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Circulatory Problems: Varicose Veins and Venous Insufficiency, Systemic Causes of Edema, Lymphedema, Reflex Sympathetic Dystrophy (Complex Regional Pain Syndrome).

Circulatory problems fall into several categories

1) Poor blood supply from the heart to the body or arterial insufficiency can be caused by resistance coming from large vessel disease (usually arteriosclerosis, or clogging of the arteries) (See link; small vessel disease (usually deterioration of the smaller arterioles and capillaries, due to diabetes);

or actual heart pumping problems such as pacemaker/beating irregularities and valve trouble.

2) Poor blood return from the body to the heart or venous insufficiency is not only caused by sluggish performance or obstruction of veins but by poor cardiac output for whatever reason. Congestive heart failure and renal failure are common systemic causes of poor circulation and chronic venous insufficiency.

Veins and How They Work

Veins return blood from all areas of the body to the heart.

They are thinner than arteries but also have smooth muscular walls with little one-way valves that help keep the blood from flowing backwards. Good muscle tone is important in both veins and arteries because they control blood flow by their ability to contract and relax. This vasoconstriction and vasodilatation is controlled by the autonomic nervous system. Blood travels to the heart with lower pressure though the venous system than through the arterial system (from the heart to the body). The venous system is comprised of very large veins, medium size veins and very small venuoles (similar in size to capillaries).

What most people don't realize is that veins are responsible for transporting and absorbing extra-vascular fluid (fluid not in the blood vessels but outside, like edema and lymph). This fluid is drained from all tissues of the body, transported by lymphatic vessels and dumped into veins. See link illustration: The veins must absorb and transport this fluid. If the muscular wall of the veins is weak, then lymphatic swelling can occur. Most people see swelling and think there must be something wrong with the lymph glands. Only when the lymphatic system is damaged by either surgical removal (as in a mastectomy), radiation treatment, or blocked by tumor, is it the primary origin of swelling.

Veins work harder when blood pools in a pendant position, because they have to push the blood up against gravity. Contraction of muscles in the limbs, help squeeze and move fluid, assisting circulation. That is why people who stand for long periods are encouraged to rise up and down on their toes to assist the flow of blood upwards and prevent fainting. Kurashova Tissue Re-education Techniques have a direct, dramatic impact on improving muscle tone of both veins and arteries.

Varicose Veins are generally enlarged, somewhat lumpy and twisted veins. They are less efficient at returning blood up to the heart. Weakness of the valves and or the smooth muscle lining of veins are common. See link

Poor venous return and/or varicosity of the veins can be caused by inflammation in the veins, prolonged standing, sitting or lying without much movement, clotting problems, obesity and pregnancy. When chemotherapy weakens general musculature it also can weaken the muscle in blood vessels. Persons exposed to injectable recreational drugs may also experience damage to their veins.

After a trauma, edema (excess accumulation of inflammatory fluid in the tissues, not bleeding) is nature's way of splinting an area to prevent movement, pain and further injury. Unfortunately it creates a diffuse pressure medium that prevents healing blood and fibrin from reaching the injury.

Fibrin is a fluid that creates binding scar tissue. When edema is present, fibrin infiltrates throughout the edema causing a lasting lumpy tissue. To assist healing of an injury edema must eliminated.

Treatment Strategies

Kurashova Tissue Re-educationTechniques directly improve circulation and reduce swelling. Gliding strokes applied without deep pressure in the direction of the lymphatic chain and heart, improves venous return. (Deep pressure in the presence of swelling is not only painful but causes vasoconstriction, thereby reducing blood flow.) Vibration of muscle recruits and tonifies the vasculature within the surrounding muscle.

Vibration over the vein itself tonifies the smooth muscles within the vein, strengthening venous return. Gliding and vibrational stokes over the back stimulate drainage through the veins and lymphatic vessels that travel along the spine and up to the heart, ultimately improving systemic circulation.

Case History: A 30 year-old woman came to me with a history of having pain for several years. The pain was in the back of both legs whenever she sat more than 5 minutes (pain being 9 on a scale of 10, 10 being the worst). She reported sitting for school and her secretarial job, 8-10 hours a day over the past 2 years. Luckily she had become an Occupational Therapist and now was on her feet for most of her workday.

