Solutions for Aching Legs
Many athletes, professionals and amateurs alike, experience some kind of leg pain at one time or another, whether from the mechanics of pounding movement on a hard surface, or keeping their legs in the same position for extended periods. But rarely do they attribute the discomfort to a dysfunction in their venous (veins) system. But not all aching legs are simply due to physical activity or even the effects of aging. It may actually be vein insufficiency that’s causing those symptoms and not that five-mile run. The first thing to understand is that leg pain in general is not normal. If your legs hurt after exercise, you should find out why.
The role veins play
While the arterial side of the human cardiovascular system has been studied extensively, much less research has been conducted on veins, also referred to as the venous system. Yet, the veins contain approximately 70 percent of the body’s total blood volume when a person is at rest.
Healthy veins carry deoxygenated blood back up to the heart via the “muscle pumps” in our feet and calves helping the blood travel against gravity. In leg veins, there are valves that open to allow the blood to flow one way: up. If the valves in the veins become damaged, some blood will flow back into the legs and “pool” there, resulting in a feeling of heaviness, leg pain, or other symptoms. This is sometimes referred to as “venous reflux.”
Some of the symptoms of vein disease are obvious: visible blue or purple-colored “spider veins,” bulging varicose veins, or even open wounds (leg ulcers) on the leg or ankle. Other symptoms are much more subtle. In addition to achiness and swelling, sensations like an itching or tingling in the legs may be an indication of vein insufficiency. Leg cramps after long periods of inactivity, or while lying in bed at night, is another possible symptom.
Some people may experience no symptoms at all—and some merely accept them as an unavoidable byproduct of physical fitness, however you can be in great shape and still have a vein disease that’s slowly developing.
How exercise impacts veins (and vice versa)
During exercise your muscles require more oxygen, so veins dilate to increase the volume of blood flowing through the circulatory system—but if your veins are not working properly, that means more blood can pool in your legs. On the other hand, exercise is beneficial from a venous standpoint because anything that improves the function of the foot and calf muscle pumps to get the blood back up to the heart is good.
Walking is the best exercise for improving the muscle-pump function, especially following vein treatment. Although walking can help manage the symptoms, it does not prevent vein problems. Neither does exercise cause vein problems, except in extreme cases. Physical activities that require your legs to support heavier weight over prolonged periods of time, such as weightlifting or backpacking can put someone at increased risk for developing venous issues. Repeated exposure to increased intra-abdominal pressure, or pressure that is transmitted to lower extremities, can cause the normal system of valves and veins to weaken over time and become incompetent.
Repetitive motion sports such as endurance running, cycling and tennis can also put a lot of stress on your leg veins and over time may overcome a normal venous system. In general, exercise (and working out the muscle pumps) is not detrimental for the vast majority of athletes who are participating in a more typical spectrum of activity. In fact, maximizing the efficiency of that system is beneficial.
Depending on each individual’s degree of vein disease, he or she may become more symptomatic because the foot pump no longer counters the vein insufficiency. One person’s level of activity, for instance, may be associated with the progression of vein disease if they have some pre-existing risk factors, such as age or family history. While exercise can influence vein dysfunction, it doesn’t necessarily prevent it or cause it.
But can poorly performing veins affect athletic performance? The short answer is yes. If the venous system is not working correctly, then the “extra” de-oxygenated blood (and blood waste products like lactate) can cause discomfort, cramping, fatigue, or other conditions that diminish performance. Even if legs feel great during training, vein issues can also cause legs to hurt after exertion and slow your recovery.
Fixing the problem
If vein problems keep someone from doing activities that aggravate his or her vein symptoms, then choosing alternate activities is one way to cope. Some people may find that swimming, for example, does not produce the same discomfort that running does. Athletes can live with the problem, but they don’t have to. There are many options for treatment so that people can continue doing their favorite sports or whatever activity they’re passionate about. They might even see an improvement in their performance.
Modern treatments have excellent initial and long-term success rates when performed by an experienced phlebologist (vein specialist). Endovenous approaches are minimally invasive treatments used to address specific large varicose veins in the legs. Endovenous ablation (EVLA) is considered the gold standard in the treatment of venous symptoms, with success rates between 90% and 98% after five years. It has largely replaced previous, more invasive standards of care, such as vein stripping.
Another option for treatment is sclerotherapy, performed either with ultrasound-guidance, or with a light-assist, which seals the vein wall of small varicose veins allowing them to fade away.
With both EVLA and sclerotherapy, patients can walk the day of the procedure and return to normal activity, including moderate exercise, within a few days. The key to safe, effective vein treatment is to consult with a board certified vein specialist who can evaluate the entire venous system so that poorly functioning veins can be treated at the source.
Dr. Cindy Asbjornsen is the founder of the Vein Healthcare Center in South Portland, Maine. Certified by the American Board of Venous and Lymphatic Medicine, she cares for all levels of venous disease, including spider veins, varicose veins and venous ulcers. She is the only vein specialist in Maine to be named a Fellow by the American College of Phlebology. You can contact Dr. Asbjornsen at 207-221-7799 or: [email protected].
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