Simple Preventative Exercises for DVT from Physiotherapists in Ealing

13. March 2019

simple preventative exercises for dvt from physiotherapists in ealing

Introduction: The Critical Role of Movement in Vascular Health

Physiotherapy is a crucial component in maintaining vascular health and preventing serious conditions like Deep Vein Thrombosis (DVT).¹ While often associated with rehabilitation from injury or surgery, the scope of modern physiotherapy has evolved significantly. It now serves as a cornerstone of preventative medicine, with physiotherapists acting as expert educators who guide the population on mitigating cardiovascular risks.² This proactive approach is essential for managing conditions where prevention is far more effective than cure—and DVT is a prime example.

Defining Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE)

A Deep Vein Thrombosis is a medical condition characterised by the formation of a blood clot (a thrombus) within one of the body's deep veins, most commonly affecting the large veins in the lower leg, thigh, or pelvis.⁵ DVT is a significant public health concern in the UK, affecting approximately one in every 1,000 people each year.⁶

The immediate and most dangerous complication of a DVT is a Pulmonary Embolism (PE). This occurs when a fragment of the blood clot breaks away, travels through the bloodstream, and lodges in the arteries of the lungs, obstructing blood flow.⁵ A PE is a life-threatening medical emergency and a leading cause of preventable hospital death.⁹ The term Venous Thromboembolism (VTE) is used to describe this spectrum, encompassing both DVT and PE.⁶

The Enemy: Immobility and Venous Stasis

The primary cause and central risk factor for DVT is immobility.⁷ The circulatory system in the legs faces a unique challenge: it must return blood to the heart against gravity. This process is not passive; it relies heavily on the 'calf muscle pump'.⁷ When a person walks or moves their ankles, the contraction of their leg muscles squeezes the deep veins, propelling blood upward.

When a person is immobile for prolonged periods—confined to a hospital bed, sitting at a desk, or cramped in an airplane seat—this muscle pump is inactive. Blood flow becomes "sluggish," a condition medically termed venous stasis.¹¹ This slow-moving blood creates the ideal conditions for a clot to form.⁷

The Long-Term Impact: Beyond the Acute Clot

The danger of DVT extends far beyond the immediate risk of a PE. As many as half of all individuals who experience a DVT go on to develop a chronic, debilitating condition known as Post-Thrombotic Syndrome (PTS).⁶ This syndrome is caused by damage to the vein valves from the initial clot, leading to persistent symptoms including chronic leg pain, swelling, skin discolouration, and in severe cases, non-healing leg ulcers (venous ulcers).⁶

This critical link between the acute clot and a potential lifetime of chronic disability reframes the importance of prevention. Preventative measures are not only about averting a life-threatening emergency but also about preserving long-term quality of life and functional mobility. In this context, physiotherapy is not merely a reactive treatment but a proactive strategy for health management across the full spectrum of the condition.⁶ This strategy involves expert risk assessment, patient education, and the implementation of preventative measures, including simple exercises and advanced physiotherapy treatment modalities.⁴

Understanding Your Risk: When to Prioritise DVT Prevention

The development of a DVT is often described as a "perfect storm" of risk factors. A 19th-century pathologist, Rudolf Virchow, identified three primary factors that contribute to clot formation, a concept still used today known as Virchow's Triad.¹¹ Understanding these factors is key to identifying who is at risk and why.

The Perfect Storm for a Clot (Virchow's Triad)

Venous Stasis (Slow Blood Flow): As discussed, this is the most significant and modifiable factor. It is caused by any form of prolonged immobility, including bed confinement after surgery, limited movement due to a leg cast, or sitting for long periods.¹¹
Endothelial Injury (Injury to the Vein Wall): Direct trauma to the vein's inner lining can trigger a clotting response. This is commonly caused by fractures, severe muscle injuries, or major surgery, particularly procedures involving the pelvis, hips, or legs.¹¹
Hypercoagulability (Changes in Blood Composition): This refers to a state where the blood is more prone to clotting. It can be caused by a variety of factors, including dehydration, cancer and its treatment, pregnancy, and the use of estrogen-containing contraceptives or hormone replacement therapy.⁷

When a person has one or more of these risk factors, their chance of developing a DVT increases significantly.¹² The following real-world scenarios illustrate how these factors combine, creating specific high-risk profiles.

