravate Vata include keeping away the causative factors responsible for Vata vitiation (Vata Prakopaka Karanani). The causative factors of Vata vitiation are mentioned in the ‘causes of vata vitiation’ under the heading ‘RLS – A Vata Vyadhi’ heading above.

Ayurvedic treatment

Restless Legs Syndrome Treatment approach – Ayurvedic aspect –

With the help of the compilation of above said aspects of RLS, the treatment line-up of RLS can be inferred as enlisted below –
Treatment and medicines on the lines of Vata Vyadhi (treatment of Vata diseases)
Treatment and medicines on the lines of Sarvanga Vata (treatment of Vata vitiation in the whole body, varied form of RLS where symptoms are seen in multiple areas other than lower limbs)
Treatment and medicines on the lines of Twak Gata Vata (treatment of vitiated Vata located in Skin)
Treatment and medicines on the lines of Gridhrasi chikitsa (treatment of sciatica)
Treatment and medicines on the lines of Mamsagata Vata (treatment of Neuro-muscular diseases)

Vatavyadhi chikitsa

Vata Vyadhi Chikitsa (Treating on the lines of Vata disorders) –
Vata disorders can be prevented by avoiding the causative factors which aggravate Vata. The causative factors for Vata disorders have been discussed in the section of ‘RLS – A Vata Vyadhi in the earlier paragraphs,

Treating Vayu:
Sneha – Administration of medicated oils / ghee, Massage, oil pouring etc
Sweda – Steaming / sudation / sweating therapy
Mridu shodanam – Evacuation treatment (mild cleansing treatments like Virechana etc)
Svadu bhojana – Consuming sweet foods
Amla bhojana – consuming sour foods
Lavana bhojana – consuming salt foods
Ushna bhojana – Hot and fresh foods
Abhyangam – Massage with herbal oils
Mardana – Tapping the body with closed fists after application of vata alleviating oils
Seka – Pouring of medicated oils over the body in streams
Paishtika Madhya – Alcohol or fermented products prepared with flours
Goudika Madhya – Alcohol or fermented products prepared with jaggery
Snigdhoshna Vasti – Medicated enemas with oils and ghee, given luke warm
Deepana pachana sneha – Oils and ghee processed with deepana (appetizer) and pachana (digestant) drugs

Vataghna herbs

Useful Vataghna herbs (Herbs alleviating Vata) –
Devadaru – Cedrus deodara
Kushta – Saussurea lappa
Bala – Sida cordifolia
Atibala – Abutilon indicum
Shallaki – Boswellia settata
Agnimantha – Clerodendrum phlomidis
Guduchi – Tinospora cordifolia
Eranda – Ricinus communis
Shatavari – Asparagus racemosus
Punarnava – Boerhavia diffusa
Dashamula – Roots of 10 drugs

Gridhrasi treatment

Gridhrasi Treatment (Treating RLS on the lines of Gridhrasi) –
The below mentioned treatments are highly beneficial in Gridhrasi vis-à-vis sciatica. By soothing the nerve pain, irritation, the treatments and medicines will also relieve the symptoms of RLS. Already we have used the term Gridhrasi interchangeably with RLS.

Abhyanga – Massage of the afflicted part (butt, lower back and lower limb) using medicated oils –
Abhyanga means performing a massage. Massage of the back, afflicted part of the buttock, lower back and lower limb / limbs is done using herbal (medicated) oils. Medicated oil and mixture of medicated ghee is also preferred in some cases. Symptoms like vague sensations, numbness, pain etc as found in RLS is generally caused due to aggravated Vayu / Vata.

Taila (oil) is said to be the best remedy for vitiated Vayu. Massage not only alleviates the morbid Vayu but also provides significant relief from sensory disturbances, numbness, pins and needles, pain, catches and other neurological symptoms associated with RLS. It nourishes and strengthens the bones, joints and soft tissues of the back and lower limb and also rejuvenates them. Abhyanga soothes the nerves and reduces their irritation.

Abhyanga when performed as a daily practice keeps up the health of low back and the nerves supplying the lower limbs, while avoiding painful conditions even in the process of inevitable ageing. Ayurveda advocates whole body massage with herbal oils to be practiced on a daily basis. Nothing is as anti-ageing, rejuvenating and aphrodisiac as a skilfully conducted herbal oil massage.

Best oils used for Abhyanga:
Tila Taila (Sesame oil)
Ksheerabala Tailam
Mahamasha Tailam
Dhanwantaram Tailam
Murivenna
Mahavishagarbha Tailam
Pinda Tailam
Mahanarayana Tailam
Prabhanjana Vimardhana Tailam
Kottamchukkadi Tailam
Sahacharadi Tailam
Yashtimadhu Tailam
Guggulutiktakam Ghritam etc.

