Dr. Swami Karmananda Saraswati MB, BS (Syd.)
Many people complain of a tired, heavy, aching feeling in their legs by the end of the day, a result of inefficient function of dilated, lengthened, tortuous, varicose veins. This easily recognizable condition only occurs in man and is related to the special circulatory stresses involved in maintaining an upright posture.
Yoga therapy brings relief to sufferers of this condition and aids in correcting and restoring damaged veins to their former condition. This is especially true of early cases where damage is not yet severe.
The condition is characteristic of middle and old age, but can occur at any time following damage to muscles and veins of the legs. It can be a result of an hereditary tendency, occurring in families from generation to generation, and frequently accompanies pregnancy. It is an occupational hazard for people who spend long periods of time on their feet, such as machine operators, process workers, traffic policemen, barbers, counter workers, cashiers and tellers.
How do varicose veins develop? To answer this question we must first consider the structure and function of the venous return system from the extremities back to the heart. In the average adult body, the column of venous blood must flow at least four feet uphill, against gravity, in order to enter the heart. This is quite an engineering feat which nature has accomplished through a system of one-way flow valves lying along the leg veins. The pumping action is established as the muscles of the thighs and calves contract with walking. These repeated contractions squeeze and milk the blood upwards along the veins towards the heart. The one-way valves within the veins serve to break up the column of blood and prevent it from flowing back down towards the feet.
It is also necessary to understand a little more about the network of veins draining each leg of blood. There are two systems of leg veins- the ‘superficial’ (flowing just beneath the skin) and the ‘deep’ (flowing within the muscles of the leg and thigh). The superficial system enters the deep system in two places – in the groin and behind the knee. In addition there are a number of perforating veins along the leg and thigh which interconnect the two systems. Varicose veins develop where the two systems are connected to each other. Normally, blood in the superficial system flows into the deep system, the junctions between the two being protected by one-way valves which prevent any back flow from deep to superficial. Now consider what happens when standing straight and erect. The muscle pump is inactive and the whole weight of the static column of blood, exerting pressures up to 90mm Hg, is bearing down upon the valves.
A varicose vein can occur in three interrelated ways:
- A valve becomes incompetent, allowing a high pressure leakage of blood back into the superficial system, distending the superficial vein. Over a period of time the engorged superficial vein becomes enlarged and tortuous.
- An obstruction of the venous return to the heart, higher up in the abdomen, causes an excessive back pressure in the veins, distending them and forcing the valves to open and become incompetent from above. This occurs classically in pregnancy, where the growing uterus impinges on the inferior vena cava, the major vein in the abdomen. For this reason, varicose veins commonly accompany pregnancy, but valvular competence is usually re-established after delivery, especially if the mother uses yoga therapy in the postpartum period.
- In thrombosis (blockage) within the deep veins of the leg, all blood flows via the superficial system, producing dilation and valvular incompetence. This is an uncommon and very serious cause of varicose veins requiring urgent medical treatment. It is characterized by intense pain on stretching the calf muscles.
The most common complaint of varicose vein sufferers is the above mentioned fatigue and discomfort by the end of each day. This may be accompanied by sharp, well localized pains in the sites of the varicose veins, swelling of the ankles by evening and an itchiness of the skin of the legs. Others find the unsightliness of their varicose veins embarrassing and socially restricting, feeling obliged to keep the veins covered when in public and consequently limiting their activities.
Fortunately, utilizing a combination of common sense, yoga practices and medical science, a satisfactory solution to most varicose vein problems can be found.
- Avoid standing unnecessarily for long periods of time. If this is not possible, then keep the muscle pump actively working and moving the blood by walking around or flexing and contracting the leg muscles as much as possible. There is a special way of walking which will bring relief. The heel is brought to the ground first with each step, and then the calf muscles are consciously used to lift the heel of the back foot as it comes forward, increasing the ‘spring’ in the step.
- Keep the legs elevated as much as possible, to drain the pooled blood from the veins. If you work at a desk, support the legs horizontally rather than down in the usual position. Similarly, your favourite relaxation spot should include a comfortable high foot rest.
During pregnancy, lying on the side will aid venous return by shifting the pressure off the inferior vena cava in the abdomen. Alternatively, the pregnant woman can relax lying fiat on the back with the feet against the wall or on a support.
