By Dr. Johnathan Edwards
For some reason journalists love to take photos documenting cyclists’ legs with their protruding, dilated leg veins. Some of these veins are massive, like what we see at a body-building contest. While the average cyclist who goes for a 30-minute bike ride or weekend race will not result in large, dilated veins, these prominent dilated veins are a common occurrence with world-class cyclists.
And why? Because professional cyclists ride a ton of miles each year and subsequently develop a sizable blood-supply network, helping to circulate the increased blood volume. Their veins are fuller, and we’re not talking a few drops of blood. The difference is substantial. Most people have around 5 liters of blood; a world-class endurance athlete can have 6 to 8 liters. Pro riders, like those pictured, have nearly twice as much blood in their bodies compared to the average joe. It’s no wonder their legs sometimes look set to explode.
➥ TWO TYPES OF VEINS
Your veins can come in two varieties—dilated and varicose. Before discussing the differences, it is essential to remember why we have veins and arteries. Arteries carry blood from the heart to the organs and tissues, and veins bring the blood back to the heart. Bulging veins are normal veins that have remained dilated for a few hours and effectively bring blood back to the heart.
The lack of fat in their legs also helps the veins protrude. Even the most prominent dilated veins are normal because they have been carrying blood through the legs for long periods, in addition to being dehydrated. During intense exercise, blood flow can increase about 10 times normal, causing veins to swell. And some cyclists have bigger veins than others. Look at that same rider in the off-season and the veins will not be so visible.
Varicose veins, on the other hand, are a medical condition in which the veins become large, dilated and twisted. The word derives its meaning from the Latin term “varix.” These veins typically develop superficially, and they do not carry blood back to the heart like normal veins. Varicose veins cause few symptoms and are usually considered to be a cosmetic problem. Varicose veins have no specific cause. Risk factors include genetics, obesity, prolonged standing and sitting, leg trauma, and pregnancy.
Anyone who sits or stands for hours, such as a hairdresser, has an increased risk of having varicose veins. They occur more often in women and cyclists. It’s important to understand that bulging veins are normal and varicose veins are diseased.
➥ DO CYCLISTS SUFFER MORE THAN MOST?
American cyclist George Hincapie has some of the ugliest varicose veins in the business. There are many others. The perception is that there is a strong connection of cyclists having varicose veins; however, finding evidence in the medical literature is difficult. Some believe that large swollen veins cause varicose veins. This is also not true.
➥ WHY DO PEOPLE GET VARICOSE VEINS?
Varicose veins are generally caused by many hours of riding. As mentioned above, prolonged sitting may lead to varicose veins, which is likely why long-distance cyclists develop varicose veins. Family history is one of the strongest indicators that you will have varicose veins. To understand why cyclists are prone to varicose veins, it is important to know that our circulatory system transports blood from the heart to the extremities and back again through a network of veins and arteries.
Within the legs, veins have small valves that open and close, ensuring blood returns to the heart. However, these valves weaken over time, and blood remains within the veins instead of returning to the heart. Then, as the vein walls are stretched, varicose veins clump together and become more visible.
➥ WILL VARICOSE VEINS AFFECT MY RIDE?
The main point is that varicose veins won’t affect your performance on the bike, but your general health can be affected in time. A lot of blood is being moved through the body whilst cycling. The trouble is, the veins dilate when you’re off the bike, sitting, resting or standing, and that’s when the problems occur. The static blood can cause swelling, discoloration and even skin ulcers. If you crash and cut a varicose vein, it may bleed profusely and immediately apply ample pressure and seek medical care. Staying active helps delay the onset of complications. But, the complications can still happen if you don’t get your varicose veins fixed.
Some believe that cyclists develop a different sort of varicose veins than others. Professor Mark Whiteley is a leading expert in varicose veins and has researched why cyclists develop varicose veins than others. He remarks that cyclists seem to have worse veins. No one knows why, but it could be the high amounts of blood flow for extended periods. He explains that cyclists often present with a different type of varicose vein called a perforator vein. A perforator vein travels through a muscle to the deeper veins of the leg.
➥ TREATING VARICOSE VEINS
Sometimes varicose veins can be more than just a cosmetic problem. Until recently, vein stripping was the standard treatment. However, stripped veins often grow back. In the last 20 years, burning the veins with lasers and microwaves have become popular. Sclerotherapy is also used to burn the veins chemically. There are surgical procedures that can remove varicose veins, radiofrequency ablation and surgical removal.
Most people should see a qualified blood-vessel expert in these cases, usually a vascular surgeon. One day, varicose-vein treatments will be automated. You will go to a varicose-vein treatment pod, insert your legs and a credit card, and your varicose veins will be treated automatically.
➥ WHAT CAN BE DONE?
The simple answer is that there is not much you can do to prevent varicose veins. Compression socks, leg-compression devices, massage, and exercise do not prevent varicose veins. There’s not a lot you can do to stop it. Remember that varicose veins are cosmetic and not usually problematic. They pose little risk to overall health, especially compared to the health advantages and joy that cycling brings. George Hincapie has been cycling many years with varicose veins, and so can you.