Deep vein thrombosis (DVT) is a condition where a blood clot forms in the deep veins, most commonly in the legs but occasionally in the arms or pelvis. DVT is part of a broader condition known as venous thromboembolism.
DVT is clinically important because clots can partially or completely block blood flow, causing pain and swelling. More seriously, part of the clot can break off and travel to the lungs, resulting in a pulmonary embolism, which is a medical emergency.
People with DVT may initially present to a physiotherapist for what appears to be a musculoskeletal issue such as calf pain, thigh pain, or swelling following injury or surgery. For this reason, physiotherapists are trained to screen for DVT risk factors and symptoms and refer urgently when a clot is suspected.
Key Facts
Risk Factors
- Recent surgery, especially orthopaedic surgery.
- Prolonged sitting or bed rest.
- Pregnancy or use of oestrogen-containing medications.
- Cancer, chronic illness, or clotting disorders.
Symptoms
- Swelling of one leg or arm, often sudden or progressive.
- Pain or tenderness, commonly in the calf or thigh.
- Warmth or redness of the affected limb.
- Pain that is not clearly linked to a specific injury.
Aggravating Factors
- Prolonged immobility such as long-distance travel or bed rest.
- Recent surgery or hospitalisation.
- Pregnancy, postpartum period, or hormone therapy.
- Previous history of DVT or clotting disorders.
Causes
DVT occurs when blood flow slows, the blood becomes more likely to clot, or the vein wall is damaged. This is sometimes described as Virchow’s triad. Factors such as immobility, surgery, trauma, hormonal changes and certain medical conditions increase the risk.
DVT is not caused by physiotherapy treatment or exercise. However, symptoms may become noticeable during movement or rehabilitation following injury or surgery.
How Is It Diagnosed?
Deep vein thrombosis is diagnosed medically and cannot be confirmed by physiotherapy assessment alone. If DVT is suspected, urgent medical referral is required.
Physiotherapists assess symptoms, risk factors and clinical presentation during the subjective examination. If red flags are present, physiotherapy treatment is stopped and immediate referral to a doctor or emergency department is made.
Investigations & Imaging
- Venous Doppler ultrasound
- Primary imaging test used to detect clots in the deep veins.
- Blood tests (e.g. D-dimer)
- May support diagnosis but cannot confirm DVT alone.
Physiotherapy Management
Physiotherapy does not treat deep vein thrombosis directly. The physiotherapist’s role is focused on early recognition, risk screening, urgent referral, and safe rehabilitation once medical clearance has been provided.
Education
Education focuses on recognising warning signs, understanding activity restrictions, and safe return to movement once anticoagulation therapy has begun and medical clearance is given.
Other Treatments
Medical management of DVT typically involves anticoagulant medications to prevent clot growth and reduce the risk of pulmonary embolism. Treatment duration varies depending on the cause and individual risk factors.
Prognosis & Return to Activity
With early diagnosis and appropriate medical treatment, most people recover well from DVT. Physiotherapy may assist with gradual return to activity once it is safe to do so.
When to See a Physio
- Unexplained limb swelling, pain or redness.
- Symptoms that do not fit a typical musculoskeletal injury.
- Recent surgery, immobilisation or prolonged travel with new symptoms.