Updated:
by
Brian David Baxt, MD, DABVLM
If you train hard, compete regularly, and prioritize your physical health, a blood clot is probably the last thing on your radar. Athletes are supposed to be the picture of cardiovascular health. And in many ways, they are. Regular exercise does reduce the overall risk of clotting disorders. But there is a real and underappreciated paradox in sports medicine: the same training habits, travel schedules, and physical demands that make elite athletes exceptional can also quietly raise their risk for deep vein thrombosis (DVT).
NBA superstar Victor Wembanyama was sidelined for an entire season because of it. Former Miami Heat star Chris Bosh ultimately retired because of a recurring clotting condition. Their stories left many wondering about the cause and commonality of such a serious condition in a high-level athlete at a young age.
We consulted the Center for Vein Restoration (CVR) vein physician, Brian David Baxt, MD, DABVLM, and learned that the answer is more nuanced than most people realize. Deep vein thrombosis can happen to anyone, from recreational athletes and weekend warriors to professional athletes.
Center for Vein Restoration is America's largest physician-led vein center, with specialized expertise to evaluate and treat venous conditions in active patients at every fitness level.
Not all blood clots are bad. In fact, vein doctors intentionally close off superficial veins every time they treat you. However, deep vein thrombosis occurs when a blood clot forms in one or more of the deep veins in the body, usually in the legs. It can cause leg pain or swelling, though sometimes there are no noticeable symptoms at all, according to Mayo Clinic
The bigger concern is what can happen next.
If a clot travels to the lungs, it can cause a potentially life-threatening pulmonary embolism (PE) that blocks blood flow and makes breathing difficult. Together, DVT and pulmonary embolism fall under the umbrella term venous thromboembolism, or VTE. According to PubMed Central, VTE represents one of the main causes of vascular damage worldwide, right after acute myocardial infarction and stroke, with an estimated 10 million cases occurring every year.
To understand how clots form, physicians rely on a foundational concept called Virchow's Triad: three conditions that, alone or in combination, set the stage for thrombosis. Those three conditions are hypercoagulability (blood that clots too readily), venous stasis (blood that flows too slowly), and endothelial injury (damage to the walls of blood vessels).
As it turns out, the athletic lifestyle can contribute to all three.
Are you concerned about your risk of blood clots? CVR can help. With 120+ locations nationwide and a team of board-certified vein specialists, Center for Vein Restoration makes it easy to get the answers you need. Find a location near you and schedule your consultation today.
📞 Call Center for Vein Restoration at 240-249-8250
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According to a sports medicine physician from NYU Langone Orthopedics, approximately one in 1,000 athletes are found to have a DVT, and it carries a higher risk of morbidity and mortality than many clinicians and athletes expect.
Injured and non-injured athletes alike can be exposed to many known risk factors for DVT, according to PubMed Central, including dehydration, trauma, immobilization, oral contraceptive use, and intercontinental travel. Additionally, the risk may be increased by unidentified genetic clotting disorders.
Here is how each pillar of Virchow's Triad shows up in the athletic world:
Venous stasis: During long travel days to competitions or with post-surgical immobilization/casting after an injury, blood begins to pool in the lower extremities.
Hypercoagulability: Several factors may increase the risk of developing VTE in athletes, including hemoconcentration induced by exertion, dehydration, and the use of oral contraceptives in female athletes.
Endothelial injury: Trauma from contact sports damages the blood vessels creating the exact environment where clots tend to form.
Height is also a compounding factor: Research suggests that for every 10-centimeter increase in height, the risk of DVT increases by approximately 30 to 40 percent, according to The Educated Patient. This is a particularly meaningful data point for athletes in sports that favor tall participants, such as basketball, swimming, and volleyball.
Lower extremity DVT has been described more frequently in athletes such as soccer players, runners, and martial artists. This type of DVT appears most often post-trauma at the level of the popliteal vein, posterior tibial vein, and peroneal vein, according to the NIH.
The tricky part is that the symptoms look like everyday sports injuries.
Unilateral leg swelling (one-sided), pain, warmth, or redness can easily be mistaken for a muscle strain, shin splints, or a charley horse. This highlights the diagnostic challenge: that clinicians need a high degree of suspicion because DVT so often mimics soft tissue injury in active patients. Unfortunately, there is no way for a layperson or a doctor to tell if it is a clot without a test such as an ultrasound. Physical exam, and the now known to be useless Homan’s sign, simply can’t tell in an office.
Also, the location of a blood clot matters for treatment. Clots above the knee (proximal DVT) are generally treated more aggressively than those below the knee (distal DVT), where watchful waiting with serial ultrasounds may be appropriate for the vast majority of cases.
A blood clot that goes undetected can quickly become a medical emergency, and no training goal is worth that risk. Call your doctor to see if scheduling a same-day DVT rule-out service at CVR today is the right thing, and let America's largest physician-led vein center evaluate your symptoms, provide an accurate diagnosis, and guide you toward the right treatment plan.
