What is the use of reverse current

Blood flow in the veins - important for a healthy circulation


After your blood has reached the body tissue via the arteries from the left heart, it must return to the right heart. This is the only way to maintain a healthy and efficient cycle. Above all, your leg muscles, the muscles of the pelvic floor and the trunk, the diaphragm and the heart are important for this. In other words, what the heart essentially does on its own for the arterial circulation is taken over by various muscle groups in the venous return flow.

Most people, including doctors, underestimate the importance of venous return flow.

Blood flow in the veins - important for a healthy circulation

In contrast to the arterial influx from the heart to the various organs, the venous return flow is a more complex and therefore more susceptible process. The return of venous blood to the heart against gravity is a major challenge for your body, especially when you seem to be standing still. Remember that the distance from the big toe to the right part of the heart is about 4/7 of your body length. So it's going uphill against gravity.

The aim of the venous return flow is to offer the right heart enough blood volume to pump so that the deoxygenated venous blood can be passed on to the lungs where it can be re-enriched with oxygen. If this does not succeed in sufficient form, then adrenaline-mediated balancing mechanisms come into force.


Symptoms of venous circulatory disorders - palpitations, drowsiness, swaying, tremors, fainting

Subjective symptoms of disturbed venous return flow are drowsiness that occurs when standing up, after standing for a long time and also when walking slowly.

Fainting is rare. If you pay close attention, you can observe unconscious compensatory reactions in your fellow human beings to improve the venous return flow and thus to prevent fainting. When standing, there is a tendency to sit down quickly, to sway or, in rare cases, a clearly visible muscle tremor.

Since circulatory disorders are accompanied by a sometimes considerable adrenaline-mediated activation, there is a risk of fear reactions in connection with standing or accompanying events. As a result, a somato-psychological circulatory disorder can develop into a psychosomatic illness with states of anxiety up to a fixation in the form of a phobia.

Well, in order to better understand these processes, we have to look at the various muscle pumps of the venous return flow.

Blood flow in the veins - various muscle pumps

So how can venous blood flow uphill while standing?

In order for the venous return flow to function and for the heart to have enough blood available again, various muscle pumps have to function and interlock properly.

Once the oxygen-rich blood has reached your big toe via arteries and sufficient oxygen has been released into the tissue, it must now return to the heart. This happens through the veins. Well, there is no heart in the big toe that pumps the blood up against gravity, so other pumps are at work here. The venous return begins with the peripheral muscle pump.

Peripheral muscle pump - from the big toe to the groin

The legs' peripheral muscle pump compresses the leg veins, pushing blood towards the heart. Compared to arteries, the veins are significantly weaker and thinner-walled (leg artery approx. 1.0-1.5 mm vs. leg vein approx. 0.5-0.75 mm) and can therefore be easily compressed. Even when you are supposedly standing still, you involuntarily tense your legs again and again with slight movements. This serves to support the venous return flow.

Non-return valves, the venous valves, prevent the blood from falling back under the force of gravity towards the foot. These are almost exclusively found in the extremities, i.e. the legs and arms. Seen from the legs, there are no more venous valves from the groin and thus from the transition to the pelvic-abdominal cavity that prevent the relapse of blood towards the foot.

Pelvic floor muscle pump - the heart in your pants

The pelvic floor is a complex structure made up of very different muscles. These contract involuntarily, i.e. unconsciously: tension in inhalation, relaxation in exhalation. The rich vein network of the pelvis is squeezed out and pressed towards the heart, the pelvic floor is, so to speak, the heart in the pants.

If you have already done pelvic floor training, you will have noticed that as the pelvic floor becomes tense, the muscles on the inside of the thigh tense as well. The thigh veins are expressed towards the abdomen and thus towards the heart.

The weaker the pelvic floor muscles, the less the pelvic floor contributes to the circulation and the venous blood then sinks into the pelvic veins. You can imagine it like this: a slim Bordeaux bottle becomes a bulbous Bocksbeutel bottle.

This increased blood volume also increases the pressure in the vein plexus in the pelvic floor, making it harder for blood to drain out of the legs. Leg edema is often the result here. Your pelvic floor also has numerous other functions.

Body trunk muscle pump - good basic tension is important

The muscles of the trunk hold tension on the abdominal veins. This is particularly important because, apart from individual cases, abdominal veins do not have any venous valves. You can think of it as pushing up a half-full upright bottle of shampoo; the opening represents the transition to the right atrium. If you do not build up tension with your hands, you cannot squeeze out the bottle. In other words, if the body tension is too low, the venous blood has a harder time getting back to the right heart.