Padabhyangam

Padabhyangam (Foot massage) –
Foot massage is an essential part of Ayurvedic massage. It should be mandatorily done as a part of Sarva Abhyanga (whole body massage with herbal oils). It is not only a soothing treatment, it also is said to be preventive and healing treatment for Sciatica. On similar grounds, Padabhyanga done daily relieves RLS.

According to Ayurveda, one who takes Padabhyanga on a daily basis can avoid being a victim of Gridhrasi (sciatica, RLS). Padabhyanga can be done using the same oils and medicines which are used for Abhyanga. Dipping the foot in hot water added with salt or in herbal decoctions or processed milk will add to the healing effect.

For all my patients who suffer from Restless Legs syndrome, Sciatica, Foot pain, Tired legs, Piriformis syndrome I advise Padabhyanga to be done either in the hospital or at home under my supervision.

Kati basti, Swedana

Kati Vasti –
Local oil pooling around the lumbar and sacroiliac joints is highly beneficial in Gridhrasi and nerve disorders afflicting the lower limbs like RLS. This treatment soothes the nerves supplying the lower limb at their origin i.e. in the lower back region, just like treating the roots of the plant.
Read related: Kati Basti: Oil pooling Treatment For Low Back Pain

Swedana (fomentation or sweat inducing therapies) –
Hot fomentation or sweat inducing treatments (sudation, steaming) is highly beneficial in combating Vata disorders (and Gridhrasi, RLS in the current discussion). Swedana is generally administered after giving Abhyanga to the patient.

The below mentioned types of Swedana are generally preferred in Vata disorders affecting the lower limb including RLS and or Gridhrasi –

Nadi Sweda –
Tube or pipe fomentation, is a form of Swedana in which the herbs are boiled with water in a big vessel, drum or pressure cooker. In either case, the apparatus should have a lid to which a nozzle is fit. To this nozzle a heat resistant tube is fit. To the end of the tube a filter is applied which absorbs the hot vapors coming out and releases only steam without the water drops falling on the body of the patient. Alternatively a cloth is tied to the end of the tube. The steam coming from the tube is used for fomenting the painful part.

Avagaha Sweda –
Tub fomentation is also beneficial in Vata disorders especially RLS and or Gridhrasi, should be done after Abhyanga. In this, the water processed with medicinal roots and herbs is filled in a bath tub or an Avagaha tub (tubs prepared with wood of medicinal plants for treatment purposes) and the patient subjected to Abhyanga (herbal oil massage) is made to sit in the tub for 30-45 minutes.

This will help the muscles and nerves to relax. Alternatively, if Avagaha is done at home, one can apply Vata alleviating oils over the painful parts (Ex, Ksheerabala taila, Mahamasha tailam, Mahanarayana Tailam etc) and sit in a tub filled with hot water added with salt.

Pinda Sweda’s – Bolus fomentations:
Churna Pinda Sweda (Powder bolus fomentation) –
Churna means powder (herbal), Pinda means bolus, Sweda is sweat, Swedana is sweat inducing treatment.
Churna Pinda Sweda is a treatment in which herbal powders having vata-alleviating, nerve-soothing, analgesic, anti-degenerative and anti-inflammatory properties are used for fomentation (sweat inducing) of painful parts.
Read related: Podikizhi – Churna Pinda Sweda Treatment Procedure, Benefits

Patra Pinda Sweda (Leaf bolus fomentation) –
Patra means leaves, Pinda means bolus, Sweda is sweat, Swedana is sweat inducing treatment.
Patra Pinda Sweda is a treatment in which leaves of medicinal plants having vata-alleviating, nerve soothing, analgesic, anti-degenerative and anti-inflammatory properties are used for fomentation (sweat inducing) of painful parts.
Read related: Patra Pinda Sweda: Ela Kizhi massage Preparation, Procedure, Benefits

Shashtika Shali Pinda Sweda (Medicated rice bolus fomentation) –
The term Shashtika Shali Pinda Sweda is made up of 4 words – Shashtika means sixty, Shali means rice, Pinda means bolus, Sweda is sweat, Swedana is sweat inducing treatment.

Shashtika Shali Pinda Sweda is a treatment in which a special type of rice called Shashtika Shali (which is harvested in 60 days and is exclusively used for treatment purposes in Ayurveda) prepared in milk processed with herbal decoction is tied in boluses and used for rubbing on the body parts which are intended to receive nutrition and strength.
Read related: Navarakizhi: Shashtika Shali Pinda Sweda Procedure, Benefits

It is extensively useful in RLS, Sciatica and Piriformis syndrome wherein it provides strength to the muscles and nerve, apart from relieving the pain. It is the best choice for all Vata disorders wherein the nerves are irritated and tissue destruction is evident. The treatment is also used in painful and or degenerative conditions like Osteoarthritis, Myalgia, GB Syndrome, Fibromyalgia, various types of Neuro-muscular and Musculoskeletal diseases.

