So how do I think about RLS? What jumps out at me is the “restless” part. The muscles are hyperactive. What can cause that? Well, I’m a Neuromuscular Therapist and when you’re a hammer everything looks like a nail, so I go right to Trigger Points! Trigger points are hyperactive. They are working 24/7. They never get a rest. When doctors look for Trigger Points with a needle, they look for a “jump sign” or “local twitch response,” a place in the muscle that makes it jump or twitch when the needle hits it. When I find a Trigger Point with my hands I often feel twitching or pulsing. Going across the fibers of the muscle, a taut band is usually present. The patient feels local pain or tenderness and a referral of symptoms shooting away from this point or radiating out around it. The job for the therapist is to find the Trigger Points and work at deactivating them with sustained pressure. Flushing of the surrounding tissue is important to remove the waste products that cause irritation of those muscles and nerves.

The second thing I think about is the tingling, burning and numbness, and in the case of Krystal S., the tripping and stumbling. From my point of view, this indicates nerve entrapment of the sciatic nerve, most commonly by the piriformis muscle (piriformis syndrome). To work on nerve entrapment, an NMT goes to the source in the spine and works outward through all the muscles that can trap the nerves along the symptomatic pathway. The search is for very tight muscles and, within them, for the taut bands formed by hyperactive Trigger Point nodules that can block the flow of nerves, producing numbness, tingling and loss of motor function. (Tripping means you can’t raise your foot with your muscles.)

The third thing I’m looking for is Trigger Points that are actively referring sensations away from the source and causing symptoms when the muscle should be at rest. Aching pain is the most common, but heat, cold, itching, tingling, numbness, abnormal sensations, twitching and goosebumps are also Trigger Point symptoms.

The fourth thing I need to consider is structural asymmetry. In Krystal’s case, an MRI revealed a structural issue. Her fifth lumbar vertabrae was fused to her sacrum, causing an asymmetry in her pelvis and the funcional part of her scoliosis. It also showed a mild structural scoliosis. These factors had probably been there since birth and had been accentuated with her growth pattern. As a result, I have to include the possibility that there may be some continuing compression and therefor irritation of the spinal nerves that serve the buttock, the posterior thigh and calf.

Read the next entry to see how I treated Krystal’s RLS in my Boston area Neuromuscular Therapy center.