Blood Flow Restriction Training for Post-Operative ACL: Fad or Feasible?  Courtney Poist, SPT

Blood Flow Restriction Training for Post-Operative ACL: Fad or Feasible? Courtney Poist, SPT

During my last semester of physical therapy school, I have had the opportunity to complete a literature review on a topic relevant to our clinical experiences as part of our research curriculum. While participating in my last clinical rotation at Physiolete, I have witnessed several young individuals begin their rehabilitation journey after ACL repair. While rehabilitating, some patients performed exercises while a blood flow restriction cuff was applied to their involved lower extremity. Although I have seen some individuals utilize this type of device while weight lifting in the gym, I had not yet seen it applied in a therapeutic setting. I decided to perform my literature review on the use of blood flow restriction training on individuals undergoing ACLR rehabilitation. By performing this research, I wanted to better understand the common protocols of BFR use and the therapeutic benefits that this tool may provide for these individuals. 

One of the most common lower extremity musculoskeletal conditions is ACL injury, occurring at an astounding rate of approximately 250,000 cases per year in the world. The NCAA reports that ACL tears have increased at a rate of 1.3% each year over a 16 year period. Additionally claiming that each year there are more than 2,000 student athletes that suffer from ACL tear. With ACL reconstruction (ACLR) surgery, the primary concerns are quadriceps atrophy, inter-limb muscular asymmetry, and articular loading imbalances. All these deficits may lead to increased occurrence of reinjury, decreased lower extremity function, and prolonged rehabilitation for those wanting to return to sports activity. Blood Flow Restriction training, otherwise known as “BFR”, has been a trending modality in recent years, but has it been scientifically backed as an effective clinical tool within physical therapy clinics- especially for those rehabilitating from ACLR?



evidence chart

For individuals undergoing ACLR Rehabilitation, the use of BFR can attenuate quadriceps atrophy, aid in knee extensor strength, and improve LE functional outcomes. It is also proven that the use of BFR can achieve similar strength gains as to high intensity, heavy loaded exercise all while decreasing intensity of knee pain and risk of re-injury. A novel finding of Jack et al. was that use of BFR within the first 12 weeks of ACL rehabilitation decreased the loss of lean bone mass, increased bone preservation and accelerated return to sport function. While reviewing these articles, I found that many clinicians implemented BFR at low intensities with high volume, utilizing a common rep schemes of 30-15-15-15. Most of the BFR cuffs within the studies were automatically inflated to calculate the level of occlusion pressure (LOP), and exercises were then performed with the cuff inflated to 80% of LOP. The type of exercises varied depending on phase of healing, however the majority of the exercises are targeted towards knee extensor and posterior chain strengthening. As research on BFR training on post-operative ACLR patients continues, treatment protocols should further standardize specificity, duration and frequency of exercises to yield the most optimal results. 

Clinical Relevance: 
BFR is a feasible clinical tool that can be implemented within the early phases of ACLR rehab. It is versatile and can be utilized without limiting exercise potential. As well as use of any other clinical modality, physical therapists must perform routine screenings and consider precautions and contraindications to BFR. Additionally, all patients should be educated on the risks and benefits of this modality and provide consent prior to the intervention. Although it is proven that BFR has positive effects, it is only practical if it is well tolerated by the patient. 


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