For many people, varicose veins and spider veins—a common, mild variation of varicose vein—are simply a cosmetic concern. For other people, varicose veins can cause aching pain and discomfort. Sometimes varicose veins lead to more serious problems. These can include severe pain, swelling and discoloration of the legs. More serious are skin ulcers near your ankle, which are caused by long-term build-up of pressure from blood not draining from these veins. This is called venous stasis. People with varicose veins are also at risk of a blood clot forming in the deeper veins (deep vein thrombosis).
The term “varicose” is derived from the Latin word “varix,” which means “twisted.” Normally, one-way valves in veins keep blood flowing from the legs up towards the heart. When these valves do not work properly, blood pools in the legs, and pressure builds up. This causes the veins to become twisted and/or bulging. Any vein may become varicose, but the veins most commonly affected are those in the legs and feet. The reason for this is because walking and standing upright increases the pressure in the veins of the lower body.
Varicose veins are a pervasive health problem that affects millions of people throughout the world. In fact, it is estimated that 40% of men and 50% of women in the United States over the age of 50 suffer from some form of vein problem. Unfortunately, many people regard the condition as a strictly cosmetic issue, unaware of the physical discomfort and emotional stress it can cause.
Definition of Varicose Veins
Varicose veins are defined as dilated, elongated, and twisted veins that are usually found in the lower limbs. The word “varicose” comes from the Latin word “varix”, which means twisted. Veins in the legs have a system of one-way valves, which assist the return of blood back to the heart. When those valves become weak or damaged, blood can collect in the veins and cause them to become twisted or enlarged. Varicose veins are a very common condition, with about half of the population having some form of venous disease and over 80 million Americans having varicose veins. Women tend to suffer from varicose veins more than men, and the incidence increases with age. About 50% of people aged 50 and older are affected by varicose veins. Many patients with varicose veins are asymptomatic, while others can have mild to severe symptoms. Varicose veins can also lead to more serious health conditions such as chronic venous insufficiency, skin changes, or venous ulcer, which can impair the quality of life and in some severe cases, lead to disability.
Prevalence of Varicose Veins
Prevalence of varicose veins: The author discusses the problem with counting the prevalence of varicose veins because some people can be asymptomatic and not seek treatment. Also discussed is the fact that varicose veins occur more frequently in women than in men, and the prevalence increases with age. Finally, there is a discussion about the genetic component of varicose veins and how it affects the prevalence and age of onset. This is believed to be due to congenitally weak vein walls and vein valves. This genetic predisposition works in conjunction with environmental factors that put additional stress on vein walls. An example of such an environmental factor is an occupation that requires prolonged standing or sitting. All of these factors increase the prevalence of varicose veins in certain people and help the reader to better understand why they occur. The high prevalence of varicose veins in those who stand for prolonged periods is partially because standing increases the pressure in the veins of the lower body, and the increased pressure often leads to the development of varicose veins.
1.3. Symptoms of Varicose Veins
Varicose veins are rope-like, bulging veins that often have a darkish blue or purple color. They most often appear in the legs and can sometimes cause pain, blood clots, skin ulcers, or other problems. Spider veins are similar to varicose veins, but they are smaller. Normally, these veins are found slightly under the skin’s surface and occur in 10% of men and 20% of women. The first sign of varicose veins is when they are small or the transient appearance of an ankle or leg swelling after standing for a long time. Any minor injury to the affected area may cause a ruptured, superficial varicose vein and result in extensive blood loss. This is a typical point when people seek medical advice, as in some cases, it requires medical intervention. Often, the heat and friction from walking will cause the skin to be itchy or inflamed. Over time, skin changes may occur. An area of the skin on the lower leg may shrink because the skin is thickened and has fat deposits, and the skin will change color. Finally, an open sore may develop and possibly bleed. This is a serious situation and requires the care of a qualified physician.
