Blood Flow Restriction Training for Acute Soft Tissue Injuries

Research Team
Carson Bryant, ATS
Brittany Litchford, ATS
Cole Ross, ATC
Chip Schaffner
Beth Funkhouser, MEd, LAT, ATC, CSCS

12/03/2017
 Table of Contents
CLINICAL SCENARIO 2
FOCUSED CLINICAL QUESTION: 2
KEYWORDS: 2
SUMMARY OF SEARCH METHODOLOGY 2
SEARCH STRATEGY: 2
SOURCES OF EVIDENCE SEARCHED: 2
BEST EVIDENCE REVIEWED: 2
CLINICAL BOTTOM LINE 2
IMPLICATIONS FOR CLINICAL PRACTICE 3
RECOMMENDATIONS FOR FUTURE RESEARCH 3
REFERENCES: 3

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CLINICAL SCENARIO
Blood flow restriction training has been used for a few years pretty extensively in
the bodybuilding community to drastically increase hypertrophy. Its popularity has
become huge, and has grown quickly in recent years. After being introduced to the
idea, and being asked about the effectiveness of this type of training, Carson had the
idea for this clinical question. Overall, about the only background to this question
that we have seen available is information from unreliable sources speaking of the
effectiveness of this type of training was for the purpose of hypertrophy.

Development of Clinical Question:

This Clinical Question was developed after my introduction to blood flow restriction
training by Chip Schaffner. This idea was brought to Carson due to my knowledge of
exercise physiology, and athletic training back ground. Thus we, Carson and
Brittany decided to make this our clinical question so that we could see the
effectiveness of this training method on soft tissue injuries. With aspirations that
this could be useful in the rehabilitation setting of our athletic training careers.

Development of Investigation Committee:

Our investigation committee was made up of Carson Bryant, Brittany Litchford, Cole
Ross, Beth Funkhouser, and Chip Schaffner. Our committee was formed with these
people due to these reasons; Beth Funkhouser is the most knowledgeable person on
the committee when concerning blood flow restriction training in the area of
rehabilitation. Cole Ross was chosen due to his expertise in hamstring tendinopathy,
and his ability to determine similarities between our research, and his graduate
research. Chip Schaffner was chosen due to him bringing the idea of this type of
training to my attention. He was the original person to show me anything about
blood flow restriction training.

Focused Clinical Question:

Does the implementation of blood flow restriction training improve rehabilitation
outcomes in athletes with acute soft tissue injuries?

Keywords:
Blood Flow Restriction Training, Rehabilitation, Therapeutic Rehabilitation, Acute
Injury Rehabilitation, Occlusion Training

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SUMMARY OF SEARCH METHODOLOGY
We approached answering this clinical question using the little clinical question
weebly page (littleclinicalquestions.weebly.com), as well as searching Medline and
JSTOR for information on blood flow restriction training. Some of the keywords we
used together are listed above.

Search Strategy:
Population: our population was determined to be patients that have soft
tissue injuries
Intervention: our intervention is using blood flow restriction training during
the populations rehabilitation program
Comparison: we are comparing blood flow restriction training to
rehabilitation without the use of blood flow restriction training
Outcome: we are determining whether or not using blood flow restriction
training in combination with traditional rehabilitation is more effective than
traditional rehabilitation alone when looking at outcomes, as well as timeline
of healing.

Sources of Evidence Searched:

Tennent DJ, Hylden CM, Johnson AE, Burns TC, Wilken JM, Owens JG. Blood
Flow Restriction Training After Knee Arthroscopy. Clinical Journal of
Sport Medicine. 2017;27(3):245-252.
doi:10.1097/jsm.0000000000000377.
Vanwye WR, Meatherholt AM, Mikesky AE. Blood Flow Restriction Training:
Implementation into Clinical Practice. International Journal of Exercise
Science. 2017;10(5):649-654.

Best Evidence Reviewed:

The “Blood Flow Restriction Training: Implementation into Clinical Practice”
article tells us that low load resistance training with blood flow restriction training
can improve outcomes and be implemented into clinical practice. The
sphygmomanometer is used to restrict blood should be manually tightened or
inflated until there is enough pressure to stop venous flow, but allow arterial flow.
In healthy individuals, with proper inflation levels, there have been no changes in
blood markers that show blood clot formation. This exercise should not be
performed to failure, or complete muscle fatigue, due to the risk for muscular
damage. Blood flow restriction training at intensities as low as 20% of someone’s
one repetition max, has shown improvements in strength and hypertrophy. This

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 could possibly lead to increased rehabilitation outcomes, with a better timeline in
acute soft tissue injury clinical situations. Still, more research is needed to
determine this possible outcome.
The “Blood Flow Restriction Training After Knee Arthroscopy: A Randomized
Controlled Pilot Study” article’s purpose is to evaluate how blood flow restriction
(BFR) training can be used as a postoperative therapeutic intervention. In this
randomized study, 17 patients were studied, 7 using traditional rehabilitation, 10
using blood flow restriction training. The BFR group showed significant increases in
thigh size after completing the 12-session rehabilitation program, compared to the
control group. Improvements in flexion and extension strength were seen with the
control group, as well as the BFR group, but, the BFR group showed nearly double
the strength increases that the control group was able to. No patients in this study
showed any complications to BFR training.

CLINICAL BOTTOM LINE

Overall, These two articles about blood flow restriction training both show us that
BFR training could show drastic improvements in patient outcomes, as well as
healing timeline. Both of these articles look at different situations, one being
hypertrophy and strength gains. The “Blood Flow Restriction Training After Knee
Arthroscopy: A Randomized Controlled Pilot Study” article focused the effectiveness
when used post-operational, thus more applicable to the athletic training
community. Both of these articles hint at the fact that there needs to be more
research done on this type of training, but at this point, both of these articles tell us
that BFR training has its place in clinical practice, when creating rehabilitation
programs for patients with acute soft tissue injuries.

Implications for Clinical Practice

The information we found while researching this clinical question can help
us as future Athletic Trainers, to develop more successful rehabilitation
programs and improve injury recovery time. With more research on the risks
involved with this type of training, and their prevalence, it would be a good
for any Athletic Trainer or clinician to implement blood flow restriction
training in rehabilitation programs for athletes with acute soft tissue injuries.

Recommendations for Future Research

In the future, more research needs to be completed regarding the safety of
this training method, as well as more specific parameters for use of BFR
training. Specifically with the parameters.

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REFERENCES:
Tennent DJ, Hylden CM, Johnson AE, Burns TC, Wilken JM, Owens JG. Blood
Flow Restriction Training After Knee Arthroscopy. Clinical Journal of
Sport Medicine. 2017;27(3):245-252.
doi:10.1097/jsm.0000000000000377.
Vanwye WR, Meatherholt AM, Mikesky AE. Blood Flow Restriction Training:
Implementation into Clinical Practice. International Journal of Exercise
Science. 2017;10(5):649-654.