What Causes Restless Legs Syndrome?

by Celeste Cooper, RN Health Professional

Do you experience a creepy, crawly, pulling sensation and the overwhelming urge to move your legs in an effort to make it stop, as if you have no control over your own body? A switch is turned on in your brain the minute you get into your recliner to relax because you don’t sleep well, either. It could be restless leg syndrome (RLS).

Restless Leg, Fibromyalgia, and Sleep

Though we don’t know for certain, restless leg syndrome (RLS) is thought to occur because of an upset in the central nervous system, as is fibromyalgia (FM). According to the National Institute of Health, restless leg syndrome is considered a common co-occurring condition to FM and both have factors that contribute to non-restorative sleep. So much so that RLS is often thought of as sleep disorder, and non-restorative sleep is a primary symptom of fibromyalgia.

This is important because sleep deprivation contributes to pain, interferes with healing, and can perpetuate muscle weakness.

Restless Leg and Muscle Cramping

So, we have RLS and maybe FM, too, but we also experience other symptoms of leg cramping and pain, and our muscles are weak and uncoordinated. We tend to describe our walking as being like a bull in a china cabinet.

What you may or may not know is that myofascial pain syndrome (MPS), a painful peripheral nervous system disorder, often causes these symptoms. Myofascial pain syndrome can occur alone or perpetuate pain in other disorders. In the case of RLS, trigger points in muscles that refer pain and other symptoms to the legs, ankles, and feet can mimic restless leg syndrome or be a perpetuating factor to it.

In an interview with pain management doctor, Dr. Karl Hurst-Wicker, he explains the effects of peripheral myofascial pain on fibromyalgia centralization, and the same could be true for restless leg syndrome.


Diagnosing FM and RLS when you also have MPS can be tricky because it is known as the "great imitator." When RLS occurs alone, or with fibromyalgia, the symptoms predominate during sedentary periods, usually at night when you sit down or get in bed. However, RLS perpetuated by the trigger points of MPS can cause symptoms throughout the day, too. It’s important to know if you have this added attraction, because the treatment for trigger points is different from primary RLS or RLS with FM.

It’s important to know to source of your unusual leg symptoms because various treatments and medications for FM and RLS may overlap. It’s also important to know that blood deficiencies, medications, and myofascial pain syndrome can perpetuate or mimic the symptoms of restless leg syndrome. Equally important is to rule out other disorders that can cause the same symptoms so the right treatments are availed.

RLS and FM are both considered centralized disorders (meaning the problem originates in the central nervous system), and both affect restorative sleep. However, myofascial pain syndrome is a peripheral nerve disorder, outside the central nervous system. It is considered a perpetuating disorder and diagnosis does not include a primary sleep problem.

When There Is a Myofascial Component

Treatment for leg pain, cramping, and other symptoms due to myofascial trigger points are quite different. Myofascial [trigger points] can be felt by the examiner because they are knotted up pieces of muscle fiber. The only thing that will treat a trigger point is some type of physical intervention, like massage, stretching, (also recommended for RLS and FM), trigger point injections, active release therapy, or trigger point pressure therapy. The goal is to return the affected muscle, in this case the legs, ankles, and feet, to their normal resting length. Myofascial trigger points restrict motion and have a symptom pattern related to the location of the trigger point. If you have painful symptoms that restrict muscle motion, a doctor or physical therapist that specializes in myofascial pain can help you.

If you have restless leg syndrome symptoms, be sure to discuss them with your healthcare provider so the right tests, contributing factors, and treatment plan is developed to help you.

Celeste Cooper, RN
Meet Our Writer
Celeste Cooper, RN

Celeste Cooper, R.N., is a freelance writer focusing on chronic pain and fibromyalgia. She is lead author of Integrative therapies for Fibromyalgia, Chronic Fatigue Syndrome, and Myofascial Pain and the Broken Body, Wounded Spirit: Balancing the See-Saw of Chronic Pain book series. She enjoys her family, writing and advocating, photography, and nature. Connect with Celeste through Twitter @PainedInkSlayer.