The Use Of Blood Flow Restriction In Early Stage Rehabilitation Following ACL Injury.
Using BFR training during rehabilitation post ACLR appears to be safe and practically feasible. No adverse effects on knee laxity have been found with BFR training compared to heavy load training.
It has also been shown both acutely and chronically that patients experience less knee pain during and for up to 24 hours post-exercise with BFR training, with a greater overall reduction in pain following 8 weeks of training.
Moreover, the perceived exertion and muscle pain responses to BFR training appears not to limit application or adherence to training.
How To Implement BFR Training
So how do we go about using BFR in a practical setting? Recent research supports individualisation of BFR application, where BFR is prescribed as a percentage of ‘arterial limb occlusion pressure’ (LOP), which represents the minimum pressure required for total arterial occlusion. Manipulation of BFR protocols has been shown to influence the perceptual, hemodynamic, and neuromuscular responses to BFR exercise.
How BFR Can Enhance The Return To Sport Process
When to return to sport following ACLR is a controversial issue. It is common for patients to be at a higher risk of re-injury compared to healthy controls.
Strength and conditioning coaches, rehabilitation specialists and surgeons utilize a range of assessments to determine an athlete’s readiness to return to sport, including:subjective rating scales, knee laxity testing, isokinetic testing, functional hop testing, balance testing, and movement assessment. Whilst this has improved over recent years, several studies have demonstrated deficits in muscular strength, kinaestheticsense, balance, and force attenuation 6 months to 2 years following reconstruction.
With this in mind, the return to sport following ACLR should not be rushed. Furthermore, we suggest BFR be used to mitigate some of these residual deficits that athletes experience.
By using BFR earlier in the rehabilitation to offset atrophy and strength loss (phase 1) and improve strength and hypertrophy (phase 2), practitioners can spend more time focussing on neuromuscular control, functional strength, rate of force development, and psychological readiness which are necessary for a successful return to competition and reducing the risk of re-injury
BFR provides a low-load safe and efficacious treatment modality for athletes following ACLR.
As it gains more acceptance in clinical settings and more robust clinical trials are published, there has been a shift in the acuity of its usage and adoption across clinical conditions.
Clinical trials have advanced to not just explore the ability of BFR to preserve and restore lost muscle mass and strength, data are now available which report its ability to preserve bone loss after ACLR, provide a reduction in pain, swelling and function.
More recent advancements have also advocated its use in prehabilitation prior to ACLR where a reduction of muscle fibrosis and upregulation of satellite cells have been shown along with accelerated return to play.
Thus, we propose that these findings provide an important message for clinicians and athletes alike - train hard, train smart and start early!
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✍️ Written by Stephen D Patterson, Johnny Owens and Luke Hughes.