Varicose Veins

According to the book, A Massage Therapist’s Guide to Pathology by Ruth Werner the definition of varicose veins is that they are distended, often twisted or ropy superficial veins.  They occur when the valves that support blood flow against gravity are damaged.  As blood collects in the system, the affected vein is stretched, distorted, and generally weakened.  Varicose veins can develop at the anus (hemorrhoids), at the esophagus or at the scrotum.  But most often they are in the legs.

 

Women get varicose veins more often than men and this is largely due to progesterone, which can weaken venous walls, and to a history of pregnancy.  Increased blood volume, shifting hormones, and the weight of the fetus on the femoral vein all work together to set the state for later problems.  Varicose veins are very common; about half of people over 50 years old have them.  Massage is not recommended for extreme varicose veins any anywhere distal to them.  Mild varicose veins should not have deep specific work done on them but are otherwise safe for massage.

 

The veins in the legs have a fascinating construction that works to move blood from the toes all the way back to the heart.  Small veins pick up the blood from the internal muscle capillaries.  These veins tend to run on the superficial aspect of muscles.  They feed into larger veins that perforate the muscle bellies and then into the really deep veins that run under the muscles, close to the bones.  When the leg muscles contract, the perforating veins are squeezed, sending their contents to the deep veins.  When the leg muscles relax, the perforating veins draw in new blood from the smaller veins.  The contraction and relaxation of the leg muscles (especial the soleus-“Sump pump of the leg”) is crucial to blood return.  The valves inside the perforating veins and the deep veins ensure that blood does not collect in the smaller, weaker superficial veins

 

What can damage the valves in the veins?  It could be simple wear and tear:  being on one’s feet for many hours a day, especially if the leg muscles are not allowed to fully contract and relax during that time, weakens the veins.  It could also be a mechanical obstruction to returning blood:  knee socks that are too tight, a knee brace, or a fetus that presses on the femoral vein.  Systemic problems from kidney or liver congestion have been seen to cause problems too.  Finally, it could be simple congenitally weak veins or a structural anomaly at the junction between the great saphenous vein and the femoral vein.

 

Varicose veins may itch or cause throbbing pain, especially at the end of the day, when legs feel tired and heavy.  They can contribute to edema around the ankles as fluid backs up in the lower leg.  Varicosities are seldom more than annoying, but they can create some unpleasant or even dangerous complication.  Chronically impaired circulation may result in varicose ulcers, which don’t heal until circulation is restored.  Skin irritation from poor circulation occasionally leads to a type of dermatitis that is not resolved until the varicosity is relieved.  Interruption in flood flow increases the likelihood of annoying night cramps.  Stagnant blood in a distended vein may coagulate, raising the possibility of clotting.  Most clots that form in varicose veins are superficial and melt easily, however, so they are usually a lesser threat than clots that form in deep leg veins.  Be aware; however, that the presence of grossly distended varicose veins may indicate an increased risk of deep vein thrombosis.  This is true especially when the varicosities have a sudden onset or change in size and quality very rapidly.

 

Mild varicose veins are usually treated with good sense.  Using support hose or elastic bandages can give extra help to damaged veins, and avoiding long periods of standing up without full contraction and relaxation of the muscles is often recommended.  Clothes that construct at the leg, the groin, or the waist should be avoided.  Reclining with the feet slightly elevated also reduces symptoms.  Sometimes hydrotherapy can help these veins heal.  Surgery for mild varicose veins in not generally recommended as a purely cosmetic intervention.  However, varicose veins are a progressive condition and they don’t usually spontaneously reverse.  If they are left untreated, their complications can be serious. It might be important to discuss what treatments might be available with your physician.  It is important to be under a doctor’s care and be checked regularly for signs of deep vein thrombosis.

 

If the vein is only slightly darkened and not raised or causing any pain, it is still wise to avoid local specific pressure, but otherwise massage is safe.  Tiny reddened “spider veins” are slightly dilated venules and are safe for massage.

by Janice Rudeen

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