Doug answers: "We need to consider risk factors in our clients that may suggest that they are vulnerable to DVT. This would include venous stasis (a period of bedrest, long plane trip (ie. to Australia maybe), or recent surgery), and activation of clotting factors (recent surgery, burn, diuretic use, dehydration). The blood is like water in a river carrying sediment. The kinetic energy of the water carries particles in suspension until the river takes a tight bend and the water slows down. This is where you will find the sand bar in a river, just around the bend from a sharp turn. Similarly, when blood slows it tends to deposit bits and pieces of blood cells, or whole blood cells, fibrin and whatever else is in suspension especially if you have a diet high in "bad" fats. If you combine the slowing blood with activation of clotting factors, then the stage is set for a thrombus.

I generally practice local precautions around any lower extremity vein, especially the femoral and soleal veins. These veins are large diameter and if they harbor clots then dislodging them may cause a life threatening pulmonary embolism.

We need to develop our palpation skills so that we know what we are in contact with most of the time! Direct firm pressure on a vein is a bad idea. Especially firm pressure in a proximal to distal direction. This will increase pressure within the vein and stress the valve that is further down the leg. These valves prevent back flow and venous stasis!

I haven't read Ida Rolf's words on direction of manipulation, but I can imagine that for many of us our fascia may migrate proximally up the front of our thighs from all the sitting that many of us do. In that case, I would want to shift, drag or restore a more anatomically neutral position to the fascia (ie. down the front of the thigh). I suggest that this is done with a broad contact that does little to stress the femoral vein. The vein probably has become a little compressed and maybe even fibrosed in the inguinal region in many of us (there is an acute condition of this that occurs with some cyclists). If that is the case, then I would hope that restoring hip extension and myofascial extensibility in the front of the hip will gradually lengthen, decompress and return more elasticity to the underlying vascular structures in an indirect way.