Role of Physical Therapy in Varicose Vein Symptom Relief
An effective physical therapy program for patients with varicose veins usually includes a combination of aquatic exercises and standard cardio exercises. Aquatic exercises such as walking in a pool are beneficial for prevention of pooling of blood in the lower extremities. Walking in water provides resistance in opposition to gravity and facilitates muscle activity while allowing full joint motion and increased venous return. This can also be achieved through swimming which is also an excellent form of exercise for this population. Standard cardio exercises such as walking, biking, and rowing, done at a low intensity, are simple and effective ways to obtain increased muscle activity and venous return from the lower extremities. Static cardiovascular exercises are also an option for patients who may have difficulty with weight-bearing exercises. Leg elevation through movement of the legs allows muscle activity without requiring the legs to support body weight. High-impact exercise should be avoided due to the risk of trauma to the legs. Step aerobics and jogging place added pressure on the legs through impact and may make symptoms worse.
Physical therapy is a conservative approach to treating varicose veins that benefits the patient with increased strength, flexibility, and endurance. Physical therapy is a positive approach to increase venous return from the lower extremities. This is important because most problems with varicose veins derive from the venous circulation from the lower extremities. With increased venous return reinforced by muscle activity, there is less pooling of blood in the veins. Less pooling in the veins means less distention to the vessel walls resulting in decreased varicosities. Although there are no specific exercises to prevent varicose veins or to eliminate them once they have occurred, there are still a variety of exercises that patients can do to relieve painful symptoms caused by varicose veins. For any exercise, it is important to avoid activities that place added pressure on the legs such as prolonged sitting or standing, as well as the avoidance of heavy lifting.
Importance of Physical Therapy
Exercise has been shown to improve arterial and venous circulation, as well as increase strength and coordination of the calf muscle pump, which is the primary anatomical and physiological component of the venous return of the lower extremities. A Cochrane review in 2011 suggested that patients with chronic venous insufficiency or varicose veins are recommended to have regular leg exercises. This is achieved through calf muscle exercises, walking, or aquatic exercises with the goal of increasing general physical activity. A study researching the effect of high resistance weight training and abdominal floor flexor on abdominal straining in patients with varicose veins suggested that these types of exercises do not exacerbate the symptoms of varicose veins compared to those who do not exercise. An emphasis should be made on low-impact activities and exercises, as high-impact activities may put additional stress on already weakened valves in the veins. Another study found that walking has similar venous return pumps to compression stockings in a study with healthy individuals. This is beneficial for those with varicose veins, with the prospect of recommending it to improve symptoms. Step tests and functional exercises should be avoided if they reproduce symptoms in the lower limb. This should be monitored carefully, as exercise prescriptions need to be tailored on an individual basis due to the wide discrepancies in symptoms and different severities of varicose veins.
Physical therapists are specialists in movement and movement dysfunction, focusing on enhancing quality of life. Patients with varicose veins often experience aching, heaviness, cramping, swelling, and fatigue in the legs. These symptoms are often exacerbated by prolonged standing or sitting. The presence of these symptoms restricts patient activities of daily living and recreational activities. The purpose of physical therapy interventions is to alleviate these symptoms and prevent the progression of venous dysfunction. PT has been proven to improve symptoms in patients with chronic venous insufficiency because PT is a safe and effective approach with minimal adverse effects.
Benefits of Physical Therapy for Varicose Veins
Specific benefits of exercise therapy identified by van Bemmelen’s group include the increased pumping effectiveness of the calf muscle, improved function of calf muscle in maintaining the calf muscle pump and improved venous return to the heart. These benefits are likely to occur from an exercise program emphasizing lower limb strength and conditioning and may therefore act to slow the progression of chronic venous insufficiency. Other potential benefits of exercise therapy for patients with varicose veins include improved mobility and greater ease of performing activities of daily living, through reduced leg symptoms and leg edema. This is likely to improve the patients quality of life and reduce the impact of varicose veins on their functional independence.
