Is physical therapy safe with a Deep Vein Thrombosis (DVT) of the left subclavian and axillary veins?

From the Guidelines

Physical therapy can be safe with a deep vein thrombosis (DVT) of the left subclavian and axillary veins, but it requires careful medical supervision and modification of activities. You should not begin physical therapy without clearance from your vascular specialist or physician managing your DVT. The American College of Chest Physicians recommends acute treatment with parenteral anticoagulation for patients with acute upper-extremity DVT that involves the axillary or more proximal veins 1.

When considering physical therapy, it is crucial to avoid exercises that increase pressure in the affected arm or that could dislodge the clot. Early therapy may focus on gentle range of motion exercises and light activities that maintain circulation without straining the affected area. As your condition improves and with appropriate anticoagulation therapy, your physical therapy can gradually progress to more intensive rehabilitation. The therapist should be fully informed about your DVT diagnosis to ensure exercises are appropriately modified.

Key considerations for safe physical therapy include:

• Gentle exercises to maintain circulation without straining the affected area
• Avoiding activities that increase pressure in the affected arm
• Gradually progressing to more intensive rehabilitation as the condition improves
• Ensuring the physical therapist is aware of the DVT diagnosis to modify exercises accordingly
• Close medical supervision throughout the physical therapy process, as suggested by guidelines for managing UEDVT 1.

The primary concern is preventing the clot from dislodging and causing a pulmonary embolism, a potentially life-threatening complication. Therefore, any physical therapy regimen must be carefully planned and monitored to prioritize the patient's safety and well-being, in line with recommendations for anticoagulant therapy and prevention of thrombosis 1.

From the Research

Safety of Physical Therapy with DVT of the Left Subclavian and Axillary Veins

• The safety of physical therapy for patients with Deep Vein Thrombosis (DVT) of the left subclavian and axillary veins is a concern due to the risk of complications such as pulmonary embolism 2.
• However, there is limited research specifically addressing the safety of physical therapy in this context.
• A study published in 2009 reported a case of a professional sportswoman who underwent local thrombolysis for DVT of the subclavian and axillary veins, and the treatment was found to be safe even with vein injury 3.
• Another study published in 2020 reported a case of a patient with effort thrombosis of the axillary and subclavian veins who was referred to physical therapy, but the study did not provide information on the safety of physical therapy in this context 4.
• A study published in 1988 found that primary DVT of the upper extremity seems to be a "benign" disease, and treatment with anticoagulants is usually sufficient 2.
• It is essential to note that physical therapy may need to be modified or avoided in patients with DVT of the left subclavian and axillary veins to prevent complications, but there is limited research to provide guidance on this topic.
• Patients with DVT of the upper extremity may be at risk of developing post-thrombotic syndrome (PTS), which can cause long-term symptoms such as swelling, chronic pain, and skin ulceration 5.
• Prevention of DVT is the only effective approach to preventing PTS, and pharmacological thromboprophylaxis may be recommended to prevent venographically proven DVT in patients at risk 5.