Traveling presents certain challenges and risks to the traveler. One of the significant risk factors for developing clots is inactivity. While traveling, a large part of the time is spent with relatively little movement. Add to this relatively constricted spaces such as the economy class section of airplanes and the risk increases significantly. Long trips with the legs folded, especially when the traveler is overweight add to the body's resistance to the outflow of blood from the legs. If there is constrictive clothing such as a girdle or tight jeans - these place increased pressure at the groin and slow outflow from the legs.

Under normal circumstances blood is pumped from the legs by the calf muscles contracting. While sitting still, there is little flexion of the calf muscle. This is especially true if a woman is wearing heels. The elevation of the heel doesn't allow the calf to flex.

On long trips it isn't unusual to become relatively dehydrated. This is exacerbated if the traveler is on a diuretic (water pill) or other heart medications. Dehydration makes the blood stickier and more likely to clot.

If the legs are crossed, there can be actual compression or occlusion of a vein. The superficial veins of the leg are the most vulnerable, especially the back of the knee and upper calf, but also on the inside of the calf and anywhere there are varicose veins. Travelers with varicose veins are especially vulnerable not only from pressure, but also because these veins become distended and congested because their valves do not work and blood tends to stagnate.

So, with all these potential problems, what is the traveler to do? The solutions are relatively simple but require forethought and discipline. Prior to travelling, everyone could benefit from taking an aspirin daily, beginning two to three days before the trip, and continuing throughout the trip. Hydration is also important. This should start two to three days before traveling and continue throughout the travel time. Avoid significant alcohol intake for 24 hours prior to traveling and during the trip. Tight clothing should be avoided, especially in the groin area. High heels should be avoided, or if they are worn, take them off while seated and move the feet. If traveling by air, one should try and do toe raises periodically while seated or walk to the bathroom or galley while in flight. Extend the legs as much as possible. Avoid crossing the legs especially at the knee. Sitting in an exit row or in an aisle seat often provides more leg room.

Wearing medical grade compression stockings, not just support stockings, is perhaps the most significant thing on can do. These stockings have varying degrees of compression, depending on the area of the leg. This helps to decrease the risk of clots and to decrease swelling and skin inflammation. Knee highs are acceptable, and thigh highs or panty hose can also be worn. Those with a history of swelling or varicose veins should wear 20-30 mm/hg compression stockings. For those who have no problems 16-20 mm/Hg compression is adequate and will give legs more energy.

While traveling may expose certain risks and challenges due to the inactivity, a little forethought and discipline can prevent a complication. Taking care of one's self and promoting leg health can make for "happy trails to you!"