Chronic Venous Insufficiency: Will Physical Therapy Treatment Work?

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Chronic venous insufficiency develops when the veins in your legs prevent blood from circulating to your heart. A weakness in the one-way valves that pump blood from the legs to the heart can cause a pooling of blood in the legs. Chronic venous insufficiency may not be a life-threatening condition, but it can be unpleasant and incapacitating. The most common treatment given to patients who suffer from this condition is physical and compression therapy. 

So will physical therapy be able to treat chronic venous insufficiency? Some of the first non-invasive treatment options for chronic venous insufficiency use elevation, elastic compression, and exercise to improve blood circulation in the veins. If those approaches are ineffective or you require a more comprehensive treatment, your doctor may modify your treatment plan to include different treatments and therapies to help you manage your symptoms.

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Physical Therapy in Patients Diagnosed With Chronic Venous Insufficiency

Chronic venous insufficiency develops when the veins in your legs don't facilitate proper blood to flow back up to your heart. The veins in your body are protected from damage by valves located inside them. When these valves are healthy, your blood flows in the right direction.

But when the valves stop working properly, blood starts to flow backward. Blood will begin to pool in your legs as a result of damaged and faulty valves. This results in symptoms such as leg chronic edema, venous obstruction, and varicose veins.

A regular activity treatment program is essential to reversing the symptoms of venous insufficiency in patients with early or mild cases. Prolonged periods of standing or sitting might put a patient at risk for worse venous insufficiency symptoms, such as bleeding and venous leg ulcers. Patients with advanced venous insufficiency have a challenging time staying active.

Patients with healthy calf pump function can benefit from walking, jogging, bicycling, and swimming. With activity, patients with restricted venous outflow frequently experience more pain and swelling. Because of early leg exhaustion, patients with muscle pump failure have a significantly lower exercise tolerance. Patients who are unable to perform physical exercise may opt for alternative physical therapy treatments, such as compression therapy and elevation.

Treatments for Venous Insufficiency

Patients whose symptoms aren’t bothersome may not need treatment for chronic venous insufficiency. As far as treatment is concerned, the three E's — exercise, elevation, and elastic compression — will be used.

  • Elastic Compression – Elastic compression stockings are tightened up from the toes to the calves. The stockings exert additional pressure on the leg veins, preventing blood from flowing backward.
  • Elevation – Immediate pain relief to the lower extremities of a patient could be achieved by elevating the legs. A doctor may also advise a patient to raise his or her legs over the heart for 15 minutes 3 to 4 times each day. This may aid in the reduction of inflammation and swelling. If you must stand or sit for an extended period of time, bending your legs many times will aid blood circulation.
  • Exercise – As a result of physical exercise, blood travels through the legs more efficiently and muscle is built that can aid in better circulation.

Chronic Venous Insufficiency: What Are the Risk Factors?

When these valves become compromised, blood leaks backward, causing chronic venous insufficiency. Valve damage can be caused by aging, long periods of sitting or standing, or a combination of aging and decreased mobility. 

Blood pressure in the veins remains raised for long periods of time when veins and valves are compromised to the point where blood flow up to the heart is difficult, resulting in an insufficient venous pump and outflow obstruction. This venous disease is characterized by abnormal venous reflux and venous edema, along with changes to the skin and subcutaneous tissue, with venous ulcers representing the most severe stage.

This venous disease is most usually caused by a blood clot in the deep veins of the legs, a condition referred to as deep vein thrombosis. Apart from venous thrombosis, this condition can also be caused by pelvic tumors and vascular abnormalities, and it can also happen for no apparent reason. Swollen legs occur when the venous pump in the superficial veins of the legs struggles to hold the blood against gravity, resulting in sluggish blood flow out of the veins.

If you have risk factors for chronic venous insufficiency, you have a greater chance of developing the disease than most people. The following are the most significant risk factors:

  • Inactivity
  • Pregnancy
  • Deep vein thrombosis
  • Obesity
  • Smoking
  • Family history of varicose veins or diagnosed with varicose veins
  • Age over 50
  • Extended periods of standing or sitting
  • Female sex
  • Activities affecting the lower extremity venous anatomy

Can Exercise Help with Chronic Venous Insufficiency?

