As many Central Pennsylvanians take to the skies this summer, the physical therapists at First Choice Rehab are calling attention to the dangers of long flights in cramped quarters.

According to Stu Basom, PT and Clinic Director at the Lemoyne office of First Choice Rehab, deep vein thrombosis (DVT), can occur after periods of being immobile, such as on long plane flights.

Basom notes that the risk of DVT increases during travel of 8 hours or more¹ and that an estimated 10 percent of passengers on long flights may develop a DVT. The symptoms of leg DVT include swelling in one or both legs and tenderness in the calf. Symptoms of a pulmonary embolus include shortness of breath and a high heart rate. "People who experience any of these symptoms should always see the doctor, especially if they occur following a long period of immobilization," he says.

Compression stockings² are recommended to help reduce the risk of DVT. "The compression helps to prevent clot formation by keeping excess blood from remaining in the leg veins," says Basom.
 
"Simple exercise can help prevent typical symptoms experienced by people who fly, including leg cramping, toe cramping, and general lower-body aching," states Basom. Simple exercises are illustrated at the end of this article.  He notes that "Sitting still for long periods may lead to swelling of the feet, which becomes obvious to many passengers when they try to put their shoes back on at the end of their flight."

Basom suggests that passengers walk up and down the aisle of the plane every hour or so to work the leg muscles and ease the back and not stay seated for the duration of the flight, if permitted by the flight attendants.

"Performing these exercises will keep the leg muscles from contracting and will help relieve stiffness during the flight. The exercises also will help prevent fluid build-up in the legs, and stretching the back and the muscles around the torso will prevent stiffening," says Basom. He also notes that if you have an existing back problem, appropriate guidance should be given to you by your physical therapist before any extensive flying.

"Sitting in such a cramped position also puts a lot of stress on the lower back, especially for people who have pre-existing back problems. If you have brought along hand luggage or a rolling case that fits under the seat, use them as foot rests to elevate your feet so that your knees are slightly higher than your hips when you are sitting," suggests Basom.

Another consideration while flying is the dehydration that occurs from the high altitudes at which planes fly and the dry, pressurized cabin air. These conditions may lead to muscle cramping and aching, so physical therapists advise passengers to drink plenty of water before and during the flight.

¹ Aryal KR, Al-Khaffaf H. Venous thromboembolic complications following air travel: what's the quantitative risk? A literature review. Eur J Vasc Endovasc Surg. 2006;31:187-99.
² Scurr JH, Machin SJ, Bailey-King S, Mackie IJ, McDonald S, Smith PD. Frequency and prevention of symptomless deep-vein thrombosis in long-haul flights: a randomised trial. Lancet. 2001;357:1485-9.

Inflight Fitness Guide From APTA

When you have little room to move and stretch on the plane, physical therapists advise doing some simple, seated exercises to keep the blood flowing, the joints mobile, and the muscles relaxed while en route.

• Heel Raises - Sit with feet flat on the floor, about hip-width apart. Lift heels so that only toes and the balls of the feet are on the floor. Hold for 5-10 seconds and lower feet back to the ground. Repeat 10 times.
• Toe Lifts - Sit with feet flat on the floor, about hip-width apart. Lift toes and balls of the feet so that only the heels are on the floor. Hold for 5-10 seconds and lower feet back to the ground. Repeat 10 times.
• Ankle Circles - While sitting, lift right leg slightly off the ground and rotate the foot clockwise, making a circle in the air. Do this 15 times clockwise, then 15 times counterclockwise. Repeat with left leg and foot. Alternatively, trace the letters of the alphabet in the air with the right, and then the left, foot.
• Overhead Stretches - Stand and reach arms straight up and stretch. Slowly lean to the left, then right, bending at the waist. Repeat this action five times to each side, holding each for 5-10 seconds. If you are unable to stand and stretch, then reach arms straight up while seated. If you have room, slowly stretch to each side as well.
• Back Twists - While sitting, reach the right arm across the body and grab the left armrest. Slowly turn the torso and head as far to the left as is comfortable. Hold for 5-10 seconds, repeat five times, and then switch sides.
• Curl Downs - While sitting, pull stomach and chin in ¾ and gently curl trunk down very slowly, reaching hands to the floor. Hold for 5-10 seconds ¾ then uncurl slowly back up. Repeat five times.
• Toe-Heel Walk - When walking down the aisle of the plane, walk on your toes one way and then return to your seat by walking on your heels.