We have read with interest the article by Agarwal et al.1 and the letter by Frisbie.2 They both have highlighted a very important and largely neglected aspect in the prevention of deep vein thrombosis (DVT) in spinal cord injury (SCI) patients, that is, the role of physical therapy. Agarwal et al. have presented more scientific evidence against the routine use of pharmacological thromboprophylaxis in resource-poor South Asian countries, which cannot be arranged in many instances because of the cost issues.

We would like to refer to our prospective study on prevalence of DVT in a cohort of 187 earthquake 2005 survivors with SCI.3 We primarily relied on clinical suspicion and carried out duplex scan only in suspected cases. Only nine cases (4.8%) had confirmed DVT on duplex scan. This was despite the fact that mechanical and pharmacological thromboprophylaxis was not available to most of the patients. One of the possible explanations that we considered was thrice daily range of motion exercise of the lower limbs along with massage of the paralyzed extremities. This was made possible because of availability of an adequate number of attendants and volunteers. This is a very important suggestion that needs to be revisited in the light of the new scientific evidence presented by Agarwal and Frisbie, although it is not meant to downplay the established role of heparin in the prophylaxis of DVT.

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