Chronic disease in the veins could result in significant discomfort. The overall quality of life in patients may be put at risk by these aches and pains. Fortunately, there are conservative approaches for chronic venous insufficiency that are minimally invasive. There are things you can do at home to help, like exercising more and establishing several healthy lifestyle changes, in addition to in-office treatments.

Recommended Exercises for Chronic Venous Insufficiency

If a patient suffers from chronic venous insufficiency, a vascular specialist or a physical therapist may recommend regular exercise. Increasing your physical activity doesn't have to be challenging, and overdoing it is counter-productive. You can keep your blood flowing by walking around the neighborhood or riding a stationary bike for 30 minutes several times a week.

Being physically active improves the circulation of your body while also conditioning your leg muscles. This movement can assist in the proper physical conditioning and pumping of blood from your legs to your heart. Stretching your calf and thigh muscles may also assist to enhance blood flow. The following are a few other exercises you can do to improve blood circulation.

1) Walking

Long periods of sitting or standing increase the risk of varicose veins and venous insufficiency. Sitting or standing for long periods of time causes poor leg circulation, making it more challenging for your veins to pump blood to your heart. As a result, blood can accumulate in your leg veins, intensifying internal venous pressure and placing strain on vein walls and valves. This weakens and impairs them over time, eventually causing venous and valvular insufficiency.

If you sit or stand for long periods of time at work, taking a half-hour break to walk around can significantly enhance blood circulation and range of motion in your legs. Walking is a low-impact activity that is suitable for people of different ages and abilities. 

A quick, brisk walk, whether during your lunch break or later in the evening, can improve not only the condition of your veins but also your overall wellness. Walking for 30 minutes a day increases blood circulation, stimulates and strengthens leg muscles, and helps to keep blood pressure in check.

2) Yoga

Yoga is a great low-impact structured exercise that works the entire body, increasing circulation and maintaining fitness levels. Yoga can help to relieve some of the pain and edema involved in dealing with venous insufficiency and varicose veins by incorporating gentle stretches with a wide range of poses that demonstrate a balance between flexibility and strength. 

Physical exercise and relaxation have a favorable effect on stress levels and blood pressure. Although yoga will neither cure or prevent venous disease, it can aid with symptom management by improving blood flow and circulation. Consult your doctor to see which yoga positions are safe for you and which ones you should avoid.

3) Cycling

Cycling is also a low-impact workout that promotes vein health. Cycling on a regular basis can help strengthen and tone leg muscles like the calves while also improving circulation. Calf muscle exercise improves the calf muscle pump function, which aids good circulation by pumping blood from the leg veins upward and back to the heart. 

Poor calf muscle pump function has been linked to a progressive worsening of symptoms in venous insufficiency patients. Although, frequent exercise in patients with venous disease can help maintain calf muscle strength. Cycling can help with edema caused by venous insufficiency, which can lead to a limited ankle range of motion.

4) Leg Lifts

Leg lifts are a simple stretch that often don't require any extra equipment. Begin by resting on your back and slowly lifting one leg at a time. For a few seconds, keep your leg in the air and count to 5. Repeat the process with your opposite leg. This exercise is beneficial for physical conditioning and stretching your legs, increasing the range of motion in your joints, and improving calf muscle strength.

Some people opt to perform leg lifts while in a standing position. This variation of the exercise can assist your muscles become more flexible. Leg lifts in an upright position are performed by extending one leg in front of you while using a steady object, such as a chair, for support. Hold your leg still for a few seconds before switching legs.

5) Swimming

Swimming is the best workout for boosting overall health and well-being, according to Harvard Health, regardless of the age or fitness level of a person. Swimming is especially beneficial for people with arthritis or limited mobility on the ankle joint. The buoyancy of the water shields the muscles, joints, and veins from pressure or damage. 

Patients can develop and strengthen muscles without the tension that other workouts can cause by simultaneously engaging muscular groups in the arms, legs, shoulders, and abdomen. Swimming promotes venous circulation and increases the range of motion in the lower extremities, while also providing a low-impact cardio workout for stronger and healthier veins.