She had been tested for everything including nerve problems and blood clots. What I felt upon examination was tightness and tenderness in her entire saphenous vein, from her foot up to her groin. Imagine a woman about 5 ft tall, sitting in the average chair, which is too high for her, the seat edge pressing into the backs of her thighs for over 8 hours! My assessment was that her veins were inflamed and thickened from sustained pressure. Her thickened hamstring muscles also needed to be treated. Within 10 treatments using Kurashova Tissue Re-education this woman was able to sit up to 3-5 hours pain free. She also adjusted her car and work chair heights to a lower position.

Reflex Sympathetic Dystrophy (now called Complex Regional Pain Syndrome, CRPS), is a condition of which the primary symptom is severe pain in a limb that does not resolve in the normal healing time nor with pain relieving medicine. It can occur after a major or relatively minor injury. Anyone at any age can experience this problem but women are more likely than men and the average age of onset is about 30 years old. CRPS used to be called shoulder/hand syndrome because it often affected the upper extremity but we now know that any limb may be affected and if it progresses it can spread throughout the whole body. Skin, blood vessel, muscle, bone and nerves can all be affected by CRPS.

The sympathetic nerve chain runs along the front of the spine and controls automatic functions of things like circulation and sweat gland activity. (See ill. 1) For reasons not clearly understood, in CRPS the sympathetic nervous system has become over-excitable and the function of blood vessels, nerves and sweat glands it controls fluctuate abnormally. Thus, there may be opening of the blood vessels causing warmth and redness, then closing of the blood vessels causing blanching, cool skin and spasming. Even the peripheral nerves, which have smooth muscular sheaths, respond to the sympathetic nervous system. Often the nerve sheaths tighten and create nerve pain, burning and irritation.

Sweat glands can also be turned on or off causing excess sweating or dryness.

Symptoms from early onset to worsening of the illness:

Early Symptoms: Localized burning or aching in the limb of injury; Localized swelling that moves when touched; Sweating; Hypersensitivity of skin to touch, temperature and movement; Muscle spasm; Stiffness; Vasodilatation and Vasoconstriction leading to a warm then a cold limb

Worsening: Diffuse, more severe pain; Swelling becomes thicker; Hair changes on the limb ( can be either excessive or reduced); Thinning of the skin; Grooving of the nails (a sign of decreased circulation to area); Diffuse early osteoporosis of limb; Thickness of the nearby joint

Severe: Loss of joint range of motion; Atrophy of muscle mass; Tight flexor tendons; Osteoporosis

Traditional CRPS Treatment often begins with pain-relieving medicine and if this is not effective many patients opt for sympathetic nerve blocks by injection or they try a TENS unit (skin electrodes give low electric stimulation to block pain).

Surgical options include cutting the sympathetic nerve chains or the implantation of a dorsal spinal column electrical stimulator.

Case History: A 40 year-old patient came to me having a 20-year history of CRPS. She had been a triathlon runner and unbeknownst to her had stress fractures in both shinbones. Despite her pain she kept running until she was diagnosed with the fractures. Her leg pain persisted after the fractures healed and her legs were always very white. Walking more than 2 blocks caused her legs (upper and lower) to burn and stiffen. She had been through all the possible conservative treatments including several nerve blocks and finally she had a dorsal spinal column stimulator implanted two years before seeing me.

The implant stimulator really helped her control her pain. She still had pain in her legs but it was more like a 5-8 out of 10 instead of 9-10 out of 10. I began treating her with Kurashova Tissue Re-education Techniques and within 4 treatments she began to have lessened CRPS symptoms. By the end of a series of 11 treatments, her pain level using the stimulator was from 0-5 out of 10.

Our treatment strategy was to help normalize the circulation in her back, buttocks and legs. We waited a month and began a second course more directly targeting her spine, saphenous veins, and the area of original injury.

This second round of treatment reduced her symptoms even further, making it less necessary to use the stimulator at times and increasing its effectiveness. She felt even more empowered in controlling her pain.

I am now offering in-person office visits. Telemedicine sessions are still available for those unable to do in-person visits.

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MovementWise Christine Inserra P.T.
Certified Teacher of the Alexander Technique & Feldenkrais Method
Physical Therapy serving Chicago and the Greater Chicagoland Area