The benefits of physical therapy in symptom relief from varicose vein disorders have been noted in the medical literature over many years. Rhodin and Lindgren (1966) noted the effects of positioning in bed exercises of foot and leg muscles for increased blood flow, and outlined specific exercises to aid patients with varicose veins. The general concepts mentioned by these authors are often used today by physical therapists and they form the scientific basis for the use of exercise therapy for patients with varicose veins. As research into the causes of varicose veins and chronic venous insufficiency continues, the diversity of exercise approaches prescribed by physical therapists is likely to increase. This point is important, as there is no single cause for varicose veins and no single type of exercise is likely to be effective for all patients. It is therefore crucial that a physical therapist performs a thorough evaluation of the patient, their veins and their general health, before prescribing an individualized exercise program.
Types of Physical Therapy Interventions
If the patient has chronic pain, a trial of iontophoresis (medication delivery using electrical current) of anti-inflammatory medication can be done. This may help alleviate the pain and discomfort of the patient at the beginning of treatment. Lastly, in more severe chronic cases of varicose veins and stasis ulcers where the skin is quite damaged and is not improving with other treatments, a therapist will do an ultrasound with the intent of giving the patient a referral to a surgeon for varicose vein stripping. While varicose vein stripping and other surgical/medical treatments are not within the scope of practice of a physical therapist, it is important to know in what circumstances a referral to a surgeon may be necessary.
Passive physical therapy interventions follow a basic routine. First, to improve the blood flow in the leg, a therapist will massage the leg in an upward motion toward the heart. This effect will promote the release of pooling blood as well as reduce pain and discomfort. The next step is compression therapy. This is the use of compression stockings. These are special stockings that are much tighter around the foot and looser as they go up the leg. This gradient of pressure will help move along the upward flow of blood. Stockings are a good alternative treatment in that they do not require any change in the patient’s lifestyle and have little to no side effects.
For the most part, physical therapy interventions are divided into two forms of therapy. The first is passive physical therapy. These are treatments that are done to the patient. The second is active physical therapy. This involves exercises and other activities that a patient can do to reduce their symptoms.
Exercises for Varicose Vein Symptom Relief
Yoga can be an effective form of exercise for those with varicose veins, as it tends to focus on relaxation and gentle movements to improve body flexibility. Though yoga can be effective, not all yoga positions are recommended as there are some positions that can potentially make varicose veins worse. Hatha or Iyengar yoga are the recommended types of yoga to ease varicose vein symptoms, and the instructor should be familiar with the symptoms and precautions. Other forms of stretching exercises to improve varicose veins include rolling on the floor to elevate the legs up the wall or lying down and using a pillow to elevate the legs while bringing the arms together above the head. The legs should be elevated for at least 15 minutes while taking deep breaths, and this should be done 4-5 times a day. All of these exercises help to improve blood circulation, with the legs up the wall position known to help drain blood from the legs leading to reduced swelling and pain in the lower limbs.
Low-impact exercises such as swimming and cycling are effective methods of improving varicose veins. Aerobic exercise is known to improve chronic venous insufficiency as it helps to improve the calf muscle pump. When your calf muscles contract, it helps move blood to your heart. As a result, the more you walk and move, the better your blood will pump through your legs back up to your heart. Regular aerobic exercise can reduce swelling and discomfort in the legs, as pooling of the blood and fluid buildup are reduced. This can also prevent new varicose veins from developing. If you prefer not to go swimming or cycling, simple regular walking will also improve your condition, aiming to walk at least 30 minutes every day. Brisk walking is known to be an excellent aerobic exercise that has the potential to improve varicose veins.
Strengthen your legs with simple exercises such as calf raises several times a day to improve or avoid obtaining varicose veins. Exercising can help lower blood pressure in your veins and slow down the rate at which new varicose veins develop. Strengthening your leg muscles will help to create a stronger support for your veins, as the healthier the veins and valves, the less pressure. This will, in turn, improve the appearance of the varicose veins as there will be less coloring and bulging if the pressure is reduced. An easy exercise that will further strengthen your leg muscles and veins is to lie flat on the floor and lift your leg up, moving it in a circular motion as if using a pair of scissors. You should aim to do this 15 times an exercise with each leg.