- Some people find the application of a firm elastic bandage or an elastic stocking each morning is most beneficial, but others find this too cumbersome and restrictive. During sleep and when the limbs are elevated, the veins will drain. Strapping the limb, not too tightly, from above the point of emergence of the varicose vein downwards in a spiralling motion, will prevent them from filling up during the day and will assist the muscle pump as the muscles contract against the added pressure of the bandage. During the day the bandage can be released periodically, the leg elevated and massaged, and then the bandage reapplied. At the end of the day the bandage is removed.
- Massage of the legs is very effective in bringing relief from the ache of varicose veins. Many people maintain that massage is not only a palliative therapy, but has a long term curative potential as well if it is carried out with awareness and on a regular basis. Massage is most pleasant and relaxing in the evening when the limbs are tired. The movement should be towards the heart, squeezing and milking the tissues of blood. A text on massage will give details of how to massage in the most effective way. This is especially soothing and effective in varicose veins accompanying pregnancy.
By adopting simple measures such as these, much relief can be gained. They have an added, inbuilt benefit- serving as methods of increasing self awareness within the daily routine.
- Asanas are very effective in the treatment of varicose veins, providing relief from symptoms and, in some cases, allowing incompetent valves to regain their efficacy. Many sufferers have reported great improvement in their condition with regular and consistent practice of these asanas.All the inverted asanas are most important. They allow the stagnant pooled blood to drain back to the heart, permitting damaged veins to resume more normal dimensions and facilitating valvular competence. Remember to rest in shavasana after any inverted posture.Sarvangasana (the shoulder stand) should be adopted for several minutes, morning and evening and whenever the legs feel tired and heavy during the day. Sirshasana (the head stand), although an excellent practice for the condition, is an advanced posture and should not be attempted by beginners nor adopted for long periods of time except under competent, direct supervision.
Asanas which stretch the muscles of the legs, toning and developing the muscle pump, should be practiced regularly as, in many cases, the problem of varicose veins manifests because the pumping system is inefficient and weak. Where the muscles are small and flabby, greater strain and pressure is applied to the valves. It is often the case that when the efficiency of the pumping system is improved through the practice of these asanas, the signs and symptoms of varicose veins disappear. Sumeru asana is excellent for this purpose. The heels must be brought to the floor if possible, stretching the calf muscles to their maximum. Tadasana is especially good for stretching the veins and enhancing the muscle pump. Pada hastasana and paschimottanasana, when correctly performed, bring a positive pressure to bear on the leg muscles which will be appreciated. Cycling (pawanmuktasana ex. 18) is especially beneficial for the veins and muscles of the thighs. Surya namaskara is a dynamic asana series with profound benefits. A few rounds should be included at the beginning of the morning program.
- Surgical removal of varicose veins may be found necessary where the condition is severe or incapacitating. It must be remembered, however that surgery does not remove the tendency to varicose veins and often other, previously unaffected veins may become varicose at a later time. Therefore, those who undergo surgical treatment for their condition should adopt the asana program given to facilitate venous return and avoid the possibility of further operations in the future.There are two main treatments of varicose veins:
- Injections of sclerosing (adherent) substances are made into the veins to join their walls together and to prevent their further use as a venous return pathway.
- Ligation and stripping of the long superficial veins of the leg is carried out. This entails tying off the ends of the veins and removing them entirely. A number of small cuts is required for this operation and the blood is left to return to the heart via the deep venous system. The surgeon must ensure that each individual communicating vein is successfully tied off.
- It is up to the individual to decide which treatment is best suited to his condition. The decision will depend on the severity of the case and the individual’s motivation to help himself. All degrees of varicose veins can be effectively treated through a combination of these therapies.We suggest you initially try the simpler, self-administered therapies, with special emphasis on the given asana program. Varicose veins do not develop overnight and you should not expect to spontaneously reverse the condition for it will take some time.Through practice of these asanas you will, however, gain immediate relief from aching legs. Over a period of weeks or months, by developing the muscle pump and emptying the veins of stagnant blood, surprising results can be obtained – especially where the veins are not grossly abnormal to begin with. It is worthwhile to try this approach before rushing off to the surgeon.