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Blood Flow Restriction Rehabilitation Following Orthopedic Surgery

Blood flow restriction (BFR) is a method of improving muscle hypertrophy, endurance, neuromuscular activation, and strength through incomplete restriction of blood vessels. BFR can increase bone mineral density as well. With the use of BFR, you do not necessarily have to perform exercises with external resistance, such as resistance bands or dumbbells. BFR works by occluding a percentage of your venous blood flow with a tourniquet cuff. Your body perceives the density of the occluded blood flow as a “weight” or load as the muscles are working towards fatigue. BFR is used for both upper and lower extremities. BFR can be used in many cases, though there are contraindications for use of BFR. BFR contraindications include, but are not limited to, peripheral vascular disease, active infection, and previous vascular surgery of the same limb to be trained with BFR. If your medical history includes medical conditions such as blood disorders, hypertension, stroke, venous thromboembolism, or neuropathy, it is advised to seek medical clearance prior to using BFR. BFR can be used safely with little to no risks, and your Physical Therapist will be able to instruct you through a BFR protocol individualized to your specific functional limitations and deficits.

BFR has demonstrated success with those who are in the post-operative phase following orthopedic surgery. Muscle weakness and atrophy are common impairments following orthopedic surgeries. Patients often have to abide by lifting or weight bearing restrictions immediately following surgery to allow for protection of the surgical repair. BFR is an advantageous tool because it allows post-operative patients to increase muscle mass and resulting strength while complying with their early post-operative restrictions. BFR has been used for rehabilitation following procedures such as ACL reconstruction, rotator cuff repair, and joint replacement. In the example of ACL reconstruction, the quadricep muscle group is one of the major muscle groups that are targeted throughout the rehabilitation process, especially early on. The knee joint relies on quadricep endurance and strength, and without it, there are consequences such as risk for re-injury. To train the quadriceps, the BFR cuff would be applied to the upper thigh, with 40-80% occlusion depending on the clinical reasoning of the prescribed exercises (such as aerobic or strength training). BFR can be used in conjunction with several exercises, including isometric (muscle contraction through a sustained muscle length), concentric (muscle contraction through muscle shortening), and eccentric (muscle contraction through muscle lengthening) exercises. General exercises that can be used with BFR training include straight leg raises, rows, shoulder extension, bicep curls, leg extensions or presses, squats, and many more!

The utilization of BFR training following orthopedic surgery is increasing, yielding favorable outcomes. BFR is versatile, as it can be used for multimodal exercises for several body parts. It promotes muscle growth, strength, and endurance. BFR is a safe and effective adjunct to post-operative rehabilitation protocols, to meet patient goals such as returning to sport or previous level of activity without limitations.


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