Introduction

“My leg swelling won’t go away,” “Blood vessels are becoming visible in my calves,” “My legs feel heavy and tired after standing for long periods.” Among those experiencing these symptoms, lower extremity varicose veins may be lurking beneath.

As a physical therapist working with many patients who have circulatory system problems, I have realized that varicose veins are not just a cosmetic issue but a condition deeply related to systemic circulatory dynamics, causing leg fatigue, pain, numbness, and skin inflammation.

From an osteopathic perspective, based on the fundamental principle that “the body is a unit,” lower extremity varicose veins can also be understood as an integrative problem of whole-body structure and function.

Today, I will discuss the causes of varicose veins based on the latest pathophysiology and the approaches to enhance natural healing capacity that osteopathy can provide.

1. Pathophysiological Understanding of Lower Extremity Varicose Veins

Basic Mechanism: Venous Valve Insufficiency and Venous Hypertension

From my knowledge of circulatory systems as a physical therapist, I understand that varicose veins are fundamentally caused by venous valve dysfunction in the great saphenous vein (GSV), small saphenous vein (SSV), and perforator veins.

Venous Valve Reflux Mechanism

• Dysfunction of one-way valves causing blood reflux
• Development of chronic venous hypertension
• Vascular wall dilation, tortuosity, and variceal changes

Osteopathic Understanding: Perspective as a Systemic Circulatory System

In osteopathy, we understand varicose veins not as a localized vascular problem but as dysfunction of systemic circulatory dynamics.

Relationship with Primary Respiratory Mechanism

• Craniosacral rhythm affects systemic body fluid circulation
• Relationship between cerebrospinal fluid circulation and venous return
• Vascular regulation function through autonomic nervous systems

Structure-Function Interrelationship

• Effects of pelvic structural misalignment on venous return
• Relationship between diaphragmatic function and intra-abdominal pressure
• Lower extremity biomechanical dysfunction and circulatory disorders

Major Risk Factors and Pathological Progression

Age-Related Factors

• Degeneration of venous wall elastic fibers (elastin)
• Collagen structure deterioration
• Decreased mechanical strength of venous valves

Genetic Factors

• Venous wall structural abnormalities due to family history
• Predisposition to connective tissue disorders
• Venous valve formation abnormalities

Mechanical Factors

• Increased venous pressure from prolonged standing or sitting
• Increased intra-abdominal pressure due to obesity
• Inferior vena cava compression during pregnancy

Hormonal Factors

• Venous wall relaxation effects of progesterone
• Estrogen effects on vascular endothelium
• Involvement of hormone replacement therapy

Molecular-Level Pathological Changes

Extracellular Matrix (ECM) Changes

• Altered ratio of Type I and III collagen
• Progression of elastin fragmentation
• Abnormal proteoglycan composition

Inflammation and Oxidative Stress Involvement

• Vascular endothelial damage due to chronic inflammation
• Tissue damage by reactive oxygen species (ROS)
• Accumulation of inflammatory cytokines

2. Comprehensive Osteopathic Approach

Circulatory Improvement Through Structural Adjustment

Integrated Pelvic Ring Adjustment From my anatomical knowledge as a physical therapist, I understand that pelvic structural misalignment causes inguinal vascular compression and pelvic congestion, contributing to increased lower extremity venous pressure.

Sacroiliac Joint Mobilization

• Recovery of sacral nutation and counternutation
• Improvement of physiological iliac mobility
• Normalization of pelvic floor muscle function

Lumbosacral Junction Adjustment

• Improvement of neurovascular bundle mobility at L4-S1 level
• Relief of nerve root compression at intervertebral foramina
• Optimization of lumbar sympathetic ganglion function

Hip Joint Function Recovery

• Improvement of acetabular-femoral head compatibility
• Enhanced flexibility of hip flexor groups
• Relief of vascular compression under inguinal ligament

Circulatory Improvement Through Visceral Manipulation

Diaphragmatic Function Optimization The diaphragm is called the “second heart” and plays an important role in venous return from the lower extremities:

• Improvement of diaphragmatic mobility
• Normalization of thoracoabdominal pressure differential
• Recovery of respiratory pump function

Abdominal Organ Adjustment

• Liver position and mobility adjustment
• Release of intestinal adhesions
• Decompression of retroperitoneal space

Pelvic Organ Function Improvement

• Uterine and ovarian position adjustment (women)
• Adjustment of periprostatic tissues (men)
• Improvement of bladder mobility

Integrative Approach Through Fascial Continuity

Deep Front Line Adjustment

• Improvement of pelvic floor muscle-diaphragm coordination
• Enhanced psoas major flexibility
• Relief of adductor group tension

Superficial Back Line Balance Adjustment

• Functional improvement of hamstring-gluteal complex
• Enhanced flexibility of gastrocnemius-soleus complex
• Plantar fascia tension adjustment

Autonomic Nervous System Harmony

Craniosacral Therapy Adjustment

• Parasympathetic activation through fourth ventricle compression (CV4)
• Adjustment of sphenoid-occipital junction
• Improvement of cerebrospinal fluid circulation

Sympathetic System Optimization

• Improvement of thoracic junction (T10-L2) mobility
• Functional adjustment of visceral ganglia
• Indirect approach to vasomotor centers

In Conclusion

Lower extremity varicose veins are not simply “due to aging” or “something inevitable.” By paying attention to lifestyle habits, body structural balance, and even visceral and neural function, fundamental improvement and progression prevention are possible.

In osteopathy, we understand these symptoms not as localized vascular problems but as integrative dysfunction of systemic circulatory dynamics and structural systems.

“The healing power lies within you”

Based on this belief, rather than symptomatic treatment, we help maximize natural healing capacity by organizing whole-body flow.

Our clinic integrates specialized knowledge as physical therapists with osteopathy’s holistic approach, providing individualized treatment programs according to each person’s circulatory dynamics and lifestyle patterns.

For those who want to fundamentally review their body before relying on surgery or medication, and those who want to improve health from a circulatory perspective, please feel free to consult with us.

Through evidence-based evaluation and comprehensive support that draws out the body’s inherent circulatory improvement capacity, we will help support your health recovery.

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For Those in Japan with Physical Discomfort

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Worried about language barriers?

We offer gentle, hands-on osteopathy to support your body’s natural healing.

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🤝 Still Learning English, but Here to Help
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My English isn’t perfect, but I’ll listen carefully and respond with care.
I often use Google Translate—please don’t hesitate to contact me.

Sota Omura,
Qualifications: Licensed Physical Therapist / Master of Health Science

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