Physical therapy in post-thrombotic syndrome: A case report

Abstract

Post-thrombotic syndrome (PTS) is a chronic venous insufficiency (CVI) associated with leg pain, swelling, feeling of heaviness, edema, and skin changes secondary to prior deep vein thrombosis (DVT) within 1st 1–2 years. It occurs in 20–50% of DVT, usually caused either by residual venous obstruction, valvular failure, or both and attributed to ambulatory venous hypertension. Treatment options for PTS are limited, but most clinicians dwell on preventive measures, using compression stockings and strengthening exercises to improve the pump action of the calf muscle. A 30-year-old married female civil servant was diagnosed with PTS fallowing treated lower limbs DVT; she presented with bilateral lower limbs edema, moderate pain, weakness of the lower limb group of muscles, and a Vilalta score of 9 out of 15. After physiotherapy sessions inform of resistance strengthening exercises, ankle pump exercises, effleurage soft-tissue manipulation, treadmill training, and using compression stockings at most day hours (4–8 h) while elevating the lower limbs in night hours for 8 weeks on alternate days visit. Pain reduced, muscle power for the lower limbs improved, edema reduced in centimeters, and Vilalta score dropped to five out of 15. This study gives an insight into employing different physical techniques that have the potential to improve clinical outcomes of PTS because it reduces Vilalta score significantly, and edema, in particular decreases in centimeters throughout the study. As such, physical therapy means such as compression stocking, goal-oriented strengthening, aerobic exercises, and effleurage soft-tissue manipulation can be considered in the management of patients with PTS.