DVT and Sports: What’s the Connection?

Medically Reviewed by Sabrina Felson, MD on April 26, 2022
6 min read

The word “athlete” may bring to mind a healthy, strong person. But that doesn’t mean these competitors aren’t at risk. Whether your chosen sport is high contact or low contact, injuries can occur. Deep vein thrombosis (DVT), also known as a blood clot, is often unexpected and mistaken for injuries that happen more often because clots are so rare in young, fit people.

DVT happens when a blood clot forms in a deep vein in the lower leg, thigh, pelvis, or arm. Since blood clots are usually thought of as something that happens to older people, if you are active and young, you may not be looking for the symptoms. The pain from a blood clot can feel like a muscle tear, charley horse, twisted ankle, or shin splints. Whether a blood clot is in your arm or, more likely, your leg, here are some symptoms to watch out for:

  • Pain or tenderness
  • Swelling
  • Skin having a blue or red color
  • Warmth over area of pain

While the risk factors for DVT are pretty much the same in all people, athletes or not, here are some things that explain why athletes may get a clot.

Leg injuries. You can get a DVT from a kick, tackle, or even a smaller trauma, like getting hit in the leg with a hockey puck or ball. Also, the veins and arteries located in the knee and lower leg can be squeezed or compressed from movements during a sports event. The injury can damage the blood vessel and block the blood flow, resulting in a DVT.

Arm injuries. Tennis and baseball players can have increased risk for DVT in the arms. One reason for this type of injury is a part of the body called the thoracic outlet, the ring formed by the top ribs, just below the collarbone. This area contains muscles and bony structures. Inside these structures, veins, arteries, and nerves supply the arm with blood. Large arm muscles take up more of this area, creating a space for the vein that is narrower than it should be. If the vein in the narrow outlet is injured, a DVT can form. If this happens you may feel swelling, pain, or numbness. But this is very rare.

Recovery. If you break a bone or have surgery, sometimes you may need a cast or brace to stop the limb from moving so it can heal. Unfortunately, your blood flows more slowly in the veins when you are wearing one of these devices than if you were able to move normally. This can cause a DVT to form.

Travel. Athletes often travel long distances. Travel times over 4 hours may increase the risks of clots. Whether you travel in a plane, bus, train, or car, sitting in a small space without moving can increase your risk for a DVT. Those who take flights lasting 8-10 hours or longer have the greatest chance of developing DVT.

Body size. Athletes like football players may be larger and weigh more than the average person. People who are tall, overweight, or have big legs are at a higher risk of blood clots. This is because the blood has a longer path to flow up the legs to reach its destination. The calf muscle helps to pump the blood up the leg. Obesity causes more pressure in the abdomen and reduces the ability of the calf-muscle pump to return the blood from the legs.

Surgery. Athletes often need surgery to fix sports injuries. The risk of blood clots from orthopedic surgery is higher than for general surgeries. Surgeries that also have a high risk for DVT are stomach (abdominal) or pelvic surgery, knee, or hip replacement. If your blood vessels are damaged during surgery, a clot can occur. A long hospital stay where you are on bed rest can also cause a clot.

Dehydration. When your body doesn’t get enough fluids or uses up fluids due to demanding sports activities, the blood vessels can narrow, and the blood thickens, increasing the risk of blood clots.

What’s in your genes?

An athlete with a family history of DVT may have an increased chance of also getting a DVT. There are several inherited clotting disorders that an athlete should discuss with a doctor to be aware of possible future blood clots. If one of these is discovered, you can take proper precautions to stay healthy.

Factor V Leiden. When one of the clotting factors in your blood mutates or changes, you may develop a blood clot in your legs or lungs. However, not all people with factor V Leiden develop blood clots.

Prothrombin 20210 mutation or factor II mutation. Prothrombin is a protein in your blood that helps it clot normally, but too much of the prothrombin protein can cause blood clots.

Antiphospholipid antibody syndrome/antiphospholipid syndrome (APS). This condition affects young women five times more than men. Abnormal proteins called antiphospholipid autoantibodies produced in your blood can lead to poor blood flow and blood clots.

Protein C or protein S deficiencies. Protein C and protein S help to stop the clotting process, but 1 out of 500 people do not have enough of either of these proteins in their body. This can allow clots to form.

Break up travel. Schedule some breaks to get up from the sitting position and stretch your legs while traveling. Walk around if you can, even if it’s only down an aisle. If you must remain seated, you can still improve your blood flow. Here are some ways.

  • Move your legs often.
  • Extend your legs straight out, and pull your toes toward you.
  • If you have enough room, pull your knee up to your chest, and hold it there with your hands on your lower leg for 15 seconds. Repeat on each side up to 10 times.
  • Stay hydrated.

Wear socks.Compression stockings have gotten more popular with athletes, especially for runners, triathletes, and other endurance sports. Compression stockings can improve blood flow, help the calf muscle pump to be more efficient, and decrease blood from pooling in the veins. They also can help relieve muscle soreness.

Medication. If you are at risk for DVT, you may need to take a blood thinner drug called an anticoagulant. This will prevent clots by blocking the factors that are causing the DVT. Depending on your sport, blood thinners may cause problems because of the chance of increased bleeding if you get injured. For example, if you play a contact sport, like football, hockey, basketball, soccer, gymnastics, alpine skiing, or boxing, an anticoagulant may not be the best choice. Blood thinners may be recommended for less contact-heavy sports, such as golf or running. In any sport, people who take blood thinners need to be very aware of any situation that may cause bleeding.

Surgery. If you have a very large clot or if the clot is causing tissue damage, you may need surgery to remove the clot.

Stay aware of symptoms of DVT. Even if you are an athlete, if you feel pain or swelling in your arms, legs, or feet, talk to your doctor or physical therapist about screening for blood clots. Try to seek help as early as possible. If a blood clot breaks away from its spot, it can travel through your bloodstream and get stuck in the small blood vessels in your lungs. This is called a pulmonary embolism (PE) and can be life-threatening.

Athletes take action to keep in top shape. You should know how to recognize the signs of DVT and call your doctor or go to the emergency room if you experience any symptoms. For athletes, staying in the game also means being on your game in prevention and treatment of blood clots.