YOU should be elevating your legs at least once a day . . . yes, YOU! The information which follows will explain why. Physicians do not emphasize the importance of leg elevation, nor do they give specifics on how best to elevate the legs, because they have not contemplated the science that you are about to learn. Don’t be afraid . . . the science involved is not that complicated.

Before going any further, I should say that there are 2 groups of patients who may not be able to elevate their legs. First, patients who have moderate to severe Congestive Heart Failure (CHF) may become short of breath when lying flat; and, therefore may not be able to use this product. Second, patients with moderate to severe Peripheral Arterial Disease (PAD) will have pain in their feet when they elevate their legs because the arterial blood has to go “up hill” against gravity. This leaves well over 200 million adults in the USA alone who should be using this product daily. Here’s why:

Our heart pumps blood into the arteries which carry blood to our arms and legs, and to all of our important organs (brain, kidneys, liver, etc.) The arteries branch into smaller and small vessels and eventually become capillaries. These are microscopic blood vessels which surround the tissue in our body and allow nutrients and oxygen to diffuse out of the blood to supply the cells which make up our body. The capillaries then pick up the CO2 and waste products produced by the cells and empty this blood into the veins which carry the blood back to the heart. When we are sitting or standing, gravity has a significant impact on venous blood flow in our legs. The veins must fight against gravity in order to get blood back to the heart.

Although the veins have valves to keep the blood flowing in the right direction, these only come into play when we are walking or are active. When the calf muscles contract, they squeeze the veins causing the valves to close and only allow blood flow back towards the heart. This is called the “calf muscle pump.” When we are simply standing or sitting, the valves are open and the pressure measured in the veins on the top of the foot ranges from 90 to 120 mm Hg. So gravity causes stagnant venous blood flow and also elevated venous pressure in our legs.

Patients with venous disease often have valves which don’t function. These are called incompetent valves. This makes it very difficult for venous blood to get back to the heart, as the “calf muscle pump” is no longer effective. So, incompetent valves further increase venous pressure.

Gravity not only affects blood flow in our veins, it is also responsible for the pressure in all of our blood vessels (arteries, capillaries, veins, and lymphatics). This pressure is called hydrostatic pressure and is simply the weight of a column of fluid. If the heart is neutral pressure, then anything elevated above the heart will have a negative hydrostatic pressure, and if the limb is dependent, it will have a positive hydrostatic pressure. You can see that our legs, more than any other area of our body, are affected by gravity.

Next, it is important to understand the circulation of the interstitial fluid. If you understand this, it is easy to see why leg elevation is useful for so many different reasons. There is a higher pressure at the arterial end of the capillary (1) than at the venous end (2). Therefore, at the arterial end of the capillary (1) interstitial fluid leaves the capillary and this fluid is then reabsorbed at the venous end (2). Any excess fluid is picked up by the lymphatics. Lymphatics are tiny blood vessels which collect excessive fluid in the soft tissue and eventually empty this fluid back into the venous system. The circulation of this interstitial fluid is critical because all of the cells of our body are surrounded by this fluid.

This diagram emphasizes again the importance of the interstitial fluid circulation because the life of our cells depends on this. The fluid which leaves the capillary at the arterial end (1) carries oxygen, proteins, glucose, and other nutrients to the cells. At the venous end (2) the fluid re-enters the capillary carrying the cellular waste products and CO2 produced by the cells. The veins then carry the venous blood back to the heart where it can be pumped to the lungs to remove the CO2 and pick up oxygen; and, pumped to the kidneys, liver, and other organs to remove the waste products.

Normally, there is a thin layer of interstitial fluid which circulates around the cells which make these exchanges efficient. However, if the fluid accumulates and becomes stagnant, the cells are sitting in their own waste products and it is more difficult for oxygen, proteins, and other nutrients to get to the cells that need them because there is a greater distance to travel. The bottom line is that when the interstitial fluid accumulates, this is not healthy for the cells.

Now we can use the science that you have just learned to understand the value of elevating your legs daily. Standing results in an increase in the hydrostatic pressure in the capillaries. Higher hydrostatic pressure in the capillaries results in the net movement of fluid out of the capillaries. This results in the accumulation of stagnant fluid around our cells which is not healthy for the cells and can hurt. In addition, standing causes stagnant venous flow which can result in high pressure in the veins which also hurts.

The same principles apply when we are sitting, except that the distance that the venous blood needs to travel against gravity is not quite as high. And, the hydrostatic pressure is greater when we are standing than when we are sitting.

With the legs elevated, just the opposite occurs. The lower hydrostatic pressure in the capillary results in the net movement of fluid back into the capillary. Fluid is reabsorbed. Then gravity is used to increase venous flow back to the heart and to lower venous pressure. Most physicians know that leg elevation works for the treatment of many medical conditions; however, they have not given much thought to these details, otherwise they would emphasize the importance of leg elevation more than they do.

So now we know that elevating the legs reduces swelling, increases venous flow, and lowers venous pressure. But, does it really matter how we elevate our legs? The answer is yes. We need to elevate the legs in the most efficient position possible because we don’t have all day to lay around with our legs elevated. Simply lying flat will reduce leg swelling; however, it will take many hours. Let’s now review the ideal position for leg elevation in order to reduce swelling, maximize venous blood flow, and lower venous pressure.