Leg Strengthening Exercises
When exercising a muscle, it will only strengthen and improve in size if the resistance is gradually increased as it becomes capable of working against the initial load. Any form of calf raises is perhaps the best way to strengthen the calf muscle. This can be done using either a loaded calf raise machine or by performing ‘body weight’ raises (or raises using some external form of weight) on a step or block. This exercise should be done with 3 sets of 10-15 raises, with as much of the raise phase done on one foot as possible (the lowering phase can be done using both feet). It is important to build up the resistance for this exercise, and if you are using a machine, the weight should be increased as strength improves.
Muscle weakness in the lower leg is a common problem for individuals who suffer from chronic venous insufficiency and/or varicose veins. Prolonged sitting and standing tends to weaken the calf muscle, which in turn can lead to an aggravation of venous problems. Weak calf muscles act as a secondary “pump” for venous blood return to the heart. When the calf muscle contracts, it forces blood out of the leg against gravity, and any weakness or impairment in the calf will result in decreased blood flow out of the leg. At worst, this can exacerbate the venous hypertension within the leg and lead to more symptoms and signs of venous disease. It is therefore important to keep the calf muscle ‘in shape’ and various strengthening exercises can be used to achieve this.
Aerobic Exercises
The very best types of workout are walking, swimming, and biking because they keep the calf muscle in consistent motion while varying the forces on each leg. Avoid running and jumping since landings put high-impact forces on the legs. Individuals with fatigue, leg discomfort, or pain with walking that is relieved by rest should look for a medical assessment for intermittent claudication. This condition, caused by inadequate blood circulation to the legs, might restrict exercise tolerance and it can be connected with more serious vascular conditions.
Exercise that is carried out regularly might aid those with varicose veins. Enhancing circulation and enhancing muscle tone is the aim. Prior to starting aerobics and strengthening workouts, it is essential to examine for and deal with any hidden venous condition to prevent worsening of signs.
Stretching Exercises
Another form of exercise that is effective at relieving symptoms of varicose veins is aerobic exercise. Aerobic exercise is one of the best treatments for chronic venous diseases. Epidemiological evidence suggests that light to moderate lifelong physical activity is associated with a reduced incidence of varicose veins. A randomized clinical trial has found significant improvement in all symptoms of chronic venous disease with the daily performance of a 15-minute fitness walk over a six-week period. This study also found that aerobic exercise improved calf muscle function and reduced ambulatory venous pressure.
According to authors, for relief of varicose vein symptoms (swelling, tightness, fatigue, and discomfort in the lower extremities), it’s important for patients to perform leg elevations and to avoid prolonged periods of standing and sitting. The patients were asked to perform leg elevation for 30 minutes with the legs at 45 degrees. During leg elevation, the patients experienced a reduction or complete resolution of their symptoms. The symptoms returned immediately on resumption of activities. These findings indicate that while standing or sitting, the venous pumping function can be improved by performing the leg elevation exercise.
Lifestyle Modifications for Varicose Vein Symptom Relief
Wearing Compression Stockings Wearing compression stockings can be a very effective means of relief for mild varicose vein symptoms. In a healthy individual, as much as 70% of the body’s blood volume is in the veins of the legs. Squeezing the veins of the lower legs with gradient compression provided by elastic stockings will enhance venous blood flow and minimize the symptoms of leg swelling and fatigue. There are different sizes and pressures of stockings. They can be fitted by a specialty store or medical supply shop and are worn up to waist high for the greatest effect on the veins.
