What the job does
Two things at once, which is why firefighters end up in both halves of this practice.
The gear. Turnout gear and SCBA add serious weight, carried high and worn for hours. Load on the trunk changes how the spine and hips share work, and it is a well-recognised contributor to the lower back pain that accumulates over a career in the fire service.
The standing. Prolonged standing is the classic occupational driver of venous insufficiency. Leg veins move blood upward against gravity using the calf muscle pump and a ladder of one-way valves. Stand still for hours, shift after shift, and the pressure those valves work against is relentless. Over years, valves fail, and the leg below them carries blood it should have sent back to the heart.
Put the two together — weight on the trunk, hours upright — and you have a body being asked for something most jobs do not ask.
Why the ache at night is the useful clue
The complaint that brings firefighters in is rarely “my veins”. It is legs that are heavy by the end of a tour, ankles with sock marks, cramps that wake you, and a back that has been grumbling for years.
That evening-worse, morning-better pattern is the signature of venous pressure. It is also the pattern that gets waved away as being on your feet all day — which is true, and is the cause rather than a reason to accept it.
What gets sorted out first
Nothing is recommended before we know which structure is producing the pain.
For legs, that means a duplex ultrasound performed standing — gravity is part of the test, and a scan done lying down can miss significant reflux entirely. It shows which veins are refluxing and how far, and it is what most insurers require before approving treatment.
For the back and knees, it means an examination: how the spine moves, where it is tender, what the nerves are doing, how the hips and the surrounding muscles have compensated for years of load.
Dr. D’Alessio is board-certified in Physical Medicine & Rehabilitation — the specialty built around restoring function rather than operating — so both examinations happen in the same appointment rather than at two practices that never speak to each other.
Treatment, and the job
Vein treatment is done in the office under local anaesthetic: radiofrequency ablation, Varithena® microfoam, or sclerotherapy for the surface vessels. You walk out and drive home. Back and knee pain is treated without surgery — targeted injections where they are indicated, and a rehabilitation plan that accounts for the fact that you will be back in gear.
Compression is discussed realistically. Graduated compression under gear is genuinely useful and is the single most practical thing most firefighters can do while everything else is arranged.
On benefits
Fire-service, municipal and union plans frequently include out-of-network benefits. Whether yours does, what it covers, and what you would be responsible for are things we check and tell you before anything is scheduled.
We will not tell you a procedure is covered until we have verified it, and if the answer is that it is not, you will hear that plainly.