By Dr. Yoon Jeon. MChiro, MB, BSc, Dip.TCM, PGCert.
Case Presentation
An 88-year-old woman attended our clinic in Southampton with a long history of Restless Legs Syndrome (RLS), which had progressively worsened over approximately 10 years.
Initially, her symptoms occurred predominantly at night. However, as the condition progressed, she began experiencing symptoms during the daytime as well.
The discomfort had become increasingly troublesome, significantly disturbing her sleep and affecting her daily activities.
The patient also described intermittent episodes of sharp, stabbing pain affecting her right toes, both shins and the inner thighs. These episodes occurred approximately two to three times daily.
At times, her leg symptoms were sufficiently troublesome while walking that she became concerned about losing her balance or falling.
She had previously consulted her GP and was prescribed Ropinirole, a dopamine agonist commonly used in the management of RLS.
Although the medication provided some relief, the benefit reportedly lasted only four to five hours before her symptoms returned.
Frustrated by the persistent symptoms and disrupted sleep, she decided to explore acupuncture as an additional treatment option.
The patient understood that acupuncture responses vary and that improvement could not be guaranteed.
Clinical Examination
The initial consultation identified several significant clinical features:
Long-standing, progressively worsening restless legs symptoms
Symptoms originally occurring at night but subsequently extending into daytime hours
Frequent sleep disturbance associated with leg discomfort
Intermittent sharp pain affecting the lower limbs
Concerns about walking confidence and balance
Partial and relatively short-lasting relief from prescribed Ropinirole
Her medical history and current medication were reviewed as part of the consultation.
In addition to Ropinirole, she reported taking Amlodipine, Simvastatin and Amitriptyline.
The combination of typical restless legs symptoms and intermittent sharp leg pain was considered clinically important, as the latter could potentially indicate an additional neuropathic or musculoskeletal component.
Clinical Impression
The overall presentation was consistent with:
Chronic Restless Legs Syndrome (RLS)
Progressive worsening of symptoms, with daytime involvement
Significant sleep disturbance associated with RLS
Intermittent lower-limb neuropathic-type pain
Incomplete and short-duration symptomatic relief from existing medication
The possibility of additional neurological or musculoskeletal contributors to the sharp leg pain was also considered.
Given her age and concerns about walking, monitoring of balance, neurological symptoms and fall risk was considered important.
Treatment
An initial course of five to six acupuncture sessions was recommended, with regular monitoring of symptoms and sleep quality.
Traditional Acupuncture
An individualised acupuncture treatment programme was provided, focusing primarily on the lower limbs and areas affected by restless legs symptoms.
Acupuncture points were selected according to the patient's clinical presentation, with the aim of alleviating discomfort and supporting better sleep.
TDP Heat Therapy
Gentle therapeutic heat was applied alongside acupuncture to provide additional comfort during treatment.
Home Exercises and Self-Care
The patient was encouraged to continue regular gentle stretching exercises, particularly involving the calves and lower limbs.
Outcome
The patient experienced a significant and progressive improvement following the commencement of acupuncture treatment.
After the initial treatment, she began noticing a reduction in leg discomfort and reported several nights of substantially improved sleep.
As treatment continued, her sleep became less disrupted. Although she occasionally woke during the night, she was increasingly able to return to sleep quickly, which represented a considerable improvement compared with her previous symptoms.
The frequency of restless legs episodes also decreased markedly. At a subsequent review, she reported experiencing symptoms on only one night during the preceding week and expressed considerable satisfaction with her progress.
By the six treatment session, approximately 5 weeks after commencing acupuncture, the patient reported feeling very well and had experienced no restless legs symptoms since her previous appointment.
This was particularly encouraging given her approximately 10-year history of progressively worsening symptoms and the limited duration of relief previously obtained from prescribed medication.
Further follow-up was arranged to monitor whether the improvement would be sustained before considering discharge from active treatment.
Discussion
Restless Legs Syndrome can be particularly challenging when symptoms have persisted for many years and begin to interfere with both sleep and daytime functioning.
In this case, the patient's symptoms had progressed over approximately a decade, with increasing discomfort and incomplete relief from prescribed medication.
The improvement reported during the acupuncture treatment course was encouraging, particularly considering the long duration of symptoms.
After the first treatment, the patient began experiencing better sleep.
Subsequent visits demonstrated progressive improvement, with increasingly infrequent symptoms.
By the fifth appointment, she reported no restless legs symptoms since her previous visit.
These changes were clinically meaningful from the patient's perspective, particularly the improvement in sleep and reduction in troublesome leg sensations.
However, several considerations are important.
RLS symptoms may fluctuate naturally, and this was an individual case involving acupuncture, supportive heat therapy, home exercises and supplementation alongside existing prescribed medication.
It is therefore not possible to determine the specific contribution of acupuncture or any other individual intervention.
Furthermore, the patient had previously reported intermittent sharp leg pain that was not necessarily attributable solely to RLS.
Continued monitoring and appropriate medical reassessment remain important, particularly if neurological symptoms, walking difficulties or balance concerns persist or worsen.
Current clinical guidelines also emphasise the importance of evaluating iron status, reviewing potential aggravating factors and assessing medication-related complications in patients with persistent RLS.
Acupuncture may be considered as an adjunctive approach for selected patients, but further high-quality research is required to establish its effectiveness and role in routine RLS management.
Conclusion
This case describes a favourable short-term outcome in an elderly patient with approximately 10 years of progressively worsening Restless Legs Syndrome.
Before attending the clinic, the patient experienced frequent night-time symptoms, disturbed sleep, daytime leg discomfort and incomplete relief from prescribed medication.
Following a course of acupuncture combined with supportive heat therapy and home management, she reported progressive improvement in both leg symptoms and sleep.
By the six treatment visit, the patient reported feeling very well and had experienced no restless legs symptoms since her previous appointment.
Although longer-term follow-up is required to determine whether the improvement is sustained, the initial response was encouraging.
This case illustrates the potential role of individualised acupuncture care as an adjunct to conventional medical management for patients experiencing persistent RLS symptoms.
References
Winkelman, J.W. et al. (2025). Treatment of restless legs syndrome and periodic limb movement disorder: an American Academy of Sleep Medicine clinical practice guideline. Journal of Clinical Sleep Medicine, 21(1), 137–152. https://doi.org/10.5664/jcsm.11390
Silber, M.H. et al. (2021). The Management of Restless Legs Syndrome: An Updated Algorithm. Mayo Clinic Proceedings, 96(7), 1921–1937. https://doi.org/10.1016/j.mayocp.2020.12.026
Clinical disclaimer: This case study describes the reported experience of an individual patient. Improvement following treatment does not establish a causal relationship, and similar results cannot be guaranteed.