First, the legs need to be elevated above the level of the heart, in order to lower the hydrostatic pressure in the capillary, which is the driving force for reabsorption of the accumulated interstitial fluid. The solid line shows the level of our heart.

Next, there is good evidence that the knee should be bent. Having the knee straight can result in kinking of the popliteal vein against the tibia. Ultrasound studies have shown partial and complete obstruction of the popliteal vein, when the knee is straight in a significant percentage of patients. The knee should be bent 20- 30 degrees in order to prevent this.

Second, this is a more comfortable position. We naturally bend our joints slightly so that the tendons are relaxed. This is a more comfortable position. In order to relax the tendons around the knee, the knee must be bent 20 to 30 degrees.

Next, studies have shown that tilting the thigh more than 45 degrees can impair venous outflow. Some studies have shown kinking of the femoral vein above 45 degrees. Other studies have shown that elevating the thighs above 45 degrees is uncomfortable.

Next, the lower leg (knee to the ankle) also needs to be tilted 15 to 20 degrees. This is where almost all of the current products fail. The way that most people elevate their legs, the leg is either horizontal or tilted in the wrong direction.

Finally, in designing a leg elevation device, the device should contour to the shape of the lower extremity in order to equally distribute pressure. This is for comfort. Many products have flat surfaces which result in areas of pressure which are uncomfortable and can cause ulcers and pressure sores.

To Summarize, the ideal position to elevate ones legs should, lower hydrostatic pressure in the legs, maximize flow in the veins, and be comfortable. The Lounge Doctor Leg Rest accomplishes all of these goals. It allows you to use gravity to your advantage rather than fight against it. This is the truly the best position to elevate your legs for all of the medical conditions discussed on this website.

Clearly, millions of people have no idea that they could benefit from leg elevation. For example, people may wonder why they have brownish spots on their legs, and not realize that they have chronic venous insufficiency. (Refer to the “vein problems” tab on our home page.) Or, people stand at work all day and come home with tired aching feet and don’t know that elevating their legs will relieve their pain much quicker than just lying flat.

For those people who do know to elevate their legs, the majority simple use pillows or cushions to elevate their legs. It is difficult to position the legs correctly simply using pillows.

A small percentage of patients buy leg elevation products, none of which are as effective as the Lounge Doctor Leg Rest. Many of these products are totally ineffective.

The product pictured on the left here is the closest competition, but is far less effective than the Lounge Doctor Leg Rest. Most importantly, with this product, the lower leg is barely tilted and the area to support the calf is poorly shaped.

Since you do not have a lot of time to lie around with your legs elevated, you want your leg elevation product to be as effective as possible. The Lounge Doctor Leg Rest elevates the legs higher, which lowers the hydrostatic pressure more and therefore results in faster re-absorption of accumulated interstitial fluid. For the same reason, it lowers the venous pressure more. It also increases venous blood flow more because it tilts the thighs and calves at the steepest angle possible without compromising flow or comfort. It is also the most comfortable position. The Lounge Doctor Leg Rest is so effective, that 15 to 20 minutes is all that it takes to empty the accumulated interstitial fluid from the day, and empty the stagnant venous blood.

So why should you elevate your legs every day?

First, there is a good chance that you have one of the medical indications listed on our home page under “Who needs a Lounge Doctor Leg Rest?” For example, half of the adult population has some form of venous disease, and all of these problems are treated with leg elevation. Click on any of these indications to learn how leg elevation is used for each of these.

Even if you do not have a specific medical indication for elevating your legs, your legs still must face the challenges of gravity each day. Combine this with our sedentary lifestyle and we are at high risk for accumulating stagnant interstitial fluid, venous stasis, and venous hypertension. Even, it we exercise each day, most of us still spend most of our day sitting and standing. By elevating our legs at the end of the day we can empty that “cellular bathwater” that has accumulated during the day, allow the stagnant venous blood to get back into the circulation, and lower the pressure in our veins. Click on the Wellness link on our home page to learn how leg elevation can help to prevent chronic venous and lymphatic disease and also help our legs look and feel great.

The best time to elevate your legs is at the end of your work day. (I realize that for some mothers the “work day” never ends.) This allows you to empty the stagnant interstitial fluid and stagnant venous blood, and lymphatic fluid which has accumulated during the day.

Another great time to elevate the legs is before bed; as this will allow your legs to have the most effective recovery from a long days work. If you simply lie flat, the accumulated fluid from the day will slowly re-absorb, but this will take most of the night. If you elevate your legs for 15 to 20 minutes before bed, you will empty the accumulated interstitial fluid and allow for the efficient exchange of nutrients in your legs for the entire night. Your legs will feel more rested and ready to go the next morning.

It is also important to elevate your legs after exercise (click on the tab “Athletes” on our home page to learn why.) If you have a full day of standing (for example waiting in lines at Disney World all day) nothing will feel better than to elevate your legs at the end of the day. Finally, if you have leg swelling then you have accumulated stagnant interstitial fluid which is not healthy and you need to empty that “cellular bathwater” by elevating your legs.

To Summarize, there are 5 times when you should consider elevating your legs:

  1. At the end of your work day
  2. Before going to bed at night
  3. After exercise
  4. After a full day of standing or sitting
  5. When your legs are swollen
If you follow these principles, soon your legs will look and feel great.

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