Lung-muscle pump - a strong diaphragm is particularly important

From the middle of the abdomen, the suction force of the lungs (and the heart) begins to support the return flow. As you inhale, the diaphragm lowers towards the abdomen and your lungs expand. This creates a negative pressure in the lungs, which pulls the venous blood in the abdomen. This happens 12-16 times per minute, depending on the number of breaths.

If your diaphragm is too weak, the venous return flow is reduced and your performance is restricted. A weakened diaphragm often results from shallow mouth and chest breathing. The diaphragm is simply not exercised enough; this is exactly the kind of deconditioning we know from other muscles in the body. Especially in older people, who usually eat less meat, there is also a vitamin B12 or iron deficiency. We can measure lung muscle strength in cardio practice using manometry.

Cardiac muscle pump - suction during the ejection phase

When you feel your pulse, the main chambers eject blood towards the lungs or systemic circulation. At the same time, the heart moves towards the apex of the heart. With the upstream connecting valves closed - tricuspid valve on the right, mitral valve on the left - this exerts suction on the respective antechamber and the upstream venous system via a negative pressure. This promotes the return flow from the system circuit on the side of the right main chamber.

The deflection of the main chamber in the direction of the apex of the heart, and thus also indirectly the suction force, can be easily measured in cardiac ultrasound with the so-called tissue Doppler. For the side wall of the right main chamber it is 3.0 - 3.5 cm in integral per heart action, for the left main chamber 2.0 - 2.5 cm. If the value on the right is lowered, e.g. almost always after a heart operation and / or after taking e.g. a beta-blocker, then there is a congestion of the influence in the chest cavity. We can recognize this in the ultrasound alone from a widening of the large lower body vein, the inferior vena cava, by significantly more than 15 mm when standing.

In addition to the suction force, the frequency of the process naturally also plays a role. If your heart rate is below 50 bpm, a so-called bradycardiac heart failure can occur due to a heartbeat that is too low.

The interaction of all muscle pumps

For the orderly forward flow in a hydraulic system, the pressure in the upstream system must be higher than in the downstream system. We call this pressure gradient a pressure gradient. In the case of venous reflux, this can best be explained on the basis of breathing.

inhalation. When you breathe in, the diaphragm tightens towards the abdomen and the lungs expand. By widening the pulmonary arteries, the vascular space is significantly expanded and the pressure drops. As the diaphragm pushes down, the organs in the abdomen and thus the thin-walled veins are compressed. So this is where the pressure rises. The result is an increase in the pressure differential between the abdomen (increase) and the chest (decrease). As a result, more venous blood flows from the abdomen to the chest.

Exhalation. When you exhale, the diaphragm relaxes towards the chest and the lungs contract due to their elastic properties. As a result, the pulmonary arteries also narrow and the pressure increases. At the same time, the pressure in the abdomen drops. The pressure gradient between the abdomen and chest becomes smaller, which results in a reduced forward flow directed towards the heart.

In order to counteract a backflow directed towards the foot, the pelvic floor muscles tense during exhalation and the pressure in the pelvis increases. This creates a pressure gradient between the pelvic area and the abdomen so that blood can flow towards the abdomen. At the same time, as the pelvic floor is tensed, the muscles on the inside of the thigh are tensed. The result is that venous blood can flow from the thigh into the abdomen (past the pelvis).

Heart and legs. Regardless of breathing, the action of the heart and the involuntary movement of the legs also maintain a pressure gradient in the upstream and downstream compartments in order to support the forward blood flow. The backflow into the legs is prevented at all times by the venous valves.

Cardiovascular training for the veins

If you train venous return, you will improve your performance and your well-being. In principle, all approaches that focus on the body trunk are suitable. Yoga is ideal here because, in addition to strengthening the muscles of the trunk, the pelvic floor and diaphragm are also strengthened.

Sometimes a specific physiotherapeutically guided pelvic floor training is required in order to learn the address, i.e. the feeling for the pelvic floor. Only when the pelvic floor has been trained professionally does training with vibration plates, e.g. Power-Plate or Galileo, make sense.


Ⓒ Cardiopraxis - cardiologists in Düsseldorf & Meerbusch