What Can Cause Tired or Heavy Legs?

In our clinic, some of the most common symptoms we hear are:

“Doc, My legs feel heavy.”

“My calves hurt (equally).”

“My knees look swollen.”

“My ankles are swollen but they don’t hurt.”

In honor of February being Heart Health Month, let’s talk about one of the most common non-orthopedic topics that directly relate to muscle and joint pain: Swelling. We also call this Lower Extremity Edema.

How Lower Extremity Edema/Swelling Forms (the Physiology)

Blood is made of a few different things:

  • Red blood cells (RBC) hold oxygen.
  • White blood cells (WBC) help fight infections.
  • Platelets are proteins that help with clotting and healing injured tissue.
  • Plasma, which makes up the largest portion of blood, contains water, enzymes, proteins, and salts.

Tissues throughout the body (such as skin, muscle, fat, or organs) require oxygen to function. We breathe oxygen into our lungs from the air, and the oxygen gets linked to red blood cells (RBC) as it flows next to our lung tissue.

Oxygenated blood then goes through our heart and is pumped to the rest of our body through arteries. Arteries have muscles in their walls that help pump the oxygenated blood to our tissues so they can function…and we can move!

Arteries get smaller and smaller until they turn into tiny vessels called capillaries. It is at the capillary level that the tissues take the oxygen from the RBC. The de-oxygenated RBC (no oxygen now) then flow from capillaries to veins. The walls of veins do not have muscles to help pump blood back to the heart to get oxygen again. Veins rely on the muscles in our body (e.g. movement) — especially the ones in our arms and legs — to move the blood back to the heart so it can pump it back to the lungs and get more oxygen! This all happens at the speed of your heart rate!

Now, gravity likes to make the job of the veins harder, especially if we aren’t moving and using our muscles to squeeze the veins and blood back to the heart. This is why the legs are most often the parts of the body we notice swelling or edema. Blood doesn’t go backwards to the arteries; it fills up in the veins. Veins only have so much room to expand, so the vein walls allow some of the plasma to go into the surrounding tissues…causing the dreaded lower extremity edema!

Bottom line: that extra plasma (fluid) going into tissues under the skin is why the legs feel heavy or when you push on your legs you can see a dent where your fingers sent or where your socks ended.

How Do We Treat And Manage Lower Extremity Edema?

  1. Get Moving! Simple movement is one of the quickest and easiest ways to help with swelling in the legs. Movement will help get that pooled fluid back up towards the rest of the body and out of the legs. Dedicated time spent during the day is one of the first steps to help get you in the right direction. Progress your motion! No need to walk a marathon day one! Start simple and walk shorter distances or lengths of time. Listen to what your body lets you do! As movement continues to get easier, start progressing into some simple exercises that will help keep your legs from swelling. Your primary care physician, physical therapist, or other related providers can help with a home exercise program!
  2. Compression Socks: Compression — either through socks, stockings, or leggings — helps push that fluid back into the vein and up towards the heart, like a contracting muscle on the veins. There are varying levels of compression to help you with swelling based on the severity of edema. Most common compression socks will have 15-20 mmHg (millimeters of mercury a unit of pressure). But there are other compression socks with a bit more squeeze including 20-30 mmHg. Make sure to reach out to your physician or provider on what works best for you. Remember, not everyone is built the same and sizing does matter for compression socks. As an added bonus for the fashion conscious, compression socks are no longer stuck in generic color tones such as black, white, or beige – there are patterns now!
  3. Physical Therapy (PT): PT is a fantastic way to get moving if you feel like you would benefit from the help. Physical Therapists will work with you one-on-one and make an individualized program to help progress your movement. In some cases, your primary care physician may recommend that you see a specialist to help with your lower leg swelling. Specialty clinics (lymphedema clinics) can further assist with you lower leg swelling if you’re having a particular difficult time reducing the swelling of the legs or if you have skin breakdown. Always keep in touch with your primary care physician, and they will help you along the way!

Now, put on some compression socks and get moving! If you have treated your lower extremity edema and continue to have pain that is related to muscles or a joint give us a call at (402) 609-3000 to make an appointment for evaluation.

Note: If you notice your legs seem more swollen, tight, or heavy you should FIRST bring this up with your primary care provider as soon as possible. For reasons too complex to get into within this article, edema can be the first sign of heart and kidney problems and these things must be ruled out with a physical exam and labs. If you have known heart or kidney disease and notice worsening of these symptoms, talk to your specialist physician.

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