Preventing deep vein thrombosis (DVT) during air travel

Also known as “economy-class syndrome” because of the cramped seating, D.V.T. also occurs among those who fly in business class and first class, researchers at Leiden University Medical Center in the Netherlands had found. D.V.T. occurs when a blood clot forms within the large deep veins of the body, usually in the leg. If untreated, part of the clot may break off and travel to the lungs, most times causing a pulmonary embolism, a potentially fatal condition said Dr. Robert Bos, MD. in an interview by The Prehab Network. Obesity a person’s stature, oral contraceptive use, hormone replacement therapy and inherited blood clotting disorders also increase the risk added Dr. Bos.

According to Alex Gomez, PT, DPT, president of Prehab USA, and EastSide Rehab in New York City and member of the American Physical Therapy Association (APTA), blood clots, can occur after periods of being immobile, such as on long plane and car rides.

Dr. Gomez stated that long periods of immobility with the knees bent increases the risk of DVT especially during travel of 8 hours or more1. An estimated 10 percent of passengers on long flights may develop a DVT.² it’s common for a clot in the legs to dislodge and travel to the lungs, called pulmonary embolus. The symptoms of leg DVT include swelling in one or both legs and tenderness in the calf, fever, unexplained cough. Symptoms of a pulmonary embolus include shortness of breath and a high heart rate. “People who experience any of these symptoms should always see the doctor, especially if they occur following a long period of immobilization,” he says.

He warns against wearing commercial compression stockings. They are only effective if custom fit; if not, they may cause harm by blocking blood flow. Dr. Gomez also recommends that when there is little room to move and stretch, do some simple, seated exercises to keep the blood flowing, the joints mobile, and the muscles relaxed while en route. Prehab,” a guide to prevention of injury” known for its effective selection of recommended exercises to prevent sports injury and enhance sports performance also includes tips on how to prevent low back and neck pain typical of extended immobility during a long flight or car ride.

The APTA suggests that passengers not stay seated for the duration of the flight and recommends that passengers walk up and down the aisle of the plane every hour or so to work the leg muscles and ease the back – that is, if the captain has turned off the “Fasten Seat Belt” sign!

The following exercises will help prevent fluid build-up in the legs, and stretching the back and the muscles around the torso will prevent stiffening,” says. Passengers with pre-existing neck, back conditions or DVT, appropriate guidance should be given to you by your physical therapist before any extensive flying.

The following are factors that would indicate a higher risk of developing DVT.

  • Obesity.
  • Smokers.
  • Dehydration.
  • History of DVT in the family.
  • Recent surgery or have been wounded.
  • If you have varicose veins or heart failure.
  • Pregnancy.
  • Under hormone replacement therapy (this includes the use of estrogen pills).
  • If you have been sitting in the same position for more than 24 hours.
  • Any conditions that increase the risk of blood clotting.
  • If you are older than 40

Recommended exercises to help prevent DVT:

Note: Do not perform these exercises if you present with any of the above symptoms or they cause pain or discomfort and consult a physician.

Ankle Rolls: Move both ankles in a circular motion clock wise then counter clock wise. Rotate your ankles in each direction for about 15 seconds.

Toe and heel lifts: With your feet on the floor bring your toes up as high as you can.  Then alternate by pulling your heel up while keeping the balls of your feet on the floor. Continue this exercise for about 15 seconds in each foot.

Knee lifts: Bend your knees about 90 degrees and raise your leg making a good muscle contraction while resisting your hand on your thigh. Repeat these exercise 15 repetitions.

Shoulder clocks: Elevate your shoulders moving them in a circular motion reaching the end of the possible ranges in all directions upward forward back and down.

Hip Flexion: Grasp your knee with both hand and bring your leg up toward your chest. Hold this your knee for about 3 seconds and repeat 10 times alternating with the other knee.

Hip External Rotation stretch: Bring one foot up and rest it over the other leg’s knee, then put downward pressure over the knee until gentle stretch is felt. Hold the stretch for 3 seconds and repeat 10 times in each leg.

Low Back Stretch: With both feet on the floor open at the width of your shoulders, bend forward until your chest is the closest to your knees by pulling on the bottom of the seat or your legs until a gentle back stretch is felt. Hold that position for 3 seconds. Put your hands on your knees and push your body up with your hands to avoid back strain.

Shoulders and upper back stretch: Clasp your hands behind your neck, stick your chest forward and move your shoulders back allowing the elbows outward and back as far as possible. Hold this position for 3 seconds and repeat 10 times without disturbing the passenger next to you.

Neck and traps stretch: Grasp one wrist and bring the arm down and across the body. While pulling on your wrist with the other hand bend your head toward the same side and slightly forward until you feel a firm stretch on your upper back traps and neck. Hold this position for 3 seconds and repeat 5 times on each side.

If you have any pain in your lower legs or present with any of the DVT symptoms avoid any massages in the area and consult with your physician.

  1. Aryal KR, Al-Khaffaf H. Venous thromboembolic complications following air travel: what’s the quantitative risk? A literature review. Eur J Vasc Endovasc Surg.2006;31:187-99.
  2. Scurr JH, Machin SJ, Bailey-King S, Mackie IJ, McDonald S, Smith PD. Frequency and prevention of symptomless deep-vein thrombosis in long-haul flights: a randomised trial. Lancet. 2001;357:1485-9.