Planes Trains and Automobiles: Healthy Travel Part Four

Part four- Preventing traveler’s thrombosis


Traveler’s thrombosis is known in medical terms as a deep vein thrombosis (DVT). A DVT is a blood clot restricting circulation usually in the lower extremity. The problem with a DVT is if the blood clot dislodges and travels from the leg to the heart, brain or lungs. It can lead to heart attack, stroke or when it goes to the lungs, it is known as a pulmonary embolism (PE) and restricts breathing. All of these are serious, life threatening conditions.


Risk factors for developing a DVT include:

  1. Dehydration
  2. Age with the risk increasing after 40 years old
  3. Obesity (body mass index: BMI greater than 30kg/m2)
  4. Previous DVT (the CDC states that one third of individuals with DVT/ PE will have a reoccurrence within 10 years)
  5. Family history of blood clots
  6. Varicose veins
  7. Recent surgery or injury (within the last three months)
  8. Pregnancy
  9. Oral contraception
  10. Hormone replacement therapy
  11. Cardio-respiratory disease
  12. Active cancer or recent cancer treatment
  13. Other chronic illness

**anyone with three or more of these risk factors should consult their doctor about preventative measures prior to long haul flight of 4hours or greater


Recognize the symptoms

Immediate treatment is always preferred. However, about half of the people with a DVT have no symptoms at all. The most common symptoms include

  1. Swelling in the leg or arm
  2. Pain and tenderness, you cannot explain
  3. Skin warm to the touch
  4. Redness to the skin

**If you have these symptoms contact your doctor as soon as possible.


The following are signs of a pulmonary embolism. If you have any of these symptoms seek immediate medical attention.

  1. Shortness of breath (difficulty breathing)
  2. Faster than normal or irregular heartbeat
  3. Chest pain or discomfort that often worsens with deep breathing or coughing
  4. Coughing up blood
  5. Anxiety, light headiness, or fainting


Preventive measures

Prevention is always preferred. The following are steps you can take to decrease the risk of DVT.

  1. Regular stretching and mobility exercise and when possible walk around the cabin during flight.
  2. Stay hydrated (drink plenty of non-alcoholic beverages) The rule of thumb is drink enough fluids to keep your urine pale in color.
  3. Taking a low dose aspirin tablet (75mg) for its anti-adhesive effects on blood platelets. Be sure to talk to your doctor before adding aspirin with any other medications.
  4. Use graded compression stockings
  5. Wear loose fitting clothing and avoid crossing your legs to reduce compression on the veins.


For online video link and handout of Exercises You Can Do in your seat: call our office 858-675-1133 and ask for your airplane, seated exercises to be e-mailed directly to you.



References for DVT information:

Gavish I, Brenner B. Air travel and the risk of thromboembolism. Intern Emerg Med 2011 Apr;6(2):113-6.

Planes Trains and Automobiles: Travel Healthy: part three

Part three- Seat Adjustments:


Bring your seatback and tray table into their upright and locked position.

Not that you would notice it was back.


If you have been on an airplane in the last few years you probably have noticed that airplane seats are not completely designed for the human body. When originally designing airplane seats the engineers incorrectly measured average hip width to determine seat width. Many of the world’s population the widest part of the body is the shoulder width. No wonder you literally are rubbing shoulders with your neighbor. This, along with seats becoming narrower and closer together means we are bound to a small space for the duration of the flight. Even the upfront, expensive seats, although provide more wiggle room do not fit all body types. So, if you do not fit, how do you keep the desired posture and alignment your physical therapist has recommended?


  1. Use the pillow (when provided), folded pashmina, blanket or jacket you brought on board behind your back. If you feel your lower back is rounded place lower down to provide lumbar support. If you feel the headrest is pushing your head forward place he roll between your shoulder blades to allow your ears to now align over your shoulders.
  2. If you are too short for your feet to touch the ground when all the way back in the seat you may want to invest in a folding foot rest or after takeoff use your carryon luggage to prevent dangling and excessive pressure on the back of the thighs reducing circulation.
  3. If you are too tall. You are too tall! The best course of action is to plan and book an aisle, bulkhead or exit row seat. Difficult for the casual travel with airlines charging more for those seats. Depending on the length of the flight and your size it might be worth a few extra dollars.
  4. If you have a lower extremity injury not only the aisle or bulkhead seat is desired but think about which side keeps the involved limb towards the aisle so when the heavy carts are not coming your way you can stretch out into that space. Keep in mind people boarding a plane do not pay attention so protect the leg by keeping it clear until people are on board.
  5. If you have an upper extremity injury sensitive to jarring especially after shoulder surgery, dislocations and fractures, attempt to get a window seat with the involved side next to the window to minimize bumps form others. Bring a pillow or jacket to support and cushion the arm.
  6. Get up frequently when possible. Perform a few exercises and stretches in your seat. See recommendations under next section: preventing traveler’s thrombosis.