Which Exercises Should Patients Avoid?

Two men in a gym lifting weights.

There are several exercises that can put pressure on your leg muscles, veins, and the ankle joint, if you have venous insufficiency or varicose veins. Excessive exercise might restrict blood flow and cause increased venous disease symptoms. People with chronic venous insufficiency should avoid performing the following exercises:

1) Weightlifting

Weightlifting puts a strain on your veins and increases abdominal pressure, making it more challenging for blood to circulate to the heart. Lifting can be safer with appropriate training and lighter weights, but people with venous disease must consult their doctor before beginning any weight training. Instead, resistance training could be a great alternative.

2) Running

While running strengthens your calf muscles, it puts extra pressure on your joints and muscles. Due to its high impact nature, running puts a lot of strain on your legs and ankles every time they come into contact with the ground, which might irritate or strain your veins. 

This may worsen venous symptoms like discomfort and edema in patients with varicose veins. By running on softer ground and wearing light compression stockings, your leg will be less likely to absorb shock.

3) Sit-ups and Crunches

Sit-ups and crunches raise abdominal pressure, which in turn raises the pressure in your leg veins. This allows blood to pool in the legs, aggravating varicose veins and if not treated properly, you might get venous insufficiency. 

When is Exercise Not a Suitable Treatment Option?

We understand that for some patients, regular physical conditioning through exercise isn’t possible. If exercise isn’t an option, you can still enhance your circulation and general vein health by doing the following:

  • Make sure blood flows properly by wearing compression garments.
  • Do calf raises or rock your heels back and forth to activate the calf pump function in the muscles and improve venous circulation.
  • Raise your legs up to decrease swelling while keeping your blood flowing.
  • Rotate your ankle joint to ensure blood circulates back to your heart and combat ankle immobility.

Although most forms of exercise are beneficial and healthy, not all activities are suitable for everyone. While exercise won’t cure or prevent venous disease, it will assist to relieve symptoms and maintain the health of your veins. Overexertion, on the other hand, might result in strain and pressure on your calf muscle pump function, which can lead to edema or discomfort.

Ask your doctor if any of the physical activities listed are appropriate for you. If you're expecting a child, consult your obstetrician before beginning a new fitness routine. Listen to your body, even if you're in excellent health. Stop immediately and seek medical advice if any activity gets uncomfortable or makes you dizzy.

When Should Patients Consider Other Treatment Options?

Although exercising can generally provide significant relief from uncomfortable chronic venous insufficiency symptoms, it isn't always sufficient to resolve your condition. Venous insufficiency  can form even if you're physically active, and they can progress even if you exercise regularly. Additionally, physical therapy in patients may not be enough to address the clinical manifestations of the condition.

The treatment of patients with venous insufficiency will be determined by their venous symptoms, age, and overall health. It will also be determined by the clinical severity score of disease and your desired outcomes from the treatment. Chronic venous insufficiency can be treated with a combination of treatments and therapies coordinated with your physical therapist and vascular specialist. 

In some cases, the veins have become too damaged for conservative approaches. Vascular surgery may be required in cases of abnormalities or blockage of blood vessels caused by ruptured blood vessels caused by years of over-stressing. A key objective of venous insufficiency treatment is to reduce the pooling of blood and prevent venous leg ulcers.

Alternative Treatment Options for Chronic Venous Insufficiency

If you observe severe symptoms of chronic venous insufficiency, you should seek treatment from a venous disease specialist. While chronic disease in the veins are likely to worsen without intervention, medicines and lifestyle changes can help to delay the progression. If conservative approaches fail, your illness can be treated using a variety of procedures and surgeries, depending on your desired outcomes.

1) Skincare

It’s essential to maintain excellent skin hygiene. Keep your skin hydrated to prevent flaking and cracking to combat the symptoms of venous insufficiency. If the skin is irritated but doesn’t have an active ulcer that is ruptured or leaking fluid, your doctor may prescribe an anti-itch cream with hydrocortisone, a zinc oxide lotion to protect the skin, or an antifungal cream to combat fungal infections.

