11-CHRONIC VENOUS INSUFFICIENCY (1).pdf

Physical Therapy for Chronic Venous Insufficiency By Dr. Mona Abdel Khalek • Veins: • Hold 75% of the blood volume • Are organized into superficial and deep veins connected by perforating veins • Have valves for unidirectional flow • Are low pressure systems (1015mmHg) • Have thin walls (superfici...

Physical Therapy for Chronic Venous Insufficiency By Dr. Mona Abdel Khalek • Veins: • Hold 75% of the blood volume • Are organized into superficial and deep veins connected by perforating veins • Have valves for unidirectional flow • Are low pressure systems (1015mmHg) • Have thin walls (superficial veins have thicker walls than deep veins.) Chronic Venous Insufficiency • Normally, when the leg muscles contract, they squeeze the deep veins of the legs, aiding in circulation. • Veins contain one-way valves that keep the blood from flowing in the opposite direction, toward the foot. Chronic Venous Insufficiency • Chronic venous insufficiency (CVI) results when the veins in the legs no longer pump blood back to the heart effectively. These valves can wear out over time, leading to blood leaking backward and pooling in the veins of the leg. Over time, the veins weaken and stretch. • Varicose veins, or superficial veins which are dilated due to faulty valves, can also cause CVI. • Blood clots can lead to CVI when they block venous blood-flow or when the clot damages the valves in the veins. Chronic Venous Insufficiency Signs&Symptoms • Pain • Pulses: normal; difficult to take with edema. • Color: normal or cyanotic on dependency. • degeneration of valve tissue, venous dilation. • Muscle pump dysfunction. • Edema • venous ulcer formation. • Classification. • Grade I: mild aching, minimal edema, dilated superficial veins. Grade II: increased edema, multiple dilated veins, changes in skin pigmentation. • Grade III: venous claudication, severe edema, • cutaneous ulceration. Edema, Varicosity, Hyperpigmentation, ulceration Risk factors • Age • Gender • Obesity • Pregnancy • Family history • Sedentary lifestyle • Jobs requiring long periods of standing or sitting in one place • Injury (broken bone) or major surgery on the leg or foot Physical therapy intervention 1. Elevation 2. Exercise 3. Elastic compression Physical therapy intervention • Elevation: Elevating the legs can help to instantly relieve pain. • Instruct a patient to elevate the legs above the heart three or four time a day for about 15 minutes at a time. This can help to reduce swelling. • If prolonged standing or sitting is necessary, bending the legs several times will help promote blood circulation. Physical therapy intervention • Exercise: Exercise helps pump blood through the legs and builds muscle that can promote better circulation. • The Aims of physical exercise: 1. Increase the movement of the ankle joint 2. Strengthen the muscle pump in the calf of the leg Physical therapy intervention • The calf pump: • The calf pump is the essential mechanism by which blood is returned to the heart from the lower limbs, and is aided by the foot pump, thigh pump and respiratory pump mechanisms. Physical therapy intervention • Ankle exercises • The exercise regimen was done with the aid of Thera-Bands • The 5 to 10 minute regimen was undertaken three times a week. • There were four parts to the exercise regimen: 1.Warm-up with ankle circling 2.Plantar flexion using the Thera-Band around the ball of the foot 3.Dorsiflexion stretches 4.cool down with some ankle circling Physical therapy intervention • Low-Impact Activities: • Bicycling • Walking • Swimming specially for elderly Physical therapy intervention • Compression Stockings: • Worn during the day • Elastic stockings with adjustments in pressure • Lower pressure stockings (20-30mm Hg) for edema and DVT prophylaxis • Higher pressure (30-40+mm Hg) for ulcers and significant venous disease Efficacy of Compression Stockings • Multilayer compression was better than single layer bandaging • Compressive therapy more effective than non-compression • Higher pressure were more effective than lower • Continued use of compression stocking reduced reoccurrence within 3-5 year