Planes, Trains and Automobiles: Healthy Travel: part Two

Part two: Managing Luggage:

Now that you have packed: carrying, pulling and lifting luggage:


Most people have luggage with wheels.   Luggage with two wheels must be tilted and then rolled. The key to avoid strain to the shoulder and arm is to keep the bag close, avoid letting the bag trail behind because this causes stress to the shoulder and leads to a twist in the lower back. When the bag is heavy there is even greater pull and stress to the shoulder and neck. The bag with 4 wheels is easier on smooth surfaces however on carpet and cobblestones you often have to tilt to two wheels to prevent repetitive tipping due to catching of a wheel.


When lifting bend your knees, keep abdominals engaged and seek help. Putting a bag in the overhead bin can be tricky, especially if you are shorter due to the need to reach further overhead. Keep carryon luggage as light as possible and use both hands to lift.


Speaking from experience, as a person who has been hit in the head with carryon luggage another person could not manage, lowering a heavy bag down can be dangerous for you and those around you so be sure to have both hands on the bag before descending from the storage compartment.


Check in next time for seat adjustments.

Planes, Trains and Automobiles: Staying Healthy Travel Tips Part one of

Air travel: staying healthy and arriving happy.

Whether you travel for work or taking the vacation of a lifetime, stay healthy with a few tips from this physical therapist, who loves to travel and wants everyone to stay healthy.

The once perceived glamor of air travel in times past has evolved into long lines, safety checks, larger carryon bags, completely full flights and cramped seating. Throw confined space with recycled air, jet lag, change in diet and altered exercise routines and it is amazing anyone who travels stays healthy. Many of these travel complaints cannot be completely avoided however with a little planning you can at least arrive at your destination healthier and happier.

Part one- Packing list:

Unfortunately, you cannot prevent the woman or man sitting next to you who has not bathed in a while or is wearing too much cologne, or worse still, both. The screaming child or the talkative neighbor is the Russian Roulette of air travel. So, it is best to first pack your patience then a few essentials like toothbrush and ID. After that considering packing following items:
1. Empty refillable water bottle, fill up once you are past TSA. Hydration is important. Dehydration is one risk factor for deep vein thrombosis (discussed later in this series of articles)
2. Healthy snacks: it is hard to resist fast food when hungry and when there are reduced healthy options. Avoid heavy meals right before flying, you don’t digest well sitting in a cramped space and it makes the seat even more uncomfortable.
3. Prevent the spread of unwanted germs. Pack hand sanitizer to use when you are not near running water. Otherwise, wash your hands often be sure to rub hands together with soap for at least 20 seconds. This is about the time it takes to sing Happy birthday to You twice.
4. Pashmina, blanket or jacket. As someone who is always cold I never leave home without it, even when going to the tropics (at 35,000 feet the air is colder). It can always double as a pillow behind your back to improve spine support.
5. Relaxing music downloaded on your phone with noise cancelling headphones. Reduce stress and attempt to tune out the agitating noise that comes with public transportation.
6. Entertainment of choice: Not all planes have TV screens and these entertainment systems do not always work so bring your own. Old fashioned books have no battery to die but for long tips can add weight to your luggage. Tablets and e-readers are convenient, but you have to consider how you hold them and what position your head tends to be in when using these devices. The flight goes much faster if you can sleep or at least keep your mind occupied.
7. Workout clothes or at least one comfortable outfit and shoes that can be worn to go for walk and get outside when you reach your destination. Studies show, going outside around 2pm at your destination helps reduce jet lag and assists your body in adjusting to the new time zone.

Check in next time for tips on managing luggage!