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By Mary Carpenter
POLITICAL COACHES on “The Good Wife” TV series advised against sitting with legs crossed at the knees because that position causes slumping. If legs must cross, they should do so at the ankles. Crossing legs at the knees has been blamed for an array of orthopedic problems — and may cause varicose veins, though some experts say that’s pure medical myth.
(In a Wall Street Journal article on the subject, the position called “sitting crossed-legged” is accompanied by photos of women’s legs crossed at the knees —as distinguished from the meditation position seated on the floor with legs crossed.)
Sitting crossed-legged puts pressure on the lower knee, unnaturally twists both knees, rotates and strains the pelvis and hunches the lower back, according to Dr. Naresh Rao, osteopath at NYU Langone Medical Center and medical advisor to the 2016 U.S. Olympic water polo team. Keeping your knees in a misaligned position for a long period of time is the most common cause of knee pain, he says, advising against sitting crossed-legged “for longer than you drink a cup of coffee.”
Crossed legs can cause a temporary rise in blood pressure—which is why blood pressure techs ask you to uncross your legs for the test—but have no long-term consequences. For those at high risk for blood clots, however, sitting crossed-legged for long periods of time could lead to deep vein thrombosis, the formation of a blood clot in a deep vein that can be life-threatening if it travels to the lungs and creates the serious blockage called pulmonary embolism.
Why people get varicose veins—or the smaller spider veins—is usually explained by family history, age and sex. Women make up three-fourths of varicose vein sufferers due to hormone changes during pregnancy and menopause. Taking hormone replacement or birth control pills can increase the risk. But why some women are more at risk than others is considered something of a mystery.
Blood flows through the veins en route back to the heart after delivering oxygen throughout the body—hence its blue, deoxygenated hue. With age, tiny valves in the blood vessels designed to prevent blood from flowing back in the wrong direction can become stretched and weakened, allowing blood to pool and enlarge the veins.
Varicose veins—and the tinier spider veins that are often precursors—rarely create more than cosmetic problems, but some cause aches and pains as well as nighttime cramping and throbbing. Complications can occur with long-term fluid build-up, so that discolored spots on the skin, sudden leg swelling and bleeding all require immediate medical attention.
The best way to prevent varicose veins is to avoid standing for long periods, Johns Hopkins dermatologist Robert Weiss told WebMD. The number two tip: “Avoid sitting with your legs crossed, it puts terrible pressure on the veins.” (Other tips involve avoiding tight clothing that constricts the waist, groin or legs; high heels worn for long periods of time; and high salt-diets.) When sitting for long periods while traveling or working on a computer, the advice ranges from getting up and walking at least every hour—to every 15 minutes.
On the other hand, Dr. Rao has seen no studies that prove a correlation between unsightly veins and leg-crossing. Put more firmly, vascular surgeon Jon Modrall at the University of Arkansas writes on the university website: “Crossing your legs does not cause varicose veins.”
To ease discomfort and keep varicose veins from getting worse, the first step is compression stockings—worn all day—along with exercising, losing weight, wearing loose clothing, elevating the legs and avoiding long periods of sitting or standing. Spider veins can be worsened by sun exposure. (Varicose veins that develop during pregnancy usually improve without treatment within a year after delivery.)
Veins that become varicose are usually close to the skin’s surface—while the more important veins taking blood to the heart lie deeper—and can thus be removed or destroyed. Until the early 2000s, the main treatment (called “stripping”) involved inserting a metal rod into the vein, at the groin and then down the leg, and then pulling it out to destroy the vein. Since then, a thin catheter or a laser can use radio waves to shrink the vessel wall and cause it to collapse and be re-absorbed. Once the varicose veins are gone, deeper veins take over the flow.
For those who are much more comfortable with legs crossed, one study tested different positions on embalmed pelvises and found that crossing legs at the knee increased elongation in the piriformis muscle, which runs behind the hip joint—compared both with sitting with legs uncrossed and with standing—thereby increasing stability in the pelvic joints.
Getting into the minutiae of leg crossing, one study found that almost twice as many people reported crossing their right leg over the left knee rather than the other way around. And surveys have noted that, for those sitting nearby, the legs-crossed position is hands down preferable to man-spreading.
—Mary Carpenter regularly reports on topical subjects in health and medicine.