If you’ve ever been the victim of Restless Leg Syndrome or its partner, Periodic Limb Movement Disorder – PLMD, you know how frustrating it is to rest when your legs seem determined to go, go, go! These two disorders are sometimes lumped together, but they actually have quite different symptoms. And even if you never experienced the problem before, as you go through recovery following your knee replacement you may find yourself awake at night with one or both legs in almost constant motion! Restless Leg Syndrome is a condition involving the nervous system that results in strange sensations in the legs (and sometimes arms) and an irresistible urge to move the limbs to relieve the sensations. These feelings are usually worse at rest, especially when lying in bed, and can lead to sleep deprivation and fatigue. No sooner have moved your leg to a more comfortable spot, and you are once again confronted with that urge and tingling forcing you to move to yet another position! RLS can be caused by problems within the body such as peripheral neuropathy. It can also be the result of deficiencies in iron, magnesium, or vitamin B-12. A 2011 study in San Paulo City, Brazil has suggested the symptoms are generated in the peripheral nervous system and can follow knee replacement surgery. When Restless Leg Syndrome occurs after a TKR, it is usually related to the surgical procedure itself. It is unavoidable that some nerve bundles and possibly the superficial fibular nerve are injured. As you heal, scaring of neural and non-neural tissues occurs differently among different individuals. The various ways in which tissues heal following surgery is likely what determines whether a person develops RLS symptoms or not. It is normally a temporary problem that resolves itself with time. However, while it’s going on, RLS can be very uncomfortable and result in extreme fatigue because of lack of quality sleep. Symptoms of Restless Leg Syndrome * Strange itching, tingling, or "crawling" sensations occurring deep within the legs. These sensations sometimes occur in the arms. * Involuntary movement or jerking of the legs while asleep or while awake and at rest. If you are asleep when this happens, the movement wakes you up and keeps you awake as it continues. * A compelling urge to move the limbs to relieve these sensations. * Restlessness, pacing, tossing and turning in bed, rubbing the legs. * Sleep disturbance and daytime fatigue. Symptoms occur primarily when you are lying down or sitting. The feelings may be relieved during activity. Periodic Limb Movement Disorder (PLMD) is repetitive cramping or jerking of the legs during sleep resulting from the rapid contraction of muscles. It occurs only when you are asleep. The movements are repetitive and rhythmic, occurring about every 20-40 seconds, and are similar to those seen in seizures. PLMD is considered a sleep disorder, because the movements often disrupt sleep and lead to daytime sleepiness. PLMD may occur with other sleep disorders. It is often linked with restless legs syndrome, but they are not the same thing. Symptoms of Periodic Leg Movement Disorder are different from RLS and include * Poor sleep and daytime sleepiness, but no awareness of leg movements during the night unless your bed partner tells you. * Leg movements involve one or both limbs. Typically the knee, ankle, and big toe joints all bend as part of the movements. The movements vary from slight to strenuous and wild kicking and thrashing. The movements last about 2 seconds, are rhythmic and repetitive, and occur every 20-40 seconds. What Can I Do To Relieve RLS or PLMD? When the leg movement is a secondary syndrome associated with your knee replacement surgery, it usually will lessen and most likely resolve itself with time. How much time is unique to each individual. It could be weeks to even several months. You may have bouts where it comes and goes with the frequency of occurrence spaced farther and farther apart as you progress with recovery. Some specific things you can try to help include: * Avoiding caffine. Drink hot green tea at bedtime. * Drinking 8 oz. of good quality tonic water (Canada Dry or Swepps) at bedtime. Check the label to be sure it has actual quinine in it. Although the amount of actual quinine in these drinks is small, it has helped some folks. * Wrapping your leg with an ACE bandage or wear knee-high compression stockings. * Engaging in gentle stretches of the muscles in the back of your leg (calf and hamstring) for 5-15 minutes before bedtime or when symptoms occur. * Taking a pain relief medication aid at bedtime. This could be Extra Strength Tylenol (1000mg), Tylenol PM, Tramadol or a narcotic such as hydrocodone. * Putting a heating pad on the small of your back for at least 20 minutes at bedtime. * Engaging in a short period of exercise (15 minutes or less) on an exercise bicycle before bed or when symptoms occur. * Taking drugs that can help relieve the symptoms such as Requip (which treats disorders such as Parkinsons disease). Your doctor (GP) may recommend other prescription drugs.