Risk Scenario 1: The Post-Surgical Patient

Individuals in, or recently discharged from, hospital are one of the highest-risk groups.⁷ The risk is especially high following major orthopaedic surgery, such as hip or knee replacements.⁷ Without preventative measures (known as prophylaxis), DVT rates in this group can be as high as 60%.¹³

This extreme risk is a clear example of Virchow's Triad in action:

Vein Injury: The surgery itself causes direct trauma to the vascular structures.¹²
Hypercoagulability: The body's natural inflammatory response to surgery alters blood composition, making it more likely to clot.
Venous Stasis: Post-operative "confinement to bed" and "limited movement" lead to severe blood flow stagnation.¹²

Historically, patients with acute DVT were restricted to bedrest.¹¹ However, modern physiotherapy treatment and UK clinical guidelines have completely reversed this. The National Institute for Health and Care Excellence (NICE) now recommends that all surgical patients undergo a VTE risk assessment ¹⁷ and that hospitals "encourage people to mobilise as soon as possible".¹⁷

A specific case published in 2025 provides clear evidence of this strategy's positive effect. A study ¹⁸ observing 162 patients recovering from lower limb traumatic fractures found that the group receiving "early rehabilitation nursing," which included "progressive lower limb functional exercises" like ankle pumps, had a significantly lower incidence of DVT compared to the control group (P=0.002). The rehabilitation group also had a shorter time to first ambulation and better functional recovery scores.¹⁸ This demonstrates that early, guided movement is a powerful and proven medical intervention.

Risk Scenario 2: The Sedentary Office Worker

The rise of desk-based jobs and, more recently, widespread working from home (WFH) has created a large population at risk from prolonged immobility.⁵ Sitting for extended periods, often defined as longer than 4-8 hours, prevents the regular contraction of the calf muscles, leading to "impaired blood circulation" and creating a DVT risk.⁵

This risk can be deceptive. An individual may be "fit" and exercise regularly, but this does not negate the risk from static sedentary behaviour. A person who runs for 45 minutes in the morning but then sits for 8-10 hours straight remains at high risk. The danger is the uninterrupted lack of movement.

The evidence for intervention is clear. A large-scale meta-analysis published in 2020 ¹⁹ concluded that "regular physical activity was significantly associated with a lower risk of VTE when compared with a sedentary or less active lifestyle".¹⁹ UK-based guidance from "Active Working" ²⁰ goes further, recommending that office workers aim for 2-4 hours of standing and light activity during working hours. The physiotherapy advice for this group is not just to exercise after work, but to "regularly break up seated-based work".²⁰ Taking short breaks every hour to stand, stretch, and move around is a key preventative strategy.²⁰

Risk Scenario 3: The Long-Distance Traveller

The term "Economy Class Syndrome" ²² emerged to describe the risk of DVT associated with long-distance travel, particularly flights lasting over 4-6 hours.²¹ This scenario is another "perfect storm" that maps perfectly to Virchow's Triad:

Stasis: Caused by sitting immobile in a cramped space, often with legs bent, for many hours.²¹
Hypercoagulability: Caused by dehydration. The dry cabin air, combined with passengers avoiding water to limit bathroom trips, or consuming diuretic beverages like alcohol and caffeine, can make the blood thicker.²¹
Endothelial Changes: Some research suggests that changes in cabin air pressure and lower oxygen levels can also contribute to the clotting cascade.²¹

The preventative advice from vascular surgeons in this scenario is unequivocal: stay hydrated, avoid excessive alcohol, and perform mobility exercises like calf raises and stretching during the flight.²¹

Risk Scenario 4: The Injured Individual

Individuals with lower-limb injuries, such as fractures or severe sprains, face a twofold DVT risk.¹² First, the injury itself—a fracture or severe muscle injury—can cause direct trauma to the vein wall (endothelial injury).¹² Second, the treatment for the injury, such as a leg cast or prescribed immobility, directly causes "slow blood flow" (venous stasis).¹²

The evidence for this risk is stark. A 2023 study ²⁴ found that the overall incidence of DVT after just 2 weeks of lower-limb immobilization was 33%. This highlights the acute danger of immobility.

