Chronic Venous Insufficiency (CVI)

Chronic venous insufficiency (CVI) develops when the veins in the legs struggle to return blood back to the heart efficiently, often because the small valves inside the veins are not working well. Blood can then pool in the lower legs, leading to swelling, aching, heaviness, and skin changes over time. While CVI is managed medically, physiotherapy at Goji Physio in Lentor, Singapore plays a valuable supporting role - using compression, exercise, and self-management strategies to improve circulation, reduce swelling, and help your legs feel and move better.

What causes and contributes to CVI?

CVI develops when the leg veins and their valves cannot keep blood moving upward effectively. Contributing factors include:

• Weakened or damaged vein valves, allowing blood to flow backward and pool
• Prolonged standing or sitting, and reduced calf-muscle activity
• Reduced mobility, higher body weight, and age
• Varicose veins as part of the same picture
• Previous deep vein thrombosis (DVT)

The calf muscles act as a pump that helps push blood back up the legs, which is one reason movement and exercise are central to management.

What are the signs of CVI?

People with CVI commonly notice:

• Aching, heaviness, or tiredness in the legs, often worse after standing
• Swelling around the ankles and lower legs, especially by the end of the day
• Skin changes over time - discolouration, dryness, or hardening near the ankle
• Varicose veins
• In more advanced cases, skin breakdown or slow-healing wounds (venous ulcers)

Any leg wound that is not healing, or sudden painful swelling in one leg, should be reviewed medically.

What does a session at Goji involve?

Your physiotherapist will take a detailed history of your symptoms, medical history, and activity levels, followed by a comprehensive lymphoedema assessment. Your first session will include:

• Detailed leg measurements: measuring both legs at multiple points to establish a baseline and assess the extent and distribution of swelling.
• Swelling and skin assessment: evaluating swelling patterns, skin condition, and tissue changes.
• Functional assessment: assessing mobility and calf-muscle pump function.
• Individualised treatment plan: developing a personalised management plan based on your assessment findings and goals.

From your second session onwards, treatment may include manual lymphatic drainage (MLD), compression bandaging, and advice on ongoing lymphoedema management, as appropriate.

How is CVI managed?

Chronic venous insufficiency (CVI) is generally managed through long-term strategies to improve circulation, control swelling, and protect skin health. Physiotherapy supports management through:

• Compression therapy: compression stockings or bandaging help reduce swelling and support venous and lymphatic return. The appropriate level of compression should be assessed individually.
• Movement and exercise: walking, ankle movements, and calf-strengthening exercises activate the calf-muscle pump to support blood and fluid return.
• Skin care: regular moisturising, skin inspection, and prompt attention to wounds or signs of infection help protect skin integrity and reduce complications.
• Manual lymphatic drainage (MLD): a specialised, gentle hands-on technique that may help manage swelling when appropriate, particularly when lymphatic dysfunction is also present.

Additional strategies include activity modification and education on long-term self-management.

For advanced CVI, significant varicose veins, persistent swelling, or venous ulcers, physiotherapy works alongside your doctor or vascular specialist, who may recommend further investigation or medical procedures to address the underlying venous problem.

Frequently asked questions

Can physiotherapy cure CVI?

CVI is a long-term condition rather than one that is cured, but it can be managed well. Exercise, compression, and self-care can improve symptoms, reduce swelling, and support your legs over time, alongside medical care.

How does exercise help my veins?

Your calf muscles act as a pump that helps push blood back up your legs. Calf-strengthening and regular walking activate this pump, which supports circulation and can reduce swelling and heaviness.

Do I need to wear compression stockings?

Compression is a mainstay of CVI management for many people, but the right type and level should be matched to you and any medical findings. Your physiotherapist and doctor will guide what is appropriate.

Are varicose veins the same as CVI?

Varicose veins can be part of CVI and share underlying causes, but not everyone with varicose veins has significant CVI. Assessment helps clarify your particular picture.

When should I see a doctor urgently?

Seek prompt medical care for a non-healing leg wound, signs of skin infection, or sudden painful swelling in one leg. Your physiotherapist will also refer you on if assessment suggests it is needed.