Personalized Blood Flow Restriction Rehabilitation (PBFR) is a therapeutic technique that utilizes a specialized tourniquet system to achieve high-intensity training with a lower load. That is strength, balance, and endurance gains may be made with lower weights and even if one is non-weight-bearing on a limb.
By decreasing the vascular flow to the muscle undergoing training, the same gain in function can be achieved with a much lower weight or resistance. This is important for surgical patients, older patients or anyone with a weight-bearing limitation.
Traditionally, resistance work to rehabilitate a limb can require 65% of a 1-repetition maximum over 12-16 weeks. Obviously, that is a long time for an individual trying to return to work or return to play. PBFR can dramatically shorten the time required to reach a pre-injury state.
The technique creates a hypoxic environment within the target muscle or group of muscles. This environment effectively mimics high-altitude training and allows for rapid gains in size and strength. These improvements have been well-documented in the scientific and rehabilitation literature.
A meta-analysis compared PBFR to a low-load rehab protocol and demonstrated 0.58 effect size for strength change with PBFR and 0.0 for the low load group. (Loenneke 2012)
This means that during a period when a patient must be non-weight bearing or has an injury that precludes heavy loads, they can achieve no gains. With PBFR, gains are possible in all situations and this will significantly accelerate rehabilitation.
Another study has demonstrated that the fiber size of slow twitch and fast twitch muscles increased after only 3 weeks of PBFR (31% and 32%); muscle did not change in size with low-load training. (Nielson 2012)
Basically, PBFR can provide a way to rehabilitate an individual that is only allowed to lift little to no weight due to restrictions placed by the doctor.
By using PBFR we can prevent anabolic resistance. Anabolic resistance is a situation whereby the limb stops making proteins for growth and healing due to disuse. The disuse is brought on by restrictions the doctors place on a limb after surgery or injury. Local protein synthesis in a limb can drop by 30% with restrictions and this, in turn, leads to size loss and weakness. Low load exercise alone does nothing to change this. However, PBFR does and there are increases in protein synthesis.
In other words, PBFR can prevent disuse atrophy of a limb. This would allow a faster return to work or play.
This technique is safe. The patient should know there will be bruising under the tourniquet, but this is no different than bruising after deep tissue massage. Some people will have an uncomfortable feeling due to the tourniquet. The cuffs we use are wide