Crucially, the same study provided a profound insight into the power of small movements. It found that the risk of sustaining a DVT was 2.62 times higher in patients who had "poor" ankle dexterity (i.e., less ability to move their ankle) compared to those with "good" dexterity.²⁴ This provides a powerful, evidence-based rationale for the simple exercises that form the core of physiotherapy prevention. It proves that even small, repetitive "micro-movements" inside a cast or boot are not trivial—they are a medically significant intervention that activates the calf pump, combats stasis, and statistically reduces the risk of a blood clot.

The Physiotherapist's DVT Prevention Toolkit: Simple, Essential Exercises

The cornerstone of DVT prevention in any at-risk individual is movement. The following simple exercises are recommended by chartered physiotherapists and are standard advice across the UK's NHS to activate the calf muscle pump, promote circulation, and reduce the risk of venous stasis.⁶

These exercises can be performed while seated or, in many cases, lying in bed. The key is consistency and frequency, especially during long periods of immobility.

1. Ankle Pumps (Foot Pumps)

This is considered the most important and effective exercise for stimulating the calf muscle pump.

Position: Seated in a chair or lying down in bed.⁶
Action: Start with your feet in a neutral position. Slowly point your toes away from you (plantarflexion) as far as you comfortably can. Hold for a moment. Then, pull your toes up toward your knees (dorsiflexion) as far as you can, feeling a stretch in your calf.²⁸ If possible, "keep your knees straight during the exercise to stretch your calf muscles".²⁵
Recommended Frequency: "Repeat 10-15 times... every hour while seated" ⁶ or "10 times... two or three times an hour".²⁵

2. Ankle Rotations (Circles)

This exercise moves the ankle joint through its full range, engaging secondary muscles.

Position: Seated, with your feet lifted slightly off the floor.⁵
Action: Lift your feet and rotate your ankles slowly as if you are "drawing circles with your toes".³¹
Recommended Frequency: "Rotate 10 times in each direction, every hour" (10 times clockwise, 10 times anti-clockwise).⁶

3. Seated Marching (Knee Lifts)

This exercise engages the larger thigh and hip muscles, further promoting blood flow from the deep veins of the thigh.

Position: Sit upright and away from the back of the chair. Hold onto the sides of the chair for support.³⁰
Action: "Lift your left leg with your knee bent as far as is comfortable".³⁰ Place your foot back down "with control," without stamping.³⁰ Repeat with the opposite leg, alternating in a "marching" motion.⁶
Recommended Frequency: "Repeat 10-15 times for each leg, every hour".⁶

4. Heel & Toe Raises (Calf Raises)

This combines two movements to create a "rocking" motion that powerfully activates the calf.

Position: Seated with feet flat on the floor, or standing while holding onto a stable surface for support.⁶
Action (Seated): Place both feet flat. First, lift your forefoot up while your heel remains on the floor (toe raise).⁵ Hold for 5 seconds. Then, point your toes toward the floor and lift your heels up, rising onto the balls of your feet (heel raise).⁵ Hold for 5 seconds.
Recommended Frequency: "Alternate heel/toe raises for 30 seconds hourly when seated for long periods".⁶

5. Knee Extensions (Seated & Lying)

This exercise contracts the quadriceps (thigh muscles), which also helps compress deep veins.

Position: Seated in a chair ⁶ or lying flat in bed.¹³
Action (Seated): Sit tall, straighten one knee, and hold the leg out straight for 3-5 seconds. Slowly lower your foot back to the floor.³³ Alternate legs.
Action (Lying - "Static Quads"): While lying down, brace your knee to "feel the muscle tighten on the front of the thigh".³² Hold this contraction for a count of 3-5 seconds, then gently relax.¹³
Recommended Frequency: "Perform 3 sets of 10 repetitions on each leg, several times a day".⁶