Sarvanga dhara, Kaya seka

Sarvanga Dhara and Kaya Seka (Pizhichil) –
Dhara or Seka means to pour in streams. In this, medicaments including herbal oils and processed milk is poured in streams all over the body along with gentle stroking for a fixed duration. This is highly effective in combating morbid Vata, Pitta and Rakta and recovery from RLS, either only in lower limbs or spread out to manifest in multiple areas of the body.
Read related: Sarvangadhara Ayurvedic treatment: Benefits, Procedure

Kaya Seka or Pizhichil is stream pouring of medicated oils over the body for a fixed amount of time (60-90 minutes). Kaya Seka, Sarvanga Takra dhara (medicated buttermilk) or Sarvanga Ksheera dhara (medicated milk) are generally preferred in RLS.

Murdhni Tailam

Murdhni means head, Tailam means oil. Thus Murdhni Tailam is a procedure of application, stream pouring or pooling of medicated oils over the head. Taila or oil is the best remedy in combating vitiated Vata.

It has controlling centres of the entire body apart from being a seat of sense organs, emotions, intellect and memory. It is also a Marma sthana (vital organ) which comprises of more than 30 vital spots, the injury of which can cause many deformities or death.

Application, pouring or pooling of oil over the head means to fortify the head, sense organs and brain. Murdhni Taila not only nourishes and strengthens the head and organs located therein; it also acts as a best stress controller. It is good for hairs and scalp bones and soothes the nerves. It promotes good sleep and keeps us healthy. Sleeplessness is one of the main complaint or cause of RLS.

Read related: Moordha Taila, Murdhni Taila: Ayurvedic Oil Treatment On Head

Murdhni Tailam is of 4 types –
Shiro-Pichu – A small sterile cotton pad is dipped in medicated oil and kept on the crown of the scalp. A bandage cloth is tied around the head and kept in place for a few hours.
Read: Shiro Pichu: Benefits, Procedure, Mode Of Action
Shiro Abhyanga – Massage of head using medicated oils

Shiro Dhara – Stream pouring of medicated liquids including oils, buttermilk, milk etc over the head for a certain fixed duration
Shiro Vasti – Pooling of medicated oil over the head, enclosed within a vertical chamber or compartment constructed over the head in the form of a cap.

Shiro lepa

Shiro Lepa – Application of herbal pastes made up of the herbs which control Vayu over the head is called Shiro Lepa. The paste is left in place until it starts getting dry and later removed. Alternatively, leaves of Castor plant, Vitex negundo etc plants which are known for Vata alleviating properties is placed over the applied paste such that there is a small opening at the crown of the head. The entire application with leaves is loosely tied with a thin bandage cloth to hold them in position. At regular intervals, medicated oil is slowly put into the opening in drops so as to keep the paste moist.

Other treatments

Other beneficial treatments in Restless legs syndrome –
Pichu (Kati-Pichu) –
A larger piece of cotton swab (pichu) is dipped in medicated oil and ghee, kept in the affected area of the back and or buttock and bandaged. It is left in place for a prescribed duration before it is removed. This is carried on day to day basis. This will continuously keep nourishing the bones, joints and tissues of the back, prevents degeneration, lessens inflammation, and heals pain and catches. Moreover it will soothe the nerves supplying the lower limb and lower back and thus relieves the symptoms of RLS. The same oils used for Abhyanga can be skilfully used in this format of treatment also.

Lepa (Kati Lepa) –
Lepa means application. Powders of drugs which alleviate pain are made into paste. The paste is applied over the low back area and or afflicted buttock area. The application can be extended over the lower limbs also. It is allowed to stay in place for a prescribed period or till the paste starts to dry. Depending on dosha involved, the Lepa is applied either hot / warm (vata, kapha vitiation) or cold (pitta, rakta vitiation).

The common medicines which are used for Lepa are –
Rasnadi Churnam
Kottamchukkadi Churnam
Grihadhoomadi Churnam
Ellumnishadi Churnam
Dashanga Lepam etc

Upanaha (Kati Upanaha) –
Upanaha means poultices. The same powders mentioned in lepa are used as medicaments in Upanaha. After mixing them with suitable medicated oils, salt etc. the medicines are applied and tied around the back such that the medicines lie in contact of the painful part for a prescribed duration until they are removed.

Abhyantara chikitsa

Abhyantara Chikitsa (Internal treatments):
Snehapana –
Consumption of oils / ghee processed with medicinal drugs is used orally in metered doses on a daily basis. Snehana will help in lubricating, soothing and strengthening the muscles and nerves. Sneha (medicated oil and or ghee) is the best in the business of combating Vata, thus helps in soothing the nerves of the low back and the lower limbs.

