Weightlifting & Varicose Veins.

[maximuspita]

Hello, Mr. Rippetoe. I have varicose veins, not the spider ones but the really ugly ones, and I would like to start weightlifting. I've checked what some medical sites say about the matter and they say I should avoid strenuous exercise like weightlifting but I would like your opinion the matter.

Thanks.

[Mark Rippetoe]

What is their reasoning on this, since the venous return blood flow is under no pressure?

[Steve Hill]

Hey, do those veins look like this guy's?

He's George Hincapie - one of the current best American cyclists. I personally don't think that you have anything to worry about!

[maximuspita]

Well, I checked around again to be sure and it seems that the medical community is divided on the issue. The best I could come up with was this:

While you may like the way your legs look due to weight lifting or long-distance running, a strenuous exercise program might result in legs that are aching, throbbing, or restless after the exercise period stops, cautions D. Brian McDonagh, Vein Clinics of America, Schaumburg, Ill. Based on treatment of patients, he believes certain types of exercise exacerbate varicose veins.

[...]Through the use of duplex ultrasound to study the diseased vein, physicians have observed that, when individuals with varicose veins hold their breath and bear down or undertake strenuous exercise which elevates abdominal pressure, backward flow of blood results. "If someone with varicose veins is doing situps or weight lifting, the additional pressure causes backwards flow of blood which, in time, will worsen the condition of the varicose veins."[...]

My veins look just like those, Steve. I did some heavy lifting this last week and my calves started cramping up around halfway through the workout. I'll just wear compression stockings and see how that works.

[Brandon Oto]

What is their reasoning on this, since the venous return blood flow is under no pressure?

Mark,

Can you clarify what you mean by this? If venous blood were under no pressure, it wouldn't go anywhere.

[Mark Rippetoe]

Yes Brandon, I'd be happy to. Venous blood is under no systolic/diastolic pressure, since it's already been through the capillaries. The pressure it's under is balanced between that provided by muscular contraction as it compresses the veins and the force of gravity. It is at maximum in the feet and lower legs and drops with proximity to the heart. And I assume the good doctor means that after the set starts your venous flow becomes retrograde from the right atrium back down the venous bed. I'd love to see this study.

[Zarsky]

I personally have noticed a reduction in the severity of varicose veins. Mine weren't very noticeable but had started right on cue at 40. I hardly see them now after just 2-3 months of lifting (and ending the long slow distance running

[Brandon Oto]

Yes Brandon, I'd be happy to. Venous blood is under no systolic/diastolic pressure, since it's already been through the capillaries. The pressure it's under is balanced between that provided by muscular contraction as it compresses the veins and the force of gravity. It is at maximum in the feet and lower legs and drops with proximity to the heart. And I assume the good doctor means that after the set starts your venous flow becomes retrograde from the right atrium back down the venous bed. I'd love to see this study.

Okay. Not to overstep my pay grade (lowly EMT here), but in my understanding:

Cardiac output is very much a factor in venuous pressure insofar as the heart has to pump to "drain" the venous system; think of it as a potential bottleneck in the system. So it would make sense that under Valsalva, where intrathoracic pressure increases, and cardiac stroke output commensurately decreases (heart can't expand as much), less venuous blood would be pumped and more would "back up" in the queue. The aforementioned pressure would also decrease compliance of the vascular system and make "less room." Either way (more blood on one hand, less compliance on the other) you have a higher venous pressure and in someone with varicose veins that's not what they want.

Your mileage may vary, I'm not a cardiologist, etc. etc. But it does make some sense.

[Mark Rippetoe]

But this pressure change is balanced by the pressure head produced by the contracting muscles, and because the blood flow through the tissues drops significantly as a result of the central and peripheral effects you describe. And how long would a set have to be before pressure from this cardiac effect backed up enough to affect varicose veins in the leg?

I'd prefer that we worried more about the effects of not training than training.

[Brandon Oto]

I'm inclined to agree, but the point is that "yes, lifting weights may make your varicose veins worse" seems like it's at least plausible... which isn't much to give maximuspta, but it's full disclosure, anyway.

Nobody said decision-making was easy. Try the stockings.