Table: Physiotherapist-Recommended DVT Prevention Exercises

Exercise	Position(s)	How to Perform	Recommended Frequency (High-Risk/Immobile)
Ankle Pumps (Foot Pumps)	Seated or Lying Down	Point toes away from you, then pull toes up towards you. Keep the knee straight if possible to stretch the calf.	10-15 repetitions, every hour. ⁶
Ankle Rotations (Circles)	Seated (feet off floor)	Lift feet from the floor. Rotate ankles slowly in a circle, 10 times clockwise, then 10 times anti-clockwise.	10 repetitions each way, every hour. ⁶
Seated Marching (Knee Lifts)	Seated	Sit tall. Lift one knee up towards your chest, keeping the knee bent. Lower with control. Alternate legs.	10-15 repetitions each leg, every hour. ⁶
Heel & Toe Raises	Seated or Standing	Seated: Place feet flat. Rock from your heels (lifting your toes) to your toes (lifting your heels).	30 seconds of continuous rocking, every hour. ⁶
Knee Extensions (Static Quads)	Seated or Lying Down	Seated: Sit tall, straighten one leg and hold for 3-5 seconds. Lower slowly. Lying: Tighten the thigh muscle, hold for 3-5 seconds, then relax.	10 repetitions each leg, several times a day. ⁶

Context-Specific Exercise Plans: Positive Effects in Real-World Scenarios

The "toolkit" of exercises provides the "what," but a professional physiotherapy plan also defines the "when" and "why" for specific situations. Applying these exercises correctly in high-risk scenarios is proven to have a positive effect.

Specific Case 1: The Post-Surgical Patient's Plan

Context: Lying in a hospital bed following a knee or hip replacement.⁷
Plan (Day 0-1): Prevention starts immediately. Even while lying flat, the patient must perform Ankle Pumps.²⁵ The NHS-recommended frequency is 10 repetitions, performed two or three times every hour.²⁵ This is supplemented with Static Quads (Lying Knee Extensions) to tighten the thigh muscles.¹³
Plan (Day 1+): The formal physiotherapy treatment plan will begin. A physiotherapist will assist the patient to sit on the edge of the bed and progress to Sit-to-Stand exercises ⁶, which powerfully engage all leg muscles.
Positive Effect: This progressive exercise plan is the standard of care. It follows NICE guidance to "encourage people to mobilise as soon as possible" ¹⁷ and is clinically proven to reduce DVT rates post-operatively by activating the muscle pump and reducing stasis.¹⁸

Specific Case 2: The Ealing Office Worker's Plan

Context: Deskbound at a computer, whether in an Ealing office or working from home.⁵
Plan: The goal is to break up static, sedentary time.²⁰

The Hourly Break: Set an alarm. Every hour, stand up, stretch, and walk for at least 5 minutes—to the water cooler, down the hall, or around the living room.²⁰
At the Desk: While seated and working, perform 30 seconds of continuous Heel & Toe Raises ⁶ and a set of 15 Ankle Pumps.⁶

Positive Effect: This "Active Working" approach ²⁰ directly counters the "impaired blood circulation" ⁵ that results from prolonged sitting. It prevents stasis from ever taking hold and is directly aligned with evidence showing that regular physical activity lowers VTE risk.¹⁹

Specific Case 3: The Long-Distance Traveller's Plan

Context: Seated on a 6-hour flight or long car journey.²¹
Plan: This is a multi-step strategy.²¹

Preparation: Choose an aisle seat if possible to make moving easier.³⁶ Hydrate well before and during the flight, and avoid excessive alcohol.²¹ Do not store luggage under the seat in front; this is critical for giving the legs room to move.²¹
Macro-Movement: Every 2-3 hours (or when safe), get up and walk the aisle.³⁶
Micro-Movement (Hourly): In the seat, perform a circuit: 15 seconds of Ankle Circles in each direction, 30 seconds of Foot Pumps/Heel-Toe Raises, and 20-30 repetitions of Knee Lifts for each leg.³¹

Positive Effect: Vascular surgeons confirm these mobility exercises "actually work" by "getting the circulation going".²¹ This simple routine actively counteracts the dangerous combination of stasis, hypercoagulability, and pressure changes associated with long-haul travel.

Advanced Physiotherapy Treatment: Innovations in DVT Prevention

electro therapy for DVT Modern physiotherapy extends far beyond manual exercises. It encompasses a spectrum of interventions, from education and simple movements to the use of advanced medical technology to manage risk. For high-risk individuals, or those whose immobility is complex, modalities like electro therapy and shockwave therapy play crucial, in-depth roles in a holistic prevention strategy.