If you’re suffering from an active ulcer, wet compresses are applied to lower extremity wounds that are leaking fluid. Your doctor will show you how to use multilayer compression bandages to protect the surface of the skin and maintain blood flow if you have venous ulceration.

2) Medication

  • Antibiotics – Antibiotics can be used to treat skin infections caused by chronic venous insufficiency, but the underlying condition must be addressed to avoid recurrence. Antibiotics can also be used to treat deeper infections and venous stasis ulcers.
  • Unna boot – An Unna boot is a medicated wrap that combines multilayer compression with a semi-rigid wound cover made of zinc oxide gel. There are other multilayer compression systems available, which are frequently used in tandem with topical wound care medications, to treat venous leg ulceration.
  • Vena-Stat – Vena-Stat, a herbal dietary supplement containing a derivative of horse chestnut extract, has proven to be beneficial to some patients. Herbal medications shouldn't be used in replacement of prescription pharmaceuticals, and they should be taken with caution because they may interact with other prescriptions, causing adverse events.

3) Non-invasive Treatment

If your chronic venous insufficiency symptoms are severe and aren't responding to medical treatment, your doctor may suggest a minimally invasive procedure. Make an appointment with a reputable vein specialist who is experienced in a variety of techniques for treating chronic venous insufficiency.

These techniques seal the vein that is causing the problem. Blood is rerouted through different blood vessels by your body. The following are some of your options to treat chronic venous insufficiency:

  • Sclerotherapy – Sclerotherapy is a procedure that includes injecting a solution into spider veins or small varicose veins, causing them to collapse and dissolve. Sclerotherapy is a straightforward, low-cost procedure that can be done at the doctor's office. Sclerotherapy can relieve the pain and discomfort of these veins while also reducing the risk of consequences like venous hemorrhage and venous ulceration. 
  • Endovenous Thermal Ablation – Endovenous thermal ablation is a popular treatment that generates intense local heat in the diseased vein using a laser or high-frequency radio waves. Each energy source has its own technology, but both types of local heat close in on the target vessel. This procedure seals the damaged veins while leaving them in place, resulting in minimum bleeding and bruising. 
  • Radiofrequency (RF) Vein Ablation – A thin tube called a catheter is used in these minimally invasive treatments. A tiny laser or radiofrequency ablation device is threaded into the vein by your doctor. Lastly, the vein is sealed closed by the heat.

4) Surgical Treatment

There are several surgical options available for the 10% or fewer of patients requiring vascular surgical treatment. These include vein ligation and stripping, ambulatory phlebectomy, and bypass surgery. The following is a short description of each of these techniques. Your doctor can advise you on the best treatment option, depending on the clinical severity score of your condition and your desired outcomes.

  • Ligation and Stripping – Ligation and stripping are frequently used in tandem. Vascular surgeons cut and tie off the damaged veins during a vein ligation surgery. The majority of patients recover in a few days and can return to their normal routine. Stripping is a surgical procedure that involves the removal of bigger veins, such as the saphenous vein, through 2 tiny incisions.
  • Phlebectomy – A vascular surgeon extracts the diseased vein through microscopic incisions in your leg during a phlebectomy surgery. You'll need to wear compression stockings for a few weeks after the treatment, but you'll be able to resume your normal activities soon after.
  • Vein Bypass – Your surgeon may conduct bypass surgery if the condition of your venous disease is serious. To reroute blood flow around the failing vein, this open surgery utilizes an artificial vein or a vein from another part of your body. An upper thigh bypass procedure is used only for the most severe cases of chronic venous insufficiency that don't respond to other treatments.

Consult a Vein Removal Specialist at Vein Center Doctor

Whether you have mild or chronic clinical signs of venous insufficiency, you deserve a treatment plan that’s tailored to your specific needs, desired outcomes, and lifestyle, as well as the severity of disease. To avoid more significant vein diseases that can negatively impact quality of life in patients, it's critical to keep veins and overall health in good shape.

At the Vein Center Doctor, we provide non-surgical treatments and consultations for venous diseases. Our team of skilled doctors can make an accurate diagnosis and offer the best course of treatment for your vein condition. Get in touch with us today to schedule an appointment with one of our vein specialists.

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