Snehapana gives outstanding results in relieving the symptoms of RLS. It also attends the disease from its root.
Sneha means medicated oil or ghee, Pana means intake. Snehapana is a procedure in which the patient is made to drink metered doses of oils and ghee which are processed with medicines. This is given in 3 forms:

Shodana Sneha – Here the medicated ghee or oils are given in higher doses so as to cause saturation in the body. The dosage is increased every day until all the cells of the body get saturated or the symptoms of proper administration (Samyak Snigdha Lakshanas) are obtained or until the patient develops aversion towards the medicine. It is usually given early in the morning on empty stomach.

It is given for patients for whom Shodana (body cleansing treatments like vamana – therapeutic emesis or virechana – therapeutic purgation) has been planned. After the body cells have been saturated with the Sneha, Swedana (whole body steaming) is given followed by administration of Vamana (therapeutic emesis) and or Virechana (Therapeutic purgation) is given.

Virechana or therapeutic purgation is one of the best treatments for Vayu disorders including Kampa Vata or Parkinson’s disorder

Shamana Sneha – The same medicaments are given in smaller doses when the extent and strength of the disease and diseased are low or moderate. It is given when the patient feels hungry, before food. The intention is to pacify the vitiated Doshas and not to expel them.

Brimhana Sneha – The sneha is given for strengthening purposes and also for promoting bulk. The medicated oil or ghee is given mixed with food.

Nitya Snehapana – In this, small metered doses of Snehana is given on a daily basis either first thing in the morning or at bedtime usually mixed in hot milk or gruels. This method is followed when the patient is not able to take higher doses or is not fit for Panchakarma procedures. It acts as a lubricant and rejuvenates the joints and soft tissues. It also helps in tackling the morbid Vata and Pitta which are causing backache.

Shamana, Snehana and Nitya Snehapana are highly beneficial to control Vayu and cure Neurological disorders like RLS. These are easy to take (under supervision) in mild to moderate cases of RLS. If the condition is stubborn and needs detoxification, Shodhana snehapana followed by a course of Shodhana shall be preferred.

The below mentioned medicaments are used for Snehapana –
Mahamasha Tailam
Ksheerabala Tailam
Gandharvahastadi Eranda Tailam (for purgation)
Nimbamritadi Eranda Tailam (for purgation)
Saraswatha Ghritam
Panchagavya Ghritam
Brahmi Ghritam
Kalyanaka Ghritam
Rasnadi Ghritam
Indukantam Ghritam
Amritaprasha Ghritam
Brihat Chagaladya Ghritam
Guggulutiktakam Ghritam
Ashwagandhadi Ghritam

Vamana – Therapeutic Emesis / vomiting –
Gridhrasi is a Vata Vyadhi i.e. predominantly a Vata disorder. Vamana is a therapy generally preferred in high Kapha conditions. Thus Vamana should not be logically given in the diseases of Vata origin. But Acharya Chakrapani suggests administering Urdhwa Shuddhi (cleansing of upper parts of the body) by giving Vamana therapy before giving Vasti (treatment of choice in Gridhrasi, vis-à-vis RLS, sciatica, piriformis syndrome).

He further emphasizes that administering Vasti which is a treatment of choice in Vata diseases without having given Vamana will be a waste exercise and that the effect of the treatment will not be fruitful. Thus it becomes clear that Vasti gives best results when administered after having administered Vamana.

Virechana –
Therapeutic purgation is very beneficial in combating Vata and Pitta related disorders, it expels morbid Kapha also. Virechana is given after having administered Snehapana (metered doses of medicated oils and or ghee given orally in increased doses until signs of saturation have occurred) and Abhyanga-Swedana (herbal oil massage and sweat inducing treatments).

Snehayukta Virechana (herbal purgatives or laxative herbs processed in oil base) is highly effective in combating Vata morbidity. This should be carefully administered in RLS having association of Kapha symptoms like stiffness, heaviness etc.

In such conditions (Vata-kaphaja Gridhrasi), Ruksha Virechana (dry purgative formulations which do not have oil base) in the form of choorna (herbal powder laxatives / purgatives) and Kashayas (decoction purgatives) etc can be given. Ex, Trivrit churna, Haritaki churna, Gandharvahastadi churna etc

Virechana is also given on a daily basis while the above said treatment procedures are carried out. This helps in regular detoxification of the cells, soothes the irritated nerves and muscle and relieves RLS and its symptoms. This procedure is called Nitya Virechana.

Below mentioned are some of the medicines used for nitya virechana –
Gandharvahastadi Eranda Tailam (for purgation)
Nimbamritadi Eranda Tailam (for purgation)
Trivrit Leham
Triphala Ghritam / Triphala churnam
Sukumara Ghritam
Drakshadi Ghritam etc

Vasti –
Vasti means medicated Enemas. Vasti is said to be the best treatment for combating vitiated Vata. It regulates and normalizes all the body mechanics, restores health in each and every cell, strengthens the body and provides long standing immunity. Vasti is also the best in the business of combating Vata disorders (neurological disorders) affecting the lower limb, RLS in this case.