Avoiding Prolonged Sitting or Standing Both sitting and standing for long periods are bad for vein health. They tend to pool the blood in the legs and increase pressure within the veins. However, it is easier to change the sedentary behavior of sitting for long hours. People with jobs that require extended periods of sitting should try to get up and move around at least once every 30 minutes to increase leg muscle activity and improve blood flow. Additionally, elevating the legs above the level of the heart for a few minutes several times a day can provide significant symptom relief. Those folks whose jobs require prolonged standing are at a more difficult situation since standing is better than sitting for vein circulation and the job activity is unlikely to change. However, there are exercises and position changes of the lower limbs that can be done to increase the calf pump activity and decrease symptoms.
Healthy Diet and Weight Management While a direct link between diet and varicose veins is difficult to establish, the value of a low-fat, high-fiber diet in preventing other circulatory diseases is well known. Since obesity is a risk factor for varicose veins, weight reduction is a good goal for overweight individuals and may result in decreased severity of their varicose vein symptoms.
It is easy to overlook lifestyle and environmental factors as contributors to varicose vein development or as agitators to existing symptoms. It is also easy, once diagnosed with varicose veins, to dismiss lifestyle changes suggested by the physical therapist as irrelevant to symptom relief. However, research has shown that attention to diet and activity can have a positive impact on the course of the varicose vein disease and its symptoms.
Healthy Diet and Weight Management
Visit with your physician before you start a diet or exercise regimen. If your family doctor gives you the OK, the best plans for losing weight and helping varicose veins contain meals reduced in calories and fat, and a regular exercise program. More extreme measures are often suggested for those individuals with intractable venous skin ulcers. In these cases, significantly restricted caloric intake has been shown to reinforce ulcer healing. This result was demonstrated by patients completing a weight reduction program using a liquid formula diet. A direct association between the degree of weight loss and the speed of ulcer healing was observed.
Healthy diet and weight management might be another option for individuals with varicose veins to alleviate signs and stop future venous problems. Obesity is a significant risk factor for varicose veins. Excess pounds exert added pressure on the veins. Avoiding crash diets is essential, given that several lacking diet programs may actually make the issue worse via quick weight reduction followed by a time of increased weight. The best method to reduce weight may differ from one individual to another, however, the basics involve increasing activity and consuming less.
Avoiding Prolonged Sitting or Standing
It is important to avoid sitting or standing in the same position for more than 30 minutes. When possible, elevate the legs above the level of the heart. This helps to bring blood from the veins and legs back to the heart to reduce the workload on the veins. This relieves the feeling of “heavy legs” and swelling in the ankles. Any type of exercise that works the muscles in the legs will also help to increase circulation and reduce the pooling of blood. Remember that the calf acts as a “peripheral heart” and any muscle movement in the legs helps to pump blood up towards the heart.
Standing motionless or sitting for long periods will make the symptoms of varicose veins worse. Numerous occupations require either continuous sitting or standing, and if this is the case, it is important to take frequent breaks and change positions often. When still, prop the feet up whenever possible. If the situation can be changed, do so. For example, if you are required to stand for long periods, try to find a job where you can sit for short intervals and vice versa. Then there are those who sit at a desk with the feet dependent on one position, often crossing the legs. This can be an irritation to the veins since it can adversely affect circulation. Try to avoid sitting with the legs crossed and change position often, at least every 30 minutes.
Wearing Compression Stockings
Compression stockings are an essential part of treatment for varicose veins. They improve the symptoms by providing external support to the veins and by limiting the amount of blood that pools in the lower legs. Stockings act as a “second heart” and they are very effective in the prevention of new veins as well as decreasing symptoms in existing veins. Support is provided through graduated compression, which is tightest at the ankle and reduces in pressure going up the leg. It is not always necessary to wear full-length stockings as below-knee styles can be sufficient. Compression stockings are usually well tolerated; however, they can be difficult to put on and often require accurate measuring and fitting by a nurse. At first, they may need to be worn for most of the day, and although uncomfortable at first, the length of time should be increased until they are being worn for the majority of the day. It is important to replace stockings every 3-6 months as the elastic fibers become less effective. This method of treatment provides the best symptomatic relief for patients and should be used in conjunction with other forms of therapy.
