Restless Leg Syndrome (RLS) is a sensory neurological condition that causes uncomfortable leg sensations and a strong urge to move. Symptoms often flare when you rest, especially in the evening or at night, which can disrupt sleep and leave you feeling flat the next day.

Because symptoms can overlap with other issues, it helps to consider related contributors such as leg pain, nerve pain, or frequent muscle cramps. A physiotherapist can also guide practical strategies, including movement and sleep habits, as part of neurological physiotherapy.

What is Restless Leg Syndrome?

RLS is commonly described as cramping, soreness, creeping, crawling, tingling, or a deep “can’t-settle” feeling in the calves or feet. Symptoms can range from mild irritation to severe discomfort. Many people notice it most when seated for long periods or when trying to fall asleep.

Restless Leg Syndrome symptoms

Common symptoms include:

• An urge to move the legs when resting
• Unpleasant sensations in the calves, shins, or feet
• Symptoms that worsen in the evening or at night
• Temporary relief with walking, stretching, or shifting position
• Difficulty falling asleep or staying asleep
• Daytime fatigue due to poor sleep

What causes restless legs?

The exact cause of Restless Leg Syndrome is not always clear. However, it has been linked to:

• Iron deficiency or reduced iron availability
• Family history (RLS often runs in families)
• Chronic conditions such as kidney disease, diabetes, Parkinson’s disease, and peripheral neuropathy
• Pregnancy, especially the third trimester
• Certain medications (for example, some anti-nausea, anti-seizure, and antipsychotic medicines)

For an Australian overview of causes, symptoms, and when to see a doctor, see Healthdirect’s Restless Legs Syndrome guide.

Treatment for Restless Leg Syndrome

Medical

• Some medicines may help reduce symptoms in some people. A GP can discuss options and check whether any current medicines might be aggravating symptoms.
• If you are iron, folate, or magnesium deficient, your GP can arrange blood tests and recommend supplements when appropriate.

Therapy: exercise

• Movement often brings temporary relief. That’s why walking during a flare can feel helpful. A regular, moderate exercise plan may also help reduce symptoms and support better sleep. In contrast, very intense exercise (or training late at night) may aggravate symptoms for some people.

Your physiotherapist can guide you with a practical plan and adjust it based on your response. For general ideas, see physiotherapist-led exercise programs.

Therapy: massage, heat, and cold

• Although no single treatment suits everyone, many people find symptoms ease with regular remedial massage or targeted leg massage, especially in the evening.
• Using a heat pack, having a warm bath, or applying a cold pack to symptomatic areas for 10–15 minutes before bed may help some people settle symptoms.

Lifestyle

Some lifestyle changes may reduce symptoms, particularly when no clear medical trigger is present. These include:

• reducing caffeine
• reducing alcohol
• avoiding tobacco
• improving sleep routines and addressing stress

People also ask: why is RLS worse at night?

RLS often follows a daily pattern where symptoms increase in the evening. This may relate to nervous system activity, fatigue, and reduced distraction when you lie still. Many people also notice symptoms more when sleep is disrupted, which can create a frustrating cycle. Improving sleep habits can help, so you may find this guide useful: sleep therapy and pain management.

What to do next

If Restless Leg Syndrome affects your sleep or daytime energy, start with a review of triggers (caffeine, alcohol, stress, late-night training, and medications) and consider a GP review for iron status and other contributors. A physiotherapist can also help you build a steady plan for movement, recovery, and bedtime strategies.

References

• Winkelman JW, Berkowski JA, DelRosso LM, et al. Treatment of restless legs syndrome and periodic limb movement disorder: an American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med. 2025;21(1):137-152.
• Trenkwalder C, et al. Restless legs syndrome: abbreviated guidelines by the International Restless Legs Syndrome Study Group (IRLSSG). Sleep Med. 2024.
• Xu Y, et al. Unraveling Restless Legs Syndrome. Frontiers/Review article. 2025.