It is given in various forms as said below –
Kashaya Vasti – (Decoction enemas) –
The best Kashaya Vasti’s (Asthapana Vasti) which can be administered in RLS are:
Erandamooladi Kashaya Vasti
Mustadi Yapana Vasti
Raja Yapana Vasti
Dashamula Vasti etc

Sneha Vasti – Enemas with medicated oils / ghee is called Sneha or Anuvasana Vasti: 
Below mentioned are a few best choices in RLS –
Ashwagandhadi Ghritam
Brihat Chagalyadi Ghritam
Guggulutiktakam Ghritam
Mahamasha Tailam
Sahacharadi Tailam
Bala tailam
Brihat saindhavadya tailam
Ksheerabala Tailam etc

Matra Vasti – It is also a variant of Anuvasana Vasti but given in small doses. It can be given on a daily basis. Anuvasana and Matra vasti pacifies vitiated Vayu and strengthens the nerves and nervous system.

Ksheera Vasti – Enemas using milk processed with medicinal herbs is called Ksheera Vasti. Since milk is used as a base for preparation of this Vasti, it acts as a nutrient apart from being a good analgesic. Ksheera Vasti’s are handy and highly effective remedies for Vata diseases. Its efficacy is unparalleled in combating neurological conditions like RLS.

Note – Among the above said treatments (external and internal treatments) many treatments have multi-dimensional approach.

Abhyanga, Padabhyanga, Different types of Swedana, Dhara, Murdni Taila, Pizhichil etc external treatments, Virechana, Snehapana, Vaasti etc internal treatments are not only used in handling Gridhrasi but also are the treatment of choices for Vata Vyadhi (neurological, musculoskeletal, neuromuscular and degenerative diseases), Sarvanga Vata, Mamsagata Vata, Twak Gata Vata, Pakshaghata (paralysis or hemiplegia), Vatarakta (Gout) etc conditions.

Wherever these terms are mentioned they should be understood in the same sense as explained above. The procedures will be the same, in whichever condition they are done. Only the permutations and combinations of the medicines used shall differ.

Since we had to discuss these treatments in brief anywhere in the topic, I thought of covering them in the context of discussing Gridhrasi treatments as applicable for RLS. Kindly note that these treatments are not limited to RLS or Sciatica, they help in combating wide array of neurological problems.

Sarvanga Vata Treatment

Abhyanga (massage) using Vata alleviating oils
Asthapana Vasti – enemas with herbal decoctions
Anuvasana Vasti – Enemas with herbal oils and or ghee
Twak Gata Vata Treatment –
Swedana – Sweat inducing treatments
Abhyanga – Herbal oil massages
Avagaha – Tub bath in herbal liquids
Hridhya anna – Foods which are compatible and pleasing to the heart

Mamsagata Vata treatment

Restless legs syndrome can be treated on the lines of Mamsagata Vata. In these conditions treatments and medicines so as to pacify vata (Vatashamana) or remove vata (Vatanulomana) should be considered.

Apart from this Balya (strengthening) and Brimhana (bulk promoting) medicines along with Rasayana’s (tissue rejuvenators, anti-ageing agents) should be given to increase the cellular immunity and aid their recovery (in terms of quality and quantity)

The below said are said to be the best in tackling Mamsagata Vata–
Virechana – Therapeutic purgation
Niruha vasti – Medicated decoction enemas
Shamana chikitsa – Palliative treatments and medicines
Other strategies to be adopted in the treatment of RLS:

Nasya – Nasal instillation of medicated ghee and / or oils is called Nasya. Brihmana Nasya (oil / ghee prepared using strengthening medicines) is preferred in RLS.
The below said medicament are used for Nasya:
Ksheerabala Tailam,
Ksheerabala tailam 101,
Dhanwantaram Tailam 101,
Mahamasha Tailam
Shadbindu tailam

Brimhana

Brimhana means bulk promoters. Medicines which improve the muscle bulk also strengthen the muscles. They also provide nutrition and nourishment to the tissues. These medicines can be used both during treatment and also during follow up. They also improve the neuro-muscular conductivity and enhance muscle power and metabolism. These medicines are highly effective in RLS.

Below said are the best Brimhana herbs –
Ksheerini – Ipomoea digitata
Rajakshavaka – Euphorbia hirta
Ashwagandha – Withania somnifera
Kakoli – Roscoea procera
Ksheerakakoli – Lilium polphyllum
Vaatyaayini – Sida cordifolia
Bhadraudani – Sida rhombifolia
Bhaaradvaaji – Thespesia lampas
Payasya – Pueraria tuberose
Rushyagandha – Argyreia speciosa

Others:
Navanna – New paddy / rice
Shali – Rice
Masha – Black grams
Godhuma – Wheat
Ikshu vikara – Sugarcane and its derivatives (jaggery, sugar etc)
Anupa mamsa – Flesh of animals living in marshy areas
Audaka mamsa – Flesh of animals living in water
Dadhi – curds
Dugdha – milk
Ghrita – Ghee
Vrishya dravya – Aphrodisiacs
Rasayana dravya – Rejuvenators

Ashwagandha is the best herb in dealing with neuro-muscular disorders.
In Kaphavarana conditions, it should be implemented only during the follow up i.e. after destroying the Kapha envelope over the Vata.

