Hello again and welcome to the second episode in our quarterly newsletter. We’re still here and you’re still getting injured, a perfect match really! The response to the first newsletter was overwhelming – with “leave us alone”, “boring rubbish” being just a few of the selection of nice feedback we have had. For those people who have put out restraining orders against us, I hope this doesn’t contravene them. As we are all planning on leaving for holidays over Christmas, we thought we might address the issue of how to best handle the long haul flights we are all about to face. From DVT (deep venous thrombosis) to back and neck ache (not to mention ruining our lovely complexion) flying presents a number of challenges to our poor bodies. We thought we might try and explain what DVT is, therefore enabling you to understand how to avoid it. Commonly called “economy class syndrome” by smug doctors and journalists who always fly business class (read: bitter small business owner who always turns right on boarding the plane and desperately avoids eye-contact with those on the left), anyone flying for long periods can be at risk.

Deep venous thrombosis is basically a clot of blood that forms in the venous (veins) system due to blood not being returned effectively to the heart. Basically after the arteries carry blood full of oxygen and nutrients to the periphery (limbs) the veins then have to take the used blood back to the heart. The only way the veins are able to do this is by running in between muscles which then squeeze on the veins when they contract. The blood then gets shifted upwards and held by a series of one-way valves until it makes it way back to the heart and lungs to be filled with wholesome goodness and then launched out to do it all again. So when we remain still for long periods, the veins don’t have the muscles around them contracting and the de-oxygenated blood can pool in areas of low muscle activity, and areas which need to work against gravity (such as the calves/ankles). This is why we always think our shoes have shrunk when we put them back on to land (well at least I used to think that – cabin pressure can do strange things you know…..).

This table should help you with identifying if you are at risk, or have a DVT

    Symptoms of DVT

  • Tenderness and redness in the
    affected area

  • Pain and swelling in areas drained by

the vein where the blood clot is


  • Fever
  • Rapid heart beat
  • Sudden, unexplained cough • Joint pain and soreness
    Risk Indicators for DVT

  • Recent injury to the vein such as a
    direct blow or trauma

  • People greatly overweight
  • The elderly
  • Recent surgery or radiation therapy • Pregnant women
  • Those whose feet don’t reach the

floor (more pressure on the back of

    the leg)

  • Those suffering from a variety of heart conditions

The most common, serious complication of DVT is a pulmonary embolism, where a blood clot breaks free from a vein wall, travels to the lung and blocks an artery in the lung. A pulmonary embolism can be life- threatening and needs immediate medical attention.

Your chances of developing DVT from a long flight are thought to be only one in several million, but you can take simple measures to reduce this risk still further (oh all right – particularly if you are flying economy class hummff..). Have a single low-dose aspirin just before you board the plane. This helps to thin the blood. However, do not take it if you have stomach ulcers or suffer badly from indigestion, or you could get bleeding in your stomach. Wear loose clothing and move around before boarding. Most important of all, do not just sit still in your seat during the flight. Wriggle your toes and flex your ankles (lifting your heels off the ground while toes remain on the floor) to keep your circulation going and walk up and down the aisle when you can (at least once an hour). Calf raises and partial squats while waiting for the bathroom are a great idea. There has been no recorded case of a passenger joining the mile high club and developing DVT on the same flight, so try and keep active! Do not cross your legs. Drink plenty of water during the flight, and avoid alcohol, to ensure you don’t become dehydrated, especially if you are an Australian male sporting team sitting anywhere near a couple of tired Physios on QF22.

Those with a higher risk of developing DVT (see table above) should consult a doctor before flying. Do seek medical advice if you have symptoms suggesting DVT, even if they only appear several weeks after you have been on a plane, or after a short flight.

We often see back and neck pains which either arise from or are aggravated by flights. Using a lumbar roll during the flight will help maintain a healthy curve in the lower back while sitting. Standing up each hour and arching backwards in a standing position (limbo style) will help bring some equilibrium to the forces acting on the spine. Turning your neck slowly to the end of range side to side and looking all the way up and down will help prevent it from stiffening up. If we have prescribed any specific exercises for your back or neck then try and do some of those either in your seat or in the aisle.

So in summary, try and keep as active as possible while you are in-flight. Particularly before and after sleeping on those red-eye overnight flights.

Enjoy the holidays, and a Merry Christmas and Happy New Year from Tokyo Physio.
Our offer of a free bottle of wine for patients who refer their friends has been popular, and we continue to offer this as a way of trying to let more of the foreign population that we are here.