Understanding Venous Insufficiency: Stages, Symptoms & Physiotherapy Management at Physio360.

INTRODUCTION;

Chronic Venous Insufficiency (CVI) is a condition in which the veins in the legs fail to efficiently return blood to the heart, often leading to symptoms such as leg swelling, varicose veins, and skin changes. Left untreated, it can lead to serious complications, including ulcers and infections. At Physio360, we specialise in identifying and managing venous insufficiency through targeted physiotherapy, lifestyle changes, and patient education.

What is Venous Insufficiency?

Venous insufficiency occurs when the vein valves in the legs become weakened or damaged. This causes blood to pool in the lower extremities rather than returning to the heart. It's more common in older adults, pregnant women, those who are overweight, and individuals who stand or sit for prolonged periods.

Stages of Venous Insufficiency (CEAP Classification)

The CEAP system is the most widely used classification method for chronic venous disorders:

C0 – No visible or palpable signs of venous disease

• Symptoms: Heaviness, tired legs, or mild discomfort• No visible veins on examination

C1 – Telangiectasias or Reticular Veins

• Also known as spider veins or thread veins• Cosmetic concern for many• No major functional issues

C2 – Varicose Veins

• Enlarged, bulging veins visible under the skin• Symptoms: Pain, heaviness, cramping, itching

C3 – Oedema (Swelling)

• Non-pitting or pitting edema around ankles and calves• Increased discomfort and heaviness• Reduced mobility

C4 – Skin Changes

• C4a: Pigmentation and eczema• C4b: Lipodermatosclerosis (hardened skin due to fat inflammation)• C4c: Atrophie blanche (white scarring)

C5 – Healed Venous Ulcer

• history of ulceration• Skin appears scarred or fragile

C6 – Active Venous Ulcer

• Open, non-healing wounds usually near the ankle• High risk of infection and severe pain• Requires urgent medical and physiotherapy care

Causes & Risk Factors

• Prolonged standing or sitting

• Obesity

• Sedentary lifestyle

• Family history

• Previous DVT (Deep Vein Thrombosis)

• Pregnancy

• Smoking

Common Symptoms

• Leg swelling

• Aching or cramping pain

• Heaviness in the legs

• Skin discolouration

• Visible varicose veins

• Itchy, flaky skin

• Ulceration near the ankle

Physiotherapy Management at Physio360

At Physio360, we focus on improving venous return, reducing symptoms, and preventing progression through a combination of therapies:

✅ 1. Compression Therapy

• Use of compression stockings to improve venous return• Helps reduce edema and pain• Essential for all CEAP stages from C2 onwards

✅ 2. Elevation Techniques

• Guided postures for leg elevation• Reduces venous pressure and swelling

✅ 3. Manual Lymphatic Drainage (MLD)

• Specialized massage technique• Promotes lymph and venous circulation• Especially useful in stages C3-C6

✅ 4. Exercise Prescription

Tailored exercise programs help activate the calf muscle pump:

Examples include:

• Ankle pumps

• Toe raises

• Heel slides

• Cycling

• Walking programs

✅ 5. Neuromuscular Electrical Stimulation (NMES)

• Stimulates calf muscles• Enhances circulation• Ideal for patients with limited mobility

✅ 6. Lifestyle Modifications

• Weight management• Smoking cessation• Hydration and a balanced diet• Education on posture and work ergonomics

Why Early Intervention Matters

Identifying and treating venous insufficiency in the early stages (C0-C2) prevents progression to more serious stages like C5 or C6. At Physio360, we emphasise proactive screening and early physiotherapy care to reduce complications and improve your quality of life.

How Physio360 Can Help You

Whether you're dealing with mild leg discomfort or chronic ulcers, Physio360 offers:

✔ Comprehensive venous assessments

✔ Personalised rehabilitation plans

✔ Evidence-based physiotherapy techniques

✔ Modern electrotherapy and compression aids

✔ Home care guidance for long-term relief

REFERENCE AND RESEARCH ARTICLE ;

1.Physiotherapy in Chronic Venous Diseasehttps://www.researchgate.net/publication/373957439_Physiotherapy_in_Chronic_Venous_Disease

2.Understanding Chronic Venous Disease: A Critical Overview of Its Pathophysiology and Medical Managementhttps://pmc.ncbi.nlm.nih.gov/articles/PMC8348673/