Balya –
Balya means strengthening. The herbs which increase the vitality and strength of the body are called Balya Dravyas. Increase in vitality and strength also depicts an increase in immunity. Bala is said to be the function of Oja (essence of body tissues in the body).

Balya medicines also maintain this oja in the body while enhancing the immunity. Balya herbs help in strengthening the nerves, soothing them, improve strength and immunity.

Below mentioned are the best Balya herbs –
Aindri – Bacopa monnieri
Rushabhi – Mucuna pruriens / Fagonia cretica / Mucuna monosperma
Atirasa (Shatavari) – Asparagus racemosa
Rushyaprokta – Argyreia petaloides
Payasya – Roscoea procera
Ashwagandha – Withania somnifera
Sthiraa – Uraria picta
Rohini – Picrorrhiza kurroa
Bala – Sida cordifolia
Atibala – Abutilon indicum

Santarpana

Santarpana means nourishing or refreshing. The below said are best in Santarpana –
Mamsarasa – Meat soup
Paya – milk
Ghrita – Ghee
Snana – Refreshing bath / shower
Vasti – Enema
Abhyanga – Massage
Tarpana – Refreshing drinks

Jeevaneeya drugs –
Jeevaneeya means to promote longevity. Jeevaneeya herbs also provide an anti-inflammatory and anti-oxidant effect on the body. Thus they are highly beneficial in RLS.

Below mentioned are the best Jeevaneeya herbs –
Jeevaka – Crepidium acuminatum / Malaxis acuminate
Rishabhaka – Manilkara hexandra / Malaxis muscifera
Meda – Polygonatum verticillatum
Mahameda – Polygonatum cirhifolium
Kakoli – Roscoea purpurea
Ksheerakakoli – Lilium polyphyllum
Mudgaparni – Phaseolus trilobus / Vigna trilobata
Mashaparni – Teramnus labialis
Jivanti – Leptadenia reticulate
Madhuka – Glycyrrhiza glabra

Vayasthapana –
Vayasthapana dravyas means longevity promoters or anti-ageing herbs.
Below mentioned are the best Vayasthapana herbs –
Mandukaparni – Centella asiatica
Sthira – Desmodium gangeticum
Punarnava – Boerhavia diffusa
Guduchi – Tinospora cordifolia
Haritaki – Terminalia chebula
Amalaki – Emblica officinalis
Rasna – Alpinia galangal
Shweta (Shweta aparajita) – Clitoria ternatea
Jivanti – Leptadenia reticulate
Atirasa – Asparagus racemosa

Rasayana –
Rasayana includes all those herbs, medicines, treatments and activities which enhance the quality of all the tissues in the body and improve the strength and immunity. They are the best immune-modulators and anti-ageing medicines.

Some of them are best antioxidants.The below said are the best Rasayana’s in RLS –
Brahmi – Bacopa monnieri
Mandukaparni – Centella asiatica
Shankapushpi – Convolvulus pluricaulis
Vidari – Pueraria tuberosa
Jivanti – Leptadenia reticulata
Punarnava – Boerhavia diffusa
Guduchi – Tinospora cordifolia
Amalaki – Emblica officinalis
Haritaki – Terminalia chebula
Vidanga – Embelia ribes
Pippali – Piper longum
Shatavari – Asparagus racemosa
Shilajit
Bibhitaki – Terminalia bellirica
Yashtimadhu – Glycyrrhiza glabra
Sthiraa – Desmodium gangeticum

Vajikarana –
Vajikarana means aphrodisiacs. Some of the Vajikara dravyas are also highly effective in RLS. They are –
Kapikachchu – Mucuna pruriens
Ashwagandha – Withania somnifera
Shatavari – Asparagus racemosus
Masha – black gram
Ksheera – milk
Ghrita – Ghee etc

Ayurvedic medicines

Useful Ayurvedic medicines in Restless legs Syndrome –

Kashaya’s (Herbal decoctions):
Sahacharadi Kashayam
Sahacharabaladi Kashayam
Rasnasaptakam Kashayam
Rasnapanchakam Kashayam
Dhanwantaram Kashayam
Amrutottaram Kashayam
Guggulutiktakam Kashayam
Kokilaksham Kashayam
Guluchyadi Kashayam
Gandharvahastadi Kashayam
Maharasnadi Kashayam
Pathyakshadhatryadi Kashayam
Prasarinyadi Kashayam
Punarnavadi Kashayam
Ashtavargam Kashayam
Drakshadi Kashayam
Dashamula Kashayam etc

