Chronic Venous Insufficiency (Heavy Legs): My Best Tips as a Physical Therapist

Here, I answer the questions most often asked of physiotherapists by sufferers of venous insufficiency, which manifests itself in the sensation of heavy legs: what are the consequences, are exercises useful in limiting symptoms?

♻️ Last update: March 4, 2025.
👩‍⚖️ Declaration of financial interests: none directly related to the subject. My complete declaration of financial interests is in the legal notice section.
Written by Nelly Darbois, physiotherapist and scientific editor

Venous insufficiency, heavy legs = the difference

Venous insufficiency and heavy legs are not exactly synonymous.

👉 Heavy legs are a symptom: you feel a sensation of heaviness in your legs, especially at the end of the day or when it’s hot.

👉 Venous insufficiency has a cause: it’s when your veins have trouble bringing blood back to the heart.

It can lead to heavy legs, as well as swelling, varicose veins and tingling.

Heavy legs can also be caused by :

• heat: it dilates your veins, especially in summer ☀️ ;
• prolonged effort: standing or sitting for too long🪑;
• muscle fatigue: after intense sport or a day on your feet 🏋️;
• overweight: your legs carry more weight ⚖️ ;
• other circulatory disorders, such as lymphedema.

The cause of heavy legs is often multi-factorial: several of these factors come into play, in addition to venous insufficiency.

Venous insufficiency is often diagnosed with a simple clinical examination. The doctor asks you questions, observes your legs and any varicose veins.)

Venous Doppler ultrasound is sometimes prescribed, but not systematically.

What are the main consequences of venous insufficiency?

Here are the main consequences of venous insufficiency.

• Heavy, painful legs, especially at the end of the day or in hot weather.
• Swelling (edema), especially in the ankles and calves.
• Varicose veins: dilated veins visible under the skin.
• Night cramps.
• Skin disorders: dry, itchy skin, brown spots.
• Venous ulcers: sores may appear.

What exercises are recommended?

Physical exercise is often recommended for venous insufficiency, as in theory it stimulates venous return and can reduce the sensation of heavy legs.

However, scientific evidence remains uncertain (Cochrane, 2023): it is difficult to objectivize benefits under experimental conditions.

❌There are therefore no typical exercises or exercise duration or frequency that can be deemed more effective than others.

Here are some ideas for exercises you can use.

• Walking : outdoors or on a treadmill, avoiding trampling, which doesn’t really count because it doesn’t activate blood circulation enough.
• Move up and down on the balls of your feet (several dozen times in a row).
• Sitting or lying down, move your toes upwards and then downwards (several dozen times in a row).
• Go up and down stairs.
• Cycling or swimming: gentle activities that mobilize the legs without overloading them.

You can introduce these exercises into your daily routine, and see if they improve your symptoms. For example, by recording your feelings VS the type of physical activity you do in a notebook or app every day.

🚨 Performing 8 hours or more of high-intensity physical activity per week a priori exposes one to a greater risk of visible varicose veins (Béliard 2023).

Why does exercise boost circulation?

When you move, your muscles (especially those in your calves) act as a natural blood pump.

👉 In concrete terms:

• Muscles contract, pressing on the veins and pushing blood upwards towards the heart.
• Valves in the veins prevent blood from flowing back down. 🩸
• This mechanism is reinforced with every step, movement or muscle contraction.

Can you play all sports if you suffer from venous insufficiency?

In theory, certain sports should be avoided, as they may aggravate symptoms. But these recommendations are based mainly on logical reasoning, and not on formal evidence.

👉 Sports not recommended by the French health insurance scheme (ameli.fr).

• Those that cause jolts and crush the arch of the foot (e.g. tennis, squash, basketball). 🏀🎾
• Those that can block blood circulation (e.g. horse riding, judo, downhill skiing). 🐎⛷️

However, there is no evidence in the scientific literature to show that people who engage in these activities are more often affected by venous insufficiency.

As there are health benefits to sport, it’s probably better to do these sports than none at all!

Should you avoid standing still for long periods when your legs are heavy?

Standing still can worsen the feeling of heavy legs.

Visually, you can also often see your feet becoming purplish and colder if you stand still for a long time.

👉 Why?

• Standing up, blood has more difficulty flowing back to the heart because of gravity.
• If the leg muscles don’t move, the muscle pump (which helps venous return) doesn’t work. 🦵🩸
• As a result, blood stagnates in the legs, which can increase discomfort and swelling.

💡 Tip: if you have to stand, move your legs regularly: stand on tiptoe, bend your knees, or walk a little. These little gestures activate circulation and relieve your legs, as does wearing socks or compression stockings .

***

That’s all I wanted to say on the subject! Any questions or comments? See you in comments!