PDFGood blood flow is crucial for health, injury prevention and injury healing. It's essential to keep your circulation in efficient working order. This means looking after your heart, lungs and blood vessels, and of course your general health.
Principles of promoting good blood flow
There are three major factors to take into account when you want to maintain or improve your circulation: movement and exercise, water and diet intake, and positive thinking.
Movement
Most people are aware that the human body is an action machine, and a sedentary, static lifestyle doesn’t suit it. Your body’s health depends on you being active on an ongoing basis all your life, within your limits, and according to your individual health and fitness at any given time. At the very least, you should avoid constricting your blood vessels through avoidable inactivity, lazy posture or tight clothing.
Water and diet
The importance of water is increasingly publicized, yet surprising numbers of people still don’t drink enough of it. In all situations, it’s essential to drink water from early morning onwards throughout the day. Your water intake should be balanced by a normal amount of salt, to prevent hyponatraemia. You should also make sure your diet is based on fresh foods, including fruit and vegetables. If in doubt, consult your doctor, nutritionist or dietician.
Positive thinking
Many people may not be aware of the significance of positive thinking, and it is key to a healthy blood flow. If you are depressed, you are likely to feel abnormally cold, even chilled to the core, and to look pale and drawn. When you feel positive and happy, you may have a glow about you. When things go wrong, it’s easy to get down-hearted. Positive thinking in trying situations protects you from being dragged down into unhappiness and depression. It’s not easy to do as a conscious action. Most people have to learn how as the result of their experiences. Psychotherapy techniques of all kinds boost people’s ability to think positively. Many people find the methods of prayer and meditation suit them. Deep breathing plays an important part in controlling stress and negative thinking.
In injury and ill-health, positive thinking helps recovery and can help prevent non-healing or complications such as reflex sympathetic dystrophy. A positive attitude is an inner strength. It’s not the same as putting a brave face on things, or making a show of courage in the face of adversity. It includes acceptance of the misfortune, belief that you will get better, and trust that things will work out as they should for the best, forming a background stimulating your will, energy and determination to do what’s needed to get better.
Risk factors
Individuals vary: people who have "slow" circulation, often linked to low blood pressure, tend to have very cold hands and feet, while others might have a very efficient blood flow and never feel the cold. Some people have relatively thin blood with low iron, others the opposite. Heredity can play a part, for instance in varicose veins, or a tendency to form cholesterol. There are many conditions and diseases which affect the circulatory system. Many medicines also have an effect, especially drugs which control female hormones. If you have any doubts about your circulation, or symptoms which worry you, always refer to your doctor for help. If you take any medicines, be sure to read the warnings and contra-indications, and follow the instructions accurately.
Harmful habits
Smoking is harmful in many ways, and especially to the circulation. It makes you more prone to blood clots, especially following injuries involving internal bleeding. It's associated with painful circulatory problems like intermittent claudication. If you can, stop, or at least cut down, especially during illness or injury. Caffeine, alcohol and drugs to enhance mood or physical performance are also possible risk factors for circulatory complications, so you should limit, reduce or eliminate your intake urgently if there are any signs of circulatory problems.
Controlling the circulatory flow in injury
In the first moments following an injury involving the musculoskeletal system, the first priority is to stem any bleeding and protect or support any obviously broken bones. In most cases, especially where the injury mainly involves the body’s soft tissues (ligaments, muscles, tendons, connective tissue) you can limit damage by applying ice or cold compresses around the area. The simplest method is to use ice cubes and pass them gently around the injured area for a couple of minutes, until the skin goes slightly reddened. Or a compress of cold water can be spread round the injured part. If you use an ice pack, I recommend applying it over a damp cloth or towel. Don’t put it directly on to the skin, and don’t leave it on for more than four or five minutes, as you might cause skin damage or excessive restriction to the blood flow.
Major injury
An injury that is obviously major, or that might involve vital areas such as the spinal cord, brain or internal organs, should be dealt with through the emergency services, or should be seen by a doctor as quickly as possible if symptoms arise in the hours following the injury. Warning signs to watch for after an injury involving the head include headaches, light-headedness, memory lapses and disturbances in vision, hearing, taste or smell. When there’s been an accident to the neck, back or any other major joint in the body, watch for tingling, numbness, stabbing or burning sensations, not only in the injured area, but anywhere in the body. Also watch out for difficulties breathing, passing urine or faeces, or for blood in the urine or faeces.
Joint dislocation
If a joint has been dislocated, don’t try to put it back into place unless you know how. If you don’t know, simply apply ice, support the bones, and transfer the casualty to the nearest emergency hospital.