Ghritam and Tailam (medicated ghee and oils):
Guggulutiktakam Ghritam
Varanadi Ghritam
Rasnadi Ghritam
Dhanwantaram Ghritam
Tiktakam Ghritam
Ksheerabala Tailam
Sahacharadi Tailam
Ksheerabala tailam 101
Dhanwantaram tailam 101

Asava / Arishtam:
Dashamularishtam
Abhayarishtam
Ashwagandharishtam
Balarishtam
Saraswatharishtam
Dhanwantararishtam
Devadarvarishtam
Punarnavasavam
Lohasavam
Lodhrasavam
Kumaryasavam
Draksharishtam etc

Vati and Gulika (Tablets):
Trayodashanga Guggulu
Rasnadi Guggulu
Simhanada Guggulu
Navaka Guggulu
Kaishora Guggulu
Yogaraja Guggulu
Mahayogaraja Guggulu
Panchatikta Ghrita Guggulu
Ekangaveera ras
Mahavata vidhwamsini ras
Vatagajankush ras
Brahmi Bati
Smritisagar Rasa
Vatakulantaka Ras
Sameera pannaga ras
Brihatvatachintamani Ras
Sutashekara ras
Trailokya chintamani Ras
Chaturbhuja Ras
Tapyadi loha
Dhatri Lauha
Punarnavadi Mandura
Ksheerabala Tailam 101 caps
Dhanwantaram Tailam 101 caps
Chandraprabha vati
Shallaki

Others (Churna, Satwa, Bhasma etc):
Kapikachchu churna
Ashwagandha churna
Shatavari churna
Guduchi satva
Rajata bhasma
Yashada Bhasma
Loha Bhasma
Mandura Bhasma
Swarna Bhasma
Swarna Makshika Bhasma
Mukta pishti

Best Rasayana’s / Lehyas (Rejuvenators, anti-ageing medicines and confections):
Ashwagandha Rasayanam
Ajashwagandha Rasayanam
Ajamamsa Rasayanam
Drakshadi Rasayanam / Drakshadi Leham
Kushmanda Rasayanam
Chyavanaprasham
Dashamula Haritaki
Vanari kalpa
Vajikara Rasayanam

External applications

The same herbal oils mentioned in Abhyanga etc. can be used for external application.
Broader horizon of tackling Restless legs syndrome (RLS) –
Restless legs syndrome (RLS) can also be treated on the lines of treatment protocol of the below said conditions –
Medo gata Vata (vitiated Vata afflicting fat tissue)
Asthigata Vata (vitiated Vata afflicting bone tissue)
Majjagata Vata (vitiated Vata afflicitng bone marrow)
Unmada Chikitsa (treatment line up of insanity and mental disorders)
Apasmara Chikitsa (treatment of epilepsy and forgetfulness)
Pakshaghata Chikitsa (treatment line up of paralysis or hemiplegia)
Ardita Chikitsa (treatment protocol of facial palsy or facial paralysis)
Vatarakta / Vatashonita Chikitsa (Treatment protocol of gout arthritis)

All the above said conditions might be different conditions from RLS disease but the principles of the treatment explained in the above said contexts are also useful in RLS. With the fear of elaborate coverage, I have skipped explaining each and every condition (mentioned above) and their treatment. But I have taken the gist of the medications and treatments done in all these disorders and summed up in the above said discussion of treatment of RLS.

Prevention

Prevention of RLS, Modern perspective –
Preventing the underlying causes is the only way of preventing RLS. No other method of prevention of RLS has been studied or established.

If RLS is due to (secondary) specific treatable causes (specific medications or treatable conditions), then the treatment of those causes may also remove or reduce RLS and its symptoms.

Treatment – Modern perspective

Treatment of RLS, Modern perspective –

The first step will be to identify the cause and treat accordingly
Treatment of RLS should not be considered until possible medical causes are ruled out, especially venous disorders. Secondary RLS may be cured if precipitating medical conditions (anaemia, venous disorder) are managed effectively. Secondary conditions causing RLS include iron deficiency varicose veins and thyroid problems.

Aim of the treatment – To reduce symptoms, decreasing number of nights with RLS symptoms, decrease severity of RLS symptoms and reducing night-time awakenings and improving the quality of life

Treatment of RLS is targeted towards easing the symptoms.
It includes –
Lifestyle changes and adjustments
Starting Regular exercise programmes
Establishing regular sleep patterns
Eliminating or reducing the use of caffeine, alcohol and tobacco
Treatment of primary diseases (RLS associated condition)

Physical measures –
Stretching the leg muscles can bring temporary relief
Walking and moving legs brings temporary relief
Symptoms usually return immediately after the moving and walking ceases
A vibratory counter-stimulation device can help some people to improve their sleep

Non-drug treatments include –
Leg massages
Hot baths
Heating pads
Ice packs applied to the legs
Good sleep habits
Vibratory pad at night

Medicines used in relieving RLS –
Dopaminergic drugs (moderate to severe RLS) – act on neurotransmitter dopamine in the brain
Benzodiazepines (sedative medications)
Narcotic pain relievers
Anticonvulsants

Note – There is no cure for RLS. These treatments and medicines can help control the condition, decrease symptoms and improve sleep.

