Surprising as it may seem, venous insufficiency is extremely common among athletes and is frequently the cause of decreased performance. The truth is, we don’t commonly think of healthy athletes as having circulatory problems and that is absolutely true when considering the arterial side of the circulation. On the contrary, however, most athletes do suffer from the consequences of venous insufficiency and its ambulatory venous hypertension without even knowing it. Heaviness, sluggishness, tiredness, tautness, and leg pain are all too often attributed to musculoskeletal causes and not underlying the venous insufficiency. Even the pain of varicose veins in athletes seems ascribed too easily to other causes. The relationship of venous disease and athletic performance has been the subject of much investigation recently and the treatment of venous reflux when present has been shown to improve athletic performance.
Venous reflux in the athlete originates from the same causes found in the general population but is made dramatically worse by aggressive training and competitive performance. There is even evidence that some intense forms of exercise such as distance running, weight training, and competitive cycling can actually cause venous reflux by placing enormous repetitive stress on the delicate valve leaflets of the venous circulation. Regardless of the sport, venous reflux wreaks havoc on the legs of an athlete. As I have described before in this series, venous insufficiency arises out of a weakness or dysfunction in the valve system in the lower extremity veins. For most women athletes, this reflux usually begins around the time of pregnancy and becomes progressive with an athletic lifestyle. For most men, there is a familial history and likely an occupation that requires prolonged standing or heavy physical lifting. The common theme for all is that once venous reflux is present, aggressive athletic training by running, cycling, weight lifting, tennis to name a few, creates progressive venous hypertension and secondary side effects of elevated pressure and venous pooling. The vasodilatation caused by exercise serves to increase the volume of venous blood pooling in the legs leading to decreased venous return to the heart, another cause of decreased performance in patients with venous insufficiency.
Before and after photos of a local cross country coach and competitive runner on the left. The after picture is following endovenous laser therapy only.
Following exercise, athletes should take certain measures to reduce venous congestion that has accumulated. The best post-exercise therapy is to walk or perform toe raises in the shallow end of the swimming pool. This will activate the calf muscle pump, the strongest driving force of the venous circulation, while eliminating some of the gravity effect because of the buoyancy of the water. The cool water will also serve to return venous tone that has been lost because of vasodilatation and increased body temperature. Other maneuvers include leg elevation and calf muscle activation against resistance bands.
Venous insufficiency in the athlete has received a lot of press lately, especially in the running community. Experts believe that wearing compression garments while training will help counterbalance the venous hypertension that builds up during exercise and will keep the lower extremity veins from becoming engorged and the legs from swelling. There will then be less blood pooling in the legs and more blood available to the active circulation. When the legs are allowed to become engorged, there is extra blood volume locked in the lower extremities leading to the feeling of heaviness, tiredness, tightness, and pain irrespective of musculoskeletal issues. The venous blood that is trapped in the legs is filled with lactic acid and metabolic waste that needs to be flushed out. Venous dysfunction inhibits this process and leads to poor performance and poor recovery time. Graduated medical compression worn while exercising will decrease the amount of venous blood trapped in the legs, enhancing venous return and the effective elimination of lactic acid and other waste byproducts of exercise. This has been shown in studies to improve recovery times. Compression Enhanced Performance (CEP) has been shown in clinical trials to increase running time by 5%, which for a marathon time of four hours would be 12 minutes gain in time. Greater performance, longer endurance, and faster recovery result when venous insufficiency is addressed.
The most definitive way for an athlete with venous insufficiency to achieve better performance and healthier legs while training and competing is to treat the underlying cause of venous reflux with minimally invasive vein therapy. This is the most durable, long term method available to alleviate the deleterious effects of venous hypertension in the athlete while decreasing the need for external compression garments. These techniques require little down time and can be tailor made to fit even the most rigorous training schedule. As a dedicated vein center, the Central Florida Vein and Vascular Center is the perfect place for athletes to seek vein care and have their special needs addressed.
By John D. Horowitz, M.D.
John D. Horowitz, M.D. is Board Certified in both Vascular Surgery and Phlebology and is uniquely trained to offer patients the most advanced vein care possible. He graduated a member of the AOA Honor Medical Society from Temple University School of Medicine in 1986, from Temple University Hospitals General Surgery Residency in 1991, and from The Ohio State University Hospitals Vascular Surgery Fellowship in 1993. Dr. Horowitz is an active member in many nationally recognized societies including the Southern Vascular, Florida Vascular and Society for Vascular Surgery, as well as the American College of Phlebology. He is nationally renowned for his innovative practice of Minimally Invasive Vein Therapy, has presented his work at many national society meetings and has authored numerous journal articles and book chapters. The Central Florida Vein and Vascular Society is routinely used as a training site for physicians seeking to learn Minimally Invasive Vein Therapy. Dr. Horowitz may be contacted at 407-293-5944 or by visiting www.cfvein.com.