One of the most frequent questions my patients ask is, “Can I exercise after their my vein procedure?” The truth is we don’t know if it’s okay to exercise after radiofrequency ablation (RFA), endovenous laser ablatoin (EVLT), or sclerotherapy (spider veins treatment). This is because there are no known studies at the time of this writing. The short answer (or suggestion) to exercising after a vein procedure is the following:
- For radiofrequency ablation or endovenous laser ablation, exercise is okay as soon as it feels okay to you.
- For sclerotherapy, wear compression stockings religiously after treatment, and stop exercise if you can for about 5 days or so.
The data
What I do know is that the initial closure rate of the greater or lesser saphenous vein after radiofrequency ablation or endovenous laser ablation is over 99%. In other words, after these procedures, we can achieve a pretty secure closure of the vein. There is a long-term failure rate, however, of about 5-7% over the next five years or so. This means that a certain percentage of people can have recurrent varicose veins even after radiofrequency ablation or laser ablation because the treated vein re-opens.
Recommendations
I personally don’t have any experience of a patient failing initial vein treatment because of vigorous post-operative exercise. However, my observation is that patients who have had re-opening of their treated greater saphenous vein are young, active patients who tend to exercise a lot. They are typically patients with a strong family history of varicose veins, and/or large varicose veins. In my mind, the constant exercise may increase the blood delivery to the legs, and therefore, the blood delivery back to the heart. This can eventually push open the previously closed vein.
Personally, I would never tell a patient to decrease exercise in order to possibly decrease the possibility of recurrent varicose veins. This is because exercise is generally great for our bodies and minds. Besides, if varicose veins recur, we can always treat them again with a procedure that’s minimally invasive and easy. I don’t even limit post-operative exercise after radiofrequency ablation or endovenous laser ablation unless the patient feels uncomfortable or has pain with exercise. My typical Bay Area varicose veins patient will start exercising a few days after their procedure. Several more hard-core patients may even do a cross fit class the day after surgery! I feel very fortunate that we live in an area of the country where so many people care about exercise and fitness, and I certainly don’t want to get in the way of that!
Exercise after sclerotherapy (spider vein treatment)
When it comes to exercise after sclerotherapy, however, I am much more conservative. Sclerotherapy does not produce as secure a closure of the spider veins as radiofrequency ablation or endovenous laser ablation does to the larger varicose veins. Surgeons depend on compression to help “seal” the smaller veins closed, and to achieve a nicer result. But even with compression, the increased blood flow to the legs during exercise may result in veins that are not completely sealed. This has not been proven, but observation has led me to believe this. Generally, I suggest pausing the exercise routine for about five days. I advise to wear compression stockings as long as possible (including at night) in order to get optimal results. This is just a suggestion, because we don’t have great proof for this. But my patients over the years have told me that stockings seem to make their results better.