Blood Flow Restriction Training in Sports: Benefits and Applications
You are managing a patient who recently underwent an ACL reconstruction. Early in the postoperative period, the physical therapist is looking to implement blood flow restriction training (BFRT) as part of the rehabilitation. Which of the following is true regarding BFRT and ACL rehab?
A) Attenuate postoperative muscle atrophy
B) Increase ACL graft cross sectional area
C) Decrease time in knee brace
D) Decrease need for post-op narcotics
The technique can be described as having the goal of occluding venous outflow of the affected limb without limiting arterial inflow. This leads to an anaerobic environment where ischemia and hypoxia occur; generating cell signaling and hormonal changes similar to what is see with high intensity resistance training. Clinically, this becomes a relevant musculoskeletal (MSK) rehabilitation tool because it does not require the high joint forces associated with heavy-load exercise. Individuals can achieve increased muscle burden and physiologic changes at a lower level of resistance training. The exact mechanism of action is poorly understood but several proposed theories include: (a) primarily related to metabolic stress, mechanical tension, (b) elevated systemic hormone production, (c) cell swelling, (d) production of reactive oxygen species (ROS), (e) intramuscular anabolic /anticatabolic signaling, and (f) increased fast-twitch fiber recruitment. It is likely multifactorial.
Image 2: Example of BFRT Device with Pneumatic Compression
Image 2: Example of Blood Flow Restriction Training Bands
There is fairly strong general evidence supporting the value of BFRT among uninjured individuals. It has been shown to increase VO2max and arterial compliance (Ozaki 2011), increase muscle strength and hypertrophy (Loenneke 2012), muscle cross sectional area (Takarada 2004) and increase glycogen storage and decrease ATP (Burgomaster 2003). Among uninjured athletes, it has been shown to increase strength and muscle size (Wortman 2020), sprint performance (Abe 2005), aerobic capacity (Abe 2010), muscle endurance and jump performance (Manimmanakorn 2013). In collegiate athletes (Luebbers 2014)and jiu-jitsu fighters (Neto 2014), it compared similarly to heavy resistance training for increasing 1RM squat performance.
Answer is A. Ohta et al found that BFRT helped attenuate muscle atrophy following ACL rehab in the early postoperative period. There is no compelling literature to show that the ACL graft increases in size. Furthermore, there is no evidence to show a decreased time in knee brace or need for post op narcotics.
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