Call 877-SCAN-DVT (877-722-6388) if you suspect that you or a loved one may have a blood clot.
While leg clots receive more attention, athletes who rely on repetitive overhead movements face a specific, often overlooked threat to the veins in their arms and shoulders.
Paget-Schroetter syndrome is a primary deep vein thrombosis of the upper extremity characterized by effort-induced axillary or subclavian vein thrombosis, typically occurring in young, healthy individuals following repetitive upper extremity exertion. It is considered the venous form of thoracic outlet syndrome.
In a comprehensive review of 123 cases of Paget-Schroetter syndrome in athletes published in ScienceDirect, baseball and weightlifting had the highest incidence at 26.8 percent and 19 percent, respectively, followed by swimming, football, and basketball.
The symptoms overlap with those of lower extremity DVT: sudden swelling (in this case, the arm), pain, a sensation of heaviness, and sometimes discoloration or visibly enlarged veins running across the shoulder and chest. Clinician awareness is critical to avoid treatment delays and misdiagnosis, and to enable a timely return to sport with minimal complications.
This matters because the treatment window is narrow.
According to NYU Langone, catheter-directed thrombolysis is most effective when performed within the first 14 days of symptom onset. When followed by surgical decompression (first-rib resection), athletes treated with this combined approach had an 84 percent likelihood of returning to their sport, compared to roughly 40 percent for those treated with anticoagulation alone.
Waiting too long or misattributing the symptoms to a shoulder strain can significantly worsen an athlete's outcome.
The primary diagnostic tool for DVT is a venous duplex ultrasound, which is noninvasive and highly sensitive for proximal clots in the lower and upper extremities. If ultrasound results are inconclusive, healthcare teams may order additional imaging or blood testing to aid in diagnosis, identify the root cause of clotting, or determine the most appropriate therapy. When pulmonary embolism is suspected, a CT pulmonary angiogram is the gold standard, according to the NIH.
Thrombophilia testing (evaluation for inherited clotting disorders) is sometimes recommended for athletes under 40, those with a strong family history of VTE, or anyone presenting with recurrent clots. While results may not change immediate management, they may help inform the long-term treatment picture in a meaningful way.
One of the most pressing questions for any athlete diagnosed with DVT is: When can I train again?
The answer depends on the type of DVT, the treatment plan, and the athlete’s physician recommendations. For many, immediate full activity is not only allowable, but advantageous to lower the risk of immobility associated with extension.
For athletes who require i anticoagulation, the approach becomes more nuanced. Shared decision-making between the athlete, team physician, and specialists, including hematology, is essential
You cannot control your genetics, your height, or the physical demands of your sport. But you can take targeted steps to reduce your risk:
Unilateral leg pain that is not responding to typical muscle injury treatment, unexplained arm swelling after an intense overhead workout, or any combination of swelling, warmth, and discoloration in a limb are all reasons to seek an evaluation from a vein specialist sooner rather than later.
At Center for Vein Restoration, our board-certified vein physicians are experienced in evaluating the full spectrum of venous conditions affecting active patients. With 120+ locations, 80+ vein doctors, and a 98 percent patient satisfaction rate, CVR exists to give you accurate answers and a clear path forward, whether you are training for your next competition or simply trying to feel your best every day.
If something feels off, trust that instinct. Early evaluation changes outcomes. Find a Center for Vein Restoration location near you and schedule your consultation today.
1: Can exercise actually cause a blood clot, or does it only happen to sedentary people? Exercise is generally protective against blood clots, but the athletic lifestyle introduces specific risk factors, including dehydration, repetitive microtrauma, long travel to competitions, post-injury immobilization, and overtraining, that can quietly raise DVT risk even in highly fit individuals. Research shows that approximately one in 1,000 athletes develops a DVT, making it far more common in active populations than most people expect.
2: What does a blood clot feel like in an athlete, and how is it different from a muscle strain? A blood clot typically presents as unilateral (one-sided) swelling, warmth, redness, and persistent pain in the affected limb, symptoms that can closely mimic a muscle strain, shin splints, or a charley horse, which is why DVT is so frequently misdiagnosed in active patients. The key red flag is that these symptoms do not improve with typical sports injury treatment and may worsen over time, which is reason enough to seek a vein specialist evaluation promptly.
3: How long does it take for an athlete to return to their sport after a DVT diagnosis? Many contact sport athletes are advised to avoid full participation after starting anticoagulation therapy. Full return to contact sport is generally not cleared until completing at least a three-month anticoagulation course.
4: What is Paget-Schroetter syndrome, and which athletes are most at risk? Paget-Schroetter syndrome is a form of upper extremity DVT caused by repetitive overhead activity that compresses the subclavian or axillary vein, leading to clot formation in the arm or shoulder. Baseball pitchers and weightlifters carry the highest risk, followed by swimmers, football players, and basketball players, and the condition requires prompt treatment within 14 days of symptom onset to maximize the chances of a full return to sport.
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