Background

Typical recommendations for increasing muscle mass include lifting weight at 60-70 percent of a person’s maximum amount for 1 repetition. Blood Flow Restriction Therapy involves applying a tightly wrapped device (usually a blood pressure cuff) at the upper portion of an extremity for a treatment session to restrict blood flow for a prescribed period of time. The treatment session is lower weight training (20-30 percent of a person’s 1 repetition maximum amount) with high repetitions.

Research shows this may provide patients a safe method to begin strength training at earlier stages of rehabilitation. This may be beneficial in improving muscle strength, power and endurance in athletes, as well as those who are recovering from musculoskeletal injuries, postoperative patients and the elderly. Blood Flow Restriction will be carried out by a physical therapist or athletic trainer with additional training in the use of Blood Flow Restriction Therapy. As this is an emerging modality, protocols have yet to be optimized or standardized, leading to variability in techniques used.

Symptoms/Risks

Blood Flow Restriction Therapy is deemed to have low risk of adverse reactions. Case reports of muscle injury (rhabdomyolysis), delayed onset muscle soreness, and nerve injuries have been cited. Patients with potential cardiovascular disease should be closely monitored. It should be avoided in pregnancy and in patients with a history of blood clots. Further research is needed to effectively screen who might be at risk for rare adverse events.

Sports Medicine Evaluation and Treatment

If an athlete injures their arm or leg and visits a sports medicine physician, physical therapy will often be a component of their recovery. Blood Flow Restriction Therapy is a modality that may be utilized by the physical therapists. This has been studied specifically in patellofemoral pain syndrome, meniscus tears, ligament sprains, knee replacements, ankle fractures, wrist fractures and after some surgeries. If treating the upper extremity, the device will be placed just above the elbow. If treating the lower extremity, the device will be placed just below the hip, around the thigh. The ideal pressure used varies depending on patient and machine-specific factors.

Injury Prevention

Blood Flow Restriction Therapy is used by some during weight training to increase muscle mass. There would be potential benefit in reducing injury by improving strength, however no scientific evidence is available to demonstrate a direct relationship between Blood Flow Restriction Therapy and reduced injury.

Return to Play

One of the main goals of Blood Flow Restriction Therapy is to hasten the return to play for athletes who had to undergo surgery or who are unable to rehab with the standard 60-70 percent of their 1 repetition maximum amount. If the athlete is able to begin strength training at earlier stages of rehab, this could allow for earlier and more effective return to activity. This therapy technique has been shown to limit muscle strength loss during rehabilitation from an injury or surgery. Ultimately, return to play is going to vary depending on the initial injury that required the use of Blood Flow Restriction Therapy and will be individualized to each patient.

AMSSM Member Authors
Andrew Kinchen, MD and Daniel Divilbiss, MD

References
Anderson AB, et al. Blood Flow Restriction Therapy: From Development to Applications. Sports Med Arthrosc Rev 2019;27:119-123.
Minniti MC, et al. The Safety of Blood Flow Restriction Training as a Therapeutic Intervention for Patients with Musculoskeletal Disorders. Am J Sport Med 2020;48(7):1773-1785.
Ramme AJ, et al. Ischemic Therapy in Musculoskeletal Medicine. Am J Sport Med 2020;1-9.