Electro Therapy (NMES) for High-Risk Immobility

Electro therapy, in this context, refers to Neuromuscular Electrical Stimulation (NMES).³⁷ This is a physiotherapy treatment ¹ where a small, battery-operated device delivers gentle electrical impulses to the calf muscles, typically via a self-adhesive pad.³⁹ These impulses cause an involuntary, rhythmic contraction of the muscles.³⁹

This treatment effectively "mimics the natural pumping action" of the calf muscle ⁶, preventing venous stasis in patients who cannot perform voluntary exercises. It is essential to understand that this is not a tool for the average office worker. It is a specific medical intervention for high-risk, immobile patients, particularly when other prevention methods (like compression stockings or medication) are contraindicated or impractical.³⁸

A key specific case in the UK involves acute stroke patients. UK guidelines often recommend Intermittent Pneumatic Compression (IPC)—inflatable sleeves that squeeze the legs—for these patients.³⁹ However, many patients cannot tolerate IPC or have contraindications.⁴¹ This is where NMES provides a vital alternative.

The evidence for its positive effect in this exact scenario is robust and UK-based:

NICE Guidance: The National Institute for Health and Care Excellence (NICE) has assessed this technology. Its guidance (MTG19) recommends the geko™ device (a form of NMES electro therapy) for DVT prevention in high-risk patients for whom other methods are impractical or contraindicated.⁴⁰
Royal Stoke University Hospital Audit: A prospective audit at this UK hospital provides a powerful real-world "specific case".⁴² The audit followed 999 acute stroke patients. Of the 687 who required mechanical prophylaxis, 203 (29.5%) used the geko™ device. At the 90-day follow-up, the results were striking: the "geko™ only" cohort (122 patients) had zero VTEs (0 cases). In contrast, the 'IPC only' group (463 patients) had 11 VTEs.⁴² This demonstrates a clear positive effect for this advanced electro therapy in a high-risk clinical setting.

Restoring Mobility to Reduce DVT Risk: The Role of Shockwave Therapy

It is critical to begin this topic with an expert clarification: Shockwave therapy is NOT a direct treatment for a DVT. Applying shockwave therapy, or even deep-tissue massage, directly over an active DVT is strictly contraindicated, as it could potentially dislodge the clot.⁶

The role of shockwave therapy in DVT prevention is more sophisticated and demonstrates the holistic, root-cause approach of modern physiotherapy. It is a preventative tool indirectly, by treating the cause of immobility.

Extracorporeal Shockwave Therapy (ESWT), or shockwave therapy, is a non-invasive physiotherapy treatment that uses high-energy acoustic waves to treat chronic soft-tissue injuries.⁴⁴ It works by stimulating a healing response at the cellular level: it increases nutrient blood flow ⁴⁴, breaks down painful scar tissue and calcifications ⁴⁹, and promotes tissue regeneration.⁴⁵

This connects to DVT prevention in a clear, logical chain:

The Problem: A patient suffers from a chronic, painful condition like plantar fasciitis or Achilles tendinopathy.⁴⁵
The Consequence: This chronic pain "can be very frustrating and even affect your mobility" ⁵¹, leading to "reduced mobility".⁵²
The Risk: As established in Section 2, this type of enforced, pain-induced immobility is a major independent risk factor for DVT.¹²
The Intervention: Shockwave therapy is a highly effective, evidence-based physiotherapy treatment for these exact conditions.
The Positive Effect: A 2018 study ⁵² on tendinopathies found that shockwave therapy "significantly reduced the pain" and "improves functionality and quality of life".⁵² By successfully treating the underlying injury, shockwave therapy breaks the cycle of pain-induced immobility.⁴⁴ By restoring a patient's ability to walk without pain, it restores the natural function of their calf muscle pump and removes the DVT risk factor that their immobility had created.

Conclusion: A Proactive Partnership for Your Vascular Health

The Physiotherapist's Role: More Than Just Exercises

The prevention of Deep Vein Thrombosis is a clear example of how physiotherapy serves as a proactive partnership in a patient's long-term health. The role of the chartered physiotherapist extends far beyond simply handing out a sheet of exercises.

