Health & Exercise Forum

Philadelphia Eagles quarterback Jalen Hurts is expected to miss the remainder of the 2026 NFL season after being diagnosed with deep vein thrombosis and bilateral pulmonary emboli (blood clots in both lungs). Unfortunately, despite being a professional athlete in exceptional health, Jalen Hurts was a victim of a “perfect storm.” In week four of the NFL season, he suffered trauma to his calf (a muscle with a generous blood supply). He developed a hematoma (a localized collection of blood outside the blood vessels, often resulting in a localized “black and blue” mark). Then, he developed a superficial blood clot (not in the deep vein). He flew 7+ hours to London, played a football game and flew home. The clot moved from his leg, into the deep vein system and traveled to his lungs. This problem, especially when associated with flying (that alone is a risk factor for a DVT) does not only occur in athletes, but the public as well. But, with a little planning, you can minimize the risk!

Air Travel

Have you noticed that being in a car or on an airplane for more than three hours leads to soreness, stiffness and swelling in your legs and neck and back pain?  With a little planning, preventing or limiting these problems on long trips is possible. Also, as people age and/or develop other health problems, they are more vulnerable to developing a more serious problem associated with long trips; deep vein thrombosis (DVT) or blood clots. But problems with long-distance travel can be avoided. The following tips, based on research and personal experience, can prevent neck, back, leg pain, stiffness and DVT.

Deep Vein Thrombosis  (DVT)

A DVT is a blood clot that forms in a deep vein. The deep veins pass through the muscles and cannot be seen like the veins just under your skin. While it may occur in your arms, it is much more common in the legs, especially the calf muscle when traveling. When a blood clot forms in a leg vein it usually sticks to the vein wall. Often, pain and swelling lead you to the doctor and treatment is rendered before serious complications develop. However, there are two possible complications. One, a pulmonary embolus occurs when a part of the clot lodged in your deep vein of the calf breaks off and gets lodged in the lung. This is a very serious problem that can be fatal. Two, post-thrombotic syndrome, occurs when you have pain and swelling in your calf after a DVT.

Risk Factors for Travel Related DVT?

The following risk factors for DVT significantly increase the potential for problems when traveling on long trips by air, more than 5 hours. Trains, cars and buses also create a risk, but air travel creates a greater risk for the following reasons: reduced cabin pressure, reduced cabin oxygen levels, dehydration and alcoholic drinks, which may increase dehydration and immobility.

• Immobility - such as sitting on a plane slows down blood flow, especially in the legs.
• Genetic Blood Clotting  - inherited Factor V Leiden – relatively rare
• Contraceptive Pill – leads to increased blood clotting
• Hormone Replacement Therapy - leads to increased blood clotting
• Previous Vein Damage – such as a trauma, surgery or previous DVT
• Over 40 Years Old – DVT risk increases with age, especially associated with poor
• health
• Recent Surgery or Trauma– such as total joint replacement, hip fracture, trauma and hematoma
• Pregnancy – 1 in 1000 pregnant women will get a DVT
• Obesity – health and mobility risk
• Family History – increases risk
• Heart Failure – increases risk

Prevention of Travel Related DVT and Leg Pain/Stiffness

• Exercise - Keep your calf and foot muscles moving every 30 minutes which can be performed in your seat;
  • Heel Raises – push toes down and heel up
  • Toe Raises – lift toes up and heel down
  • Leg Kicks – extend leg up and down
  • Hip Hike – raise knee up 4-6 inches and down
• Compression Stockings – Wear elastic compression stockings when you travel on         
• long trips by air (or car, bus, train etc) and have risk factors
• Anticoagulant Medication – If you are at high risk of DVT your physician may discuss the use of medication to prevent clots. Sometimes, a simple aspirin may do the trick.         
• Walk – keep moving every 30-45 minutes…walk around the cabin
• Hydrate – Drink plenty of water, stay hydrated, and avoid alcohol

Prevention of Travel Related Neck and Back Pain

Airplane seats are “C” shaped and force you to round your neck and back forwards. These exercises are designed to stretch and extend your back in the opposite direction. Please perform slowly, hold for 3-5 seconds and repeat 10 times each hour.

• Chin Tuck: Tuck your chin back to bring your head over shoulders.
• Shoulder Blade Pinch: Pinch your shoulder blades together.
• Standing Extension: While standing, put your hands behind back and extend lower back 10-20 degrees.
• Bend Your Knees Up Toward Your Chest – one at a time
• Arch Lower Back Slightly

Sitting: When sitting in an airplane seat, take the neck pillow in the overhead compartment and place it in the small of your lower back. While sitting or standing up, perform postural exercises every 30-45 minutes.

Visit your doctor regularly and listen to your body.    

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This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopedic and sports physical therapy in Scranton and Clarks Summit. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine. For all of Dr. Mackarey's articles, visit our exercise forum!