Flying is a common way to travel, and most people may see it as an opportunity to relax and rest during the trip. However, it is important to remain relatively active while on a plane. However, sitting for extended periods during long flights or taking multiple flights within a short space of time can increase your risk of experiencing muscle and joint pain, cramps or blood clots in your leg. More than 300 million people travel on long-distance flights (generally more than four hours) each year in the United States. Blood clots, also called deep vein thrombosis (DVT), can be a serious risk for some long-distance travelers. In fact, anyone traveling more than four hours, whether by air, car, bus, or train, can be at risk for blood clots.

At Vascular Care Specialists of Los Angeles, Dr. Mathew Cheung and Dr. Peter Lin discuss why blood clots or DVT can occur when you travel or take long-distance flights. In this article, we hope you can become aware that DVT can occur in anyone who sit for extended periods during long flights. More importantly, we share some simple exercises you can do while traveling on the plane which can reduce your risk of DVT.

Deep vein thrombosis (DVT) is a blood clot that develops in deep veins in the body, usually in the legs. DVT becomes life-threatening when the clot breaks off and moves through the blood stream causing an embolism.

Signs and symptoms of DVT can include:

• Swelling in the affected leg. Rarely this swelling is across both legs
• Pain in the leg. This pain often starts in your calf and can feel like cramping or soreness
• Red or discoloration of the skin
• A feeling of warmth in the affected leg

Even if you travel a long distance, the risk of developing a blood clot is generally very small. Your level of risk depends on the duration of travel as well as whether you have any other risks for blood clots. Most people who develop travel-associated blood clots have one or more other risks for blood clots, such as:

• Older age (risk increases after age 40)
• Obesity (body mass index [BMI] greater than 30kg/m2)
• Recent surgery or injury (within 3 months)
• Use of estrogen-containing contraceptives (for example, birth control pills, rings, patches)
• Hormone replacement therapy (medical treatment in which hormones are given to reduce the effects of menopause)
• Pregnancy and the postpartum period (up to 3 months after childbirth)
• Previous blood clot or a family history of blood clots
• Active cancer or recent cancer treatment
•  Limited mobility (for example, a leg cast)
• Catheter placed in a large vein
• Varicose veins

The combination of long-distance travel with one or more of these risks may increase the likelihood of developing a blood clot. The more risks you have, the greater your chances of experiencing a blood clot. If you plan on traveling soon, talk with your doctor to learn more about what you can do to protect your health. The most important thing you can do is to learn and recognize the symptoms of blood clots.

When travelling, there is always a greater risk of developing DVT due to the increased sedentary time over a long-haul flight. This risk is heightened even more if you already suffer from varicose veins before flying. Blood clots or DVT typically form in the deep veins (veins below the surface that are not visible through the skin) of your legs during travel because you are sitting still in a confined space for long periods of time. The longer you are immobile, the greater is your risk of developing a blood clot. Many times the blood clot will dissolve on its own. However, a serious health problem can occur when a part of the blood clot breaks off and travels to the lungs causing a blockage which is called a pulmonary embolism, and it may be fatal. The good news is there are things you can do to protect your health and reduce your risk of blood clots during a long-distance trip. Fortunately, this does not mean you cannot fly at all, but there is a few precautions you should take to avoid the risk of serious complications. Some of these include trying to regularly stretch and walk up and down the isles to allow maximal blood circulation. There are several exercises you can easily complete while flying to lessen your risk of DVT:

• Ankle Circles: Lift your feet off the floor and twirl your feet as if you’re drawing circles with your toes. Continue this for 15 seconds, then reverse direction. Repeat as desired.
• Foot Pumps: Keep your heels on the floor and lift the front of your feet toward you as high as possible. Hold for a second or two, then flatten your feet and lift your heels as high as possible, keeping the balls of your feet on the floor. Continue for 30 seconds, andrepeat as desired.
• Knee Lifts: Keeping your leg bent, lift your knee up to your chest. Bring back to normal position and repeat with your other leg. Repeat 20 to 30 times for each leg.
• Shoulder Roll: Lift your shoulders upward, then pull them backward, downward, and forward, creating a gentle circular motion. Continue for 30 seconds. Then reverse direction if desired.
• Arm Curl: Start with arms on chair rests, bent at a 90-degree angle. Raise one hand up to your chest and back down. Alternate hands and continue for 30 seconds.

• Knee to Chest: With both hands clasped around your right knee, bend forward slightly and pull your knee to your chest. Hold the stretch for 15 seconds; then slowly let your knee down. Repeat the same stretch with your left knee. Perform 10 stretches for each leg.
• Forward Flex: Keep both feet on the floor and slowly bend forward, reaching for your ankles. Hold the stretch for 15 seconds and slowly return to a normal seated position.
• Overhead Stretch: Raise both hands straight up over your head. Use one hand to grab the wrist of the opposite hand and gently pull to one side. Hold the stretch for 15 seconds, and repeat with the other arm.
• Shoulder Stretch: Bring your right hand over your left shoulder. Then place your left hand behind your right elbow and gently pull your elbow toward your body. Hold the stretch for 15 seconds and repeat with the other arm.
• Neck Roll: Relax your neck and shoulders. Then drop your right ear to your right shoulder and gently roll your head forward and to the other side, holding each position about 5 seconds. Repeat 5 times.

• Try to keep your feet elevated by using the leg rests at the highest elevation. Rest your feet on your carry-on luggage if necessary.
• If you have an opportunity to move around the cabin, walk to the restroom and back.
• Drink plenty of fluids, preferably water, to avoid dehydration.
• Walk for 30 minutes before boarding the plane.
• If you are on anticoagulants, consider wearing a medical alert ID bracelet or necklace when you travel.

At Vascular Care Specialists of Los Angeles, we strive to provide the best service, care, and results possible. If you have deep vein thrombosis or circulation-related leg problems and would like to learn more about treatment options, give us a call at 626-275-9566 to schedule an appointment. You can also visit us at www.vcsla.com for more information.