Physiotherapists are trained experts in screening and risk assessment.⁵⁴ In fact, Evidence-Based Clinical Practice Guidelines (CPGs) for VTE management mandate that physiotherapists "should assess the risk of VTE in patients with reduced mobility" during any initial examination.¹⁴ Because physiotherapists work with at-risk patients every day, they are in a unique position to "catch DVT in patients that have come in for what they thought were minor aches and pains" ⁵⁴, referring them for urgent medical diagnosis and care.

Your Personalised Prevention Plan in Ealing

This report has detailed the simple, effective exercises and advanced treatments available for DVT prevention. However, the most effective plan is one that is tailored to an individual's specific risk profile.

For individuals in the Ealing area ⁵⁸ who fall into any of the high-risk categories discussed—those facing surgery, immobilised by injury, navigating long-distance travel, or concerned about a sedentary desk job—the recommended course of action is to be proactive. A consultation with a chartered physiotherapist for a formal VTE risk assessment can provide a personalised prevention plan. This plan can confirm which exercises are safe and effective for the specific condition, provide education on lifestyle modifications, and determine if advanced modalities are appropriate.

Taking proactive, expert-guided steps is the most effective way to protect your vascular health and mitigate risk, demonstrating the lifelong value of physiotherapy.

Frequently Asked Questions About DVT Prevention

What are the warning signs of DVT I should watch for?

Common DVT symptoms include leg swelling, pain or tenderness (often in the calf), warmth, and redness or discoloration of the skin. If you experience these symptoms, especially with chest pain or shortness of breath, seek immediate medical attention as these could indicate a pulmonary embolism.

Can compression stockings prevent DVT, and when should I wear them?

Graduated compression stockings can help prevent DVT by improving blood flow in the legs, and are commonly recommended for long flights, post-surgery recovery, and during pregnancy. Your physiotherapist or doctor can advise on the correct compression level and duration of wear for your specific situation.

Is it safe to exercise if I've previously had a DVT?

Once your doctor has cleared you and you've completed the initial treatment phase, gentle exercise under physiotherapy guidance is generally encouraged to prevent recurrence and improve circulation. However, never attempt exercise during the acute DVT phase without explicit medical clearance.

Can DVT affect younger, healthy people, or is it only a risk for older adults?

While DVT risk increases with age, younger people can develop blood clots, especially with risk factors like oral contraceptives, pregnancy, prolonged immobility, or genetic clotting disorders. Anyone experiencing prolonged periods of immobility should take preventative measures regardless of age.

Are there specific foods or supplements that help prevent blood clots?

Staying well-hydrated is crucial for preventing blood clots, as dehydration increases blood thickness and clotting risk. While no specific foods prevent DVT, maintaining a healthy diet and avoiding excessive alcohol consumption support overall vascular health.

How is DVT diagnosed by medical professionals?

DVT is typically diagnosed using ultrasound imaging (Doppler scan) to visualize blood flow in the veins, combined with blood tests such as D-dimer to detect clotting activity. Your GP or hospital specialist will determine which diagnostic tests are appropriate based on your symptoms and risk factors.

Can I use massage or foam rolling to improve circulation and prevent DVT?

While gentle massage and movement are beneficial for healthy legs, never apply deep tissue massage or foam rolling if you suspect a DVT, as this could dislodge the clot. For prevention, the physiotherapy exercises outlined in this guide are safer and more effective than self-massage.

Do I need to take blood thinning medication to prevent DVT?

Blood thinning medication (anticoagulants) may be prescribed for high-risk individuals, such as after major surgery or for those with previous DVT history, but this decision is made by your doctor based on individual risk assessment. Many people can effectively manage their DVT risk through mobility exercises and lifestyle modifications alone.

Is DVT hereditary, and should I be tested if family members have had blood clots?

Some clotting disorders are genetic (thrombophilia), increasing DVT risk in families. If you have multiple family members with DVT history, especially at young ages, discuss genetic testing and personalised prevention strategies with your GP or haematologist.

How soon after surgery can I return to normal activities without DVT risk?

The timeline varies depending on the surgery type, but most patients are encouraged to mobilise within hours to days post-operatively under physiotherapy guidance to reduce DVT risk. Your surgeon and physiotherapist will create a personalised mobilisation plan that balances healing requirements with the need to maintain circulation.