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Health & Exercise Forum


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Jun 9, 2022

Despite a recent surge in Covid cases from the new variant, more than 70 percent of Americans anticipate high levels of enthusiasm for travel this summer. Moreover, travel abroad in 2022 is expected to exceed pre-pandemic levels, as isolation weary Americans take to the air!

Confession; I recently was on a long trip that required sitting on an airplane for more than six hours…and I wore compression stockings … guess I’m getting older (and wiser)!

Have you noticed that being in a car or on an airplane for more than three hours leads to neck and back pain? Soreness, stiffness and swelling in your legs? 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 develop a more serious problem associated with long trips; deep vein thrombosis (DVT) or blood clots. But problems from long-distance travel can be avoided. The following tips, based research and personal experience, can prevent neck, back and leg pain and 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 logged 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 the 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.
  • Blood Clotting Problems  - are inherited problems and 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


  • Recent Surgery or Trauma– such as total joint replacement or hip fracture
  • Pregnancy – 1 in 1000 pregnant women will get a DVT
  • Obesity – health and mobility risk
  • Family History – increases risk
  • Heart Failure – increases risk

Risk Factors For Travel Related Neck and Back Pain

  • History – of neck, back, and leg pain or previous injuries
  • Arthritis – osteoarthritis and other forms of arthritis
  • Over 40 Years Old – makes you more prone to back pain and stiff joints
  • Obesity/Deconditioning – makes you more prone to back pain and stiff joints
  • Poor Posture – slouching, slumping, falling asleep in airplane seats
  • Poor Ergonomics – working on laptop or reading with head down and slouched for prolonged periods when traveling
  • Sleep Deprivation – lack of sleep for long periods

Prevention of Travel Related DVT and Leg Pain/Stiffness

  • Exercise - Keep calf and foot muscles moving every 30 minutes and 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
    • Leg Squeeze – squeeze knees together and apart
  • 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


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.

NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!”  

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:

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at GCSOM.