When muscle tension and hyperactivity from Trigger Points are the cause of RLS, Neuromuscular Therapy is very successful in relieving symptoms and sometimes eliminating this disturbing condition. When an initial series of appointments works, but symptoms return, underlying or perpetuating factors need to be discovered.
Treatment in the case of Krystal S. in my Neuromuscular Therapy center in Metro-West Boston took ten appointments to make her comfortable.
At the first appointment because I suspected, from noting a scoliosis and structural asymmetry, that this might be the source of her problem, I started work in the low back. The deep and superficial muscles and ligaments of the lumbar spine (5 lowest vertabrae) and their attachments to the sacrum and hip bone were treated with Neuromuscular Therapy techniques to relieve any joint tension that might be irritating the nerves. The muscles of the buttock and hip were treated next for Trigger Points and for muscular entrapment of the sciatic nerve. Symptomatic muscles in the back of her leg were treated last to relieve local tension and remove irritating waste products. I was surprised that she was not hypersensitive to touch and that I could work with deep pressure. She was given a heel lift to level her pelvis and taught some specific Active Isolated Stretches.
She reported at her second and third treatments that she was feeling relief already, so I went to work more specifically on the muscles in the back of the more symptomatic limb. In the fourth and fifth sessions, treatment progressed to the quadriceps pain in the front of her thigh and to the muscles of the inner thigh and groin where there might be femoral nerve entrapment. She continued to improve as we backtracked to include more treatment of the muscles addressed at first.
Successive treatments continued work on all muscles, but focused attention on the piriformis deep in the buttock which turned out to be the primary source! The condition is called piriformis syndrome. Trigger points here created her symptom pattern: pain to the back of the thigh, bad pins and needles down the back of her leg to her calf, pain in the front of her thigh to the knee and shooting pain into the side of her thigh. Just as important, it was causing entrapment of the sciatic nerve. Active Isolated Stretching for the piriformis was important at the end of each session to give her more lasting relief.
Her first course of treatment took ten sessions. She returned a few months later saying that she had felt good for weeks, but the symptoms had gradually returned. Another series of ten treatments worked to keep her symptoms manageable for a year. Since then she returns as needed for maintenance because she has structural and physiological factors that cause a return of symptoms.
My next post will discuss her perpetuating factors.