DVT (Deep Vein Thrombosis): Physiotherapy Role in Prevention & Post-DVT Rehabilitation

DVT (Deep Vein Thrombosis): Physiotherapy in Prevention and Rehabilitation

Deep Vein Thrombosis (DVT) occurs when a blood clot forms in the deep veins of the leg, most commonly in the calf (distal DVT) or thigh (proximal DVT). The immediate danger is pulmonary embolism (PE) — if the clot breaks free and travels to the lungs. The longer-term consequence is post-thrombotic syndrome (chronic venous insufficiency).

Physiotherapy's Role: Three Key Areas

1. Prevention of DVT (Prophylactic Physiotherapy)

DVT is most commonly a complication of:

• Major surgery (hip, knee, spine, abdominal)
• Prolonged immobilization (hospitalization, long-haul flights)
• Neurological conditions causing lower limb paralysis
• Obesity and pregnancy

Physiotherapy DVT prevention programme:

Ankle Pump Exercises: The most important exercise. Lie on back. Pump foot up and down (dorsiflexion and plantarflexion) briskly. 20 reps every hour. This activates the soleal venous pump — squeezing the deep leg veins and propelling blood toward the heart.

Calf Raises: Standing. Rise on toes, hold 2 seconds, lower. Activates gastrocnemius-soleus complex as the venous pump.

Quad Sets: Tighten thigh muscles with knee straight. Hold 5 seconds. Activates femoral vein blood flow.

Early Ambulation: Walking as soon as medically cleared — Day 1 post-surgery for most elective procedures. Mechanical compression stockings worn during limited activity periods.

2. Acute DVT Management (With Anticoagulation)

When DVT is confirmed and anticoagulation (LMWH, rivaroxaban, apixaban) is initiated:

Early mobilization is safe and beneficial:

• Walking programme from Day 2: 10 minutes, 3× daily, progressing to 30 minutes daily
• Compression stockings: Class II graduated compression stocking on the affected leg reduces symptoms and post-thrombotic syndrome risk by 50%
• Limb elevation during rest: Above heart level when sitting

What to avoid acutely:

• Massage of the affected leg (dislodgement risk)
• High-intensity exercise until therapeutic anticoagulation is confirmed
• Prolonged immobility

3. Post-Thrombotic Syndrome Rehabilitation

Post-thrombotic syndrome (PTS) develops when DVT damages venous valves, causing chronic venous hypertension. Symptoms: leg swelling, aching, heaviness, skin discoloration, venous ulcers.

Physiotherapy management of PTS:

• Manual Lymphatic Drainage (MLD): Gentle massage technique that redirects venous and lymphatic flow around damaged valves
• Compression bandaging/wrapping: Multi-layer compression for acute swelling reduction
• Progressive walking programme: Improves calf muscle pump function
• Leg elevation protocol: Legs elevated 30° above heart level for 30 minutes, 3× daily
• Aquatic therapy: Hydrostatic pressure of water provides continuous compression while exercise improves venous return

When to Immediately Escalate (DVT Red Flags)

• Sudden onset of breathlessness — possible PE (emergency)
• Leg dramatically increasing in swelling, turning blue or white (phlegmasia)
• Calf pain with swelling in post-operative patient — always investigate