By: Patrick  Jacobs, PT, DPT and Clinic Manager at ApexNetwork Physical Therapy in Paris, IL
This man is recovering from knee surgery.As a health care provider, outpatient physical therapist should be proficient in dealing with all systems, not just the neurological and musculoskeletal systems, which is what the majority of the diagnoses we see fall under. Being able to detect and refer out for certain diagnoses is a vital part of being a health care provider. Pulmonary embolisms can be deadly and physical therapist can help prevent them.
Pulmonary emboli (PE) are a complication of venous thrombosis, in which blood clots or thrombi travel from a systemic vein through the right side of the heart and into the pulmonary circulation, where they lodge in branches of the pulmonary artery.1 Each year 500,000 to 1 million Americans have a pulmonary embolic event1 and 10% of those patients result in death, making it the third most common cause of death in the US.1 For this reason, physical therapists need to be able to identify, or take precaution, when people come to the clinic with signs and symptoms of deep vein thrombosis (DVT).
One of the most effective ways for a physical therapist to help with identifying is taking a comprehensive history of the patient. Risk factors for a DVT in the lower extremity include:1

  • Immobilization
    • Bedrest – sedentary lifestyle
    • Long periods of travel
    • Fracture stabilization
  • Injuries to the leg
  • Increased age
  • Infections and inflammatory diseases
  • Pregnancy and individuals taking oral contraceptives
  • Cancer
  • Smoking
  • Obesity
  • Thrombocytosis
  • Orthopedic patients
    • Post op hip or knee

By taking a comprehensive history, we can identify if the person has risk factors and is at a higher risk for developing a DVT. After taking a comprehensive history it is time to perform the physical exam. Common signs and symptoms of a DVT include:2

  • Pain, swelling, tenderness along the distribution of the deep leg vein
  • Erythematic skin (redness)
  • Cyanosis
  • Positive Homans sign (dorsiflex ankle and squeeze calf)
    • Positive if painful
    • Not specific
  • Wells Clinical Prediction Rule
    • A list of questions that help rule in or rule out a DVT

As physical therapist, we have the knowledge to make clinical decisions that help keep our patients safe. It is our duty to identify these risks and physical signs and symptoms.
By taking a comprehensive history, listening to the patient, providing a thorough physical examination, and using our clinical expertise and judgment, we can help our patients even more by referring them back to the doctor or a specialist.

  1. Hillegass EA. Essentials of Cardiopulmonary Physical Therapy. 3rd ed. St. Louis, MO: Elsevier/Saunders; 2011.
  2. Hirsh J, Agnes LYY. How we diagnose and treat deep vein thrombosis. Blood. Published 2002. Accessed August 21, 2016.