The same drugs are not helpful to everyone. If a drug relieves one person the same may worsen the symptoms of the other. A drug which works for a while may lose its effectiveness over a period of time

Use of Iron –
All patients with RLS should have their serum ferritin (measure of the body’s iron stores) tested. It should be at least 50?g/L for those with RLS. Oral iron supplements can increase ferritin levels. For some, increasing ferritin will eliminate or reduce RLS symptoms.

Prognosis –
RLS symptoms may gradually worsen with age. Those with idiopathic form of RLS will show slow progression of disease in comparison to those having an associated medical condition.

Current therapies can control RLS, minimize its symptoms and enhance sleep quality. Still, some patients have remissions, periods in which symptoms decrease or disappear for days, weeks or months, although symptoms usually eventually reappear. Diagnosis of RLS doesn’t rule out the chances or existence of other neurological conditions.

Studies, Research

Studies & research works on RLS –
In 2007, RLS was detected in 36% patients attending a phlebology (vein disease) clinic, compared to 18% in a control group

An association between ADHD (Attention Deficit Hyperactivity Disorder) and RLS or Periodic Limb Movement Disorder has been observed. Both these conditions are related to dopamine (neurotransmitter) dysfunction. They are also treated on similar lines.

A 2005 study suggested that up to 44% of people with ADHD had comorbid (co-existing) RLS and up to 26% of people with RLS had confirmed ADHD or symptoms of the condition.

A 2009 study updated that 39% of people with RLS also might have ADHD compared to 14% of controls and those showing signs of both had more severe RLS, suggesting that perhaps either the difficulties of RLS and low sleep quality caused ADHD-like distraction or that dopamine was a possible common factor and its improvement helped both, and that people with RLS might wish to consider ADHD testing as well, but cautioned that neither condition was proved as the cause of the other.

History

The first known description of RLS was by Sir Thomas Willis in 1672. He emphasized the sleep disruption and limb movements experienced by people with RLS. Initially it was published in Latin (De Anima Brutorum, 1672) but later translated to English (The London Practise of Physick, 1685).

The term ‘fidgets in the legs’ was used as early as ‘the early 19th century’

Subsequently other descriptions of RLS were published including those by Francois Boissier de Sauvages (1763), Magnus Huss (1849), Theodur Wittmaack (1861), George Miller Beard (1880), Georges Gilles de la Tourette (1898), Hermann Oppenheim (1923) and Frederick Gerard Allison (1943).

In 1945 Karl-Alex Ekbom provided a detailed and comprehensive report of this condition in his thesis, Restless legs: clinical study of hitherto overlooked disease. Ekbom coined the term ‘restless legs’ and continued work on this disorder throughout his career. He described the essential diagnostic symptoms, differential diagnosis from other conditions, prevalence, and relation to anaemia and common occurrence during pregnancy.

Ekbom’s work was rediscovered by Arthur S. Wlaters and Wayne A Hening in the 1980’s.

Subsequent landmark publications include 1995 and 2003 papers, which revised and updated the diagnostic criteria.

Journal of Parkinsonism and RLS in the first peer-reviewed, online, open access journal dedicated to publishing research about PD and was founded by a Canadian neurologist Dr Abdul Qayyum Rana.

Just before finishing –
Restless Legs Syndrome is a very common condition which most of us suffer and we are not aware that we have it. It looks like a simple disease or condition. It may also look like a casual symptom which will wear away with time. But RLS has its own complexities.

It is a silent killer which develops slowly. Horrible thing is that its presentation is so simple many times that we understand it as it is. When we suffer from tiredness or weird sensations in the lower limbs / legs or any part of the body very often we should learn not to ignore it or to ignore it with a casual overlook.

With passage of time these neurological disorders might get worse. Management and treatment for the same would be very difficult when they get a chronic picture.

Ayurveda has best remedies, medicines and treatments in combating Vata disorders with special reference to neurological diseases, RLS in this context. Prevention is better than cure for any disease in question. But there are fewer clues to take preventive measures in neurological diseases.

By the time we come to know that neurological diseases like RLS are much more than casual affairs and by the time some diagnosis is made it would have breached the point of easy and effective approach. This article is to give an idea of best Ayurvedic treatment options available for RLS. An Ayurvedic doctor in your neighborhood would be the best person to help you out from RLS.
Article by Dr Raghuram Y.S. MD (Ayu).
Email: drraghuramys@gmail.com