Soft tissue injury
When an injury involves the soft tissues only, you can usually safely put arnica or heparinoid cream over it, or, if the skin is cut open, round the edges of the injured area. Don’t apply heat ointments. Never rub an injured muscle, or let anyone else rub it, unless you are absolutely sure you know what you or they are doing. Rubbing a newly injured muscle hard risks increasing internal bleeding. In the case of the front-thigh muscles in particular, there is a high risk of bone forming in the muscle tissue as a result. This is technically called myositis ossificans.
Any soft-tissue injury with internal bleeding or effusion of tissue fluid carries a risk of causing a blood clot (thrombus) to form in the veins. If this happens, you will usually feel a localized burning pain, and the area will be extremely tender to touch. If a blood clot spreads within the veins, it can go deeply, without necessarily causing obvious symptoms on the surface. Apart from the localized discomfort of a blood clot, the danger is that it can break up and travel to lodge in the lungs or heart. A clot which does this is called an embolus. If there is a suspicion that you might have a blood clot after an injury, you should see a specialist urgently to have the area assessed and scanned, and start any necessary treatment. The more you take care to look after your circulation in all circumstances, the less the risk of blood clots forming.
Overnight compresses can work like magic on soft-tissue injuries. You can use herbal remedies such as arnica lotion or oil of St John’s wort, daubed on swabs and held in place with a bandage. Another popular natural remedy for joint sprains and muscle strains is a poultice made of potato, red onion and herbs. Unless there is an adverse reaction, which is rare, you can use these compresses over several nights. If you do notice any kind of adverse reaction, take the poultice off straight away and seek professional help.
Maintaining the circulation in a cast, splint or bandaging
When a plaster-of-Paris (POP) cast is used after an operation or to protect an injured area, you have to be on the watch for constriction of your blood flow inside the cast. The injury can cause swelling, especially if you don’t do what’s necessary to prevent it. This very quickly makes the cast too tight, causing skin sores and sometimes even blood clots. After an operation, there is always a risk of infection in the operation scar. The plaster should be removed immediately, at the first hint of any disruption to the blood flow.
Whenever possible, doctors and practitioners try to use removable splints or bandaging, so that it is easier to check on the state of the injured part, to treat it, and to avoid problems. A removable support also makes it possible to wash the area when any scars have healed.
Warning signs to check for:
* visible swelling in the regions above and below the cast
* interrupted flow to the extremities. Squeeze each toe, in the case of a leg injury, or finger if your arm is in plaster. The skin will turn pale. As you stop squeezing, it should immediately return to its normal colour as the blood flows through again.
* numbness, discomfort or a burning sensation
* skin soreness anywhere within or around the cast.
Support bandaging
The best way to provide light support is to use a crepe bandage over a layer of cotton wool wadding, or two layers of crepe bandage. Any bandage or splint should protect the whole area affected by the injury, not just the injured part itself. So an ankle or lower leg support should extend from the toes to below the knee; a knee support from well below to well above the knee; a wrist support from the hand to at least half-way up the forearm; and an elbow support from half-way up the forearm almost to the shoulder. When the hand or wrist are protected, the thumb and fingers are usually left free, if at all possible, so that you can exercise and use them.
A tubular or stocking bandage restricts the circulation, especially the lymph flow, and it can lead to significant muscle wasting (atrophy) if worn for any length of time. After wearing an enclosed tubular support for a few hours, you feel a great sense of relief when you take it off, as though the skin and underlying tissues can breathe again. So I recommend that you avoid wearing this type of support except to hold dressings in place for very short periods.
Non-weight-bearing, general care
If you can’t take weight through your foot because of injury, you need to take special care to keep the blood flow going, and to avoid allowing swelling to build up in the injured area. When you are sitting, put the foot up on a soft support. Don’t sit still for long periods. Exercise the leg by lifting it up and down, and doing any movements you can manage. Raise your arms and exercise your hands as vigorously as possible. Try to get up and move around, or lie down with your feet raised on pillows. If you can, you should rub the sole of the foot over a wooden roller or golf ball at frequent intervals.
Once the immediate, acute phase has passed, which takes some 3 to 5 days, gentle massage of the leg generally, and then around the injured area, can safely be used to help the circulatory flow. If the sole of the foot is accessible, it’s extremely helpful to massage the central area, where the blood vessels form arcs at their furthest point from the heart. Pressure on the sole of the foot is an important mechanism for promoting the venous return up the leg, together with the action of the calf muscles against the veins, usually termed the “muscle pump”. The sooner you can start to take at least a little pressure through the foot, the better. Pressing the foot down gently in a bowl of warm water is often a good way to start.
General exercises
Unless there is a special reason why you can’t, you should do general exercises for the rest of the body while your injury is immobilized. The same is true if your injury doesn’t need full support or splinting, but needs to be protected and semi-immobilized in bandaging. Don’t let yourself get dragged down into total inactivity, just because one part of your body can’t be exercised normally for a while. You can choose suitable exercises from the lists of core exercises, but only those which do not cause any stress or pain to your injury.
Your circulation during bedrest for illness or injury
In all cases, deep breathing helps to maintain your lungs and blood flow, and it helps reduce your blood pressure. If you can, do 3-4 deep breaths every hour or so, breathing in through your nose, out with a slight sighing sound through your mouth. Try visualizing a beautiful coloured light perfusing the air coming in through your nose, down to your lungs, and then spreading out through your whole body, right down to your fingers and toes. You can also visualize harmful bugs, viruses or bacteria being expelled from your body as you breathe out.
Illness
If you are in bed because of illness, you should not try to be physically active, but you should keep moving as much as you can without overtiring yourself. You should try to move around in your bed, turning over at regular intervals, moving your feet up and down and round in circles, and raising your arms.
For the patient who is too ill to do as much, nursing care involves turning the patient at regular intervals, as well as checking, bathing, and protecting the skin against bedsores. If the patient cannot move at all, passive movements of all the sound parts of the patient’s body help to prevent stiffening of the joints and muscles (technically known as contractures, which distort the body into abnormal rigid positions). For the unconscious patient with neurological damage, such as stroke or head injury, early stage movements should be part of rehabilitation treatment. Even in cases of persistent vegetative state (long-term coma), actively stimulating the body through particular movement patterns not only helps to maintain the patient’s circulation, but can help towards recovery of a certain amount of function, even before consciousness is regained. This is a very specialized form of patient handling. It’s always best if a specialist neurological physiotherapist can be involved from the start, to do the treatments, and to teach the basic handling to all who have responsibility for the patient’s daily care.
Injury or surgery
If you are in bed because of an injury or following an orthopaedic operation, you should try to be as active as possible, keeping everything working round the injured part. You will be reminded to do movements for the legs and arms, and to change position in your bed as often as possible: it’s good to aim at simple movements every half hour or so, at least. You should be able to do isometric exercises, tightening your muscles for a count of three, then relaxing completely. You can work through the different areas of your body, doing three to five repetitions for each muscle group.
Remember to relax totally between repetitions: this allows your blood to flow freely, and failure to do so might cause cramp. You may be able to do exercises with weights or pulleys using your uninjured limbs, which you can do at intervals during the day. The more activity you can manage without causing pain or harm to the injured area, the quicker your recovery will be, with less risk of complications.
Your circulation in normal life
Looking after your blood flow means being aware of maintaining good posture, as best you can, at all times. Failure to do so can be a factor in muscle and joint injuries, as well as back and neck problems.
Standing
If you have to stand for long periods, keep your feet and legs moving slightly, to prevent blood from pooling in the lower legs. Always try to stand with your weight equally balanced on both legs. If you suffer from circulatory problems like varicose veins or oedema because of diabetes or previous injury, use support stockings or bandaging according to your doctor’s recommendations.
Sitting
When you sit, never sit with your legs crossed at the knees or ankles. Arrange your desk or table so that you do not hunch, lean or twist. Choose an upright chair, preferably high enough for your hips to be slightly above the level of your knees. If your knees are higher than your hips when you drive, adjust your car seat, or put a cushion on the seat to lift your hips. Avoid low easy chairs, and never curl up on a sofa. If you want to rest and relax, lie down.
Exercises to counteract inactivity
If you are still for long periods because of studies or work, try to walk around whenever possible. If you can, slip off your shoes now and then, and rub the soles of your feet over a golf ball or foot-roller. Exercise your arms by lifting them up and out, in all directions, or swinging them round in circles. Work your hands by squeezing a soft ball or using Chinese iron balls. Most importantly, activate your deep abdominal muscles at frequent intervals: this is something you can do sitting or standing, anywhere any time, without anyone noticing. If your legs feel puffy by the end of the day, lie down with your feet up, or have a warm bath and then try to do exercises for the whole body, including the arms and hands.
General fitness
For normal fitness at any age, you should try to do some regular moderate aerobic exercise, two or three times a week, such as brisk walking, walking up and down stairs or escalators, gym workouts, exercise classes, tennis, cycling, or swimming. If you like running, don’t be tempted to do it on a daily basis, as it carries a high risk of injury, especially stress fractures in your leg bones. Children should be encouraged to play games they enjoy. If you do sports, always make sure you are fit to play: this means playing regularly, preferably doing background training, and always preparing carefully after a lay-off for illness or injury before you play again. Before seasonal sports like a skiing holiday, you should try to prepare over a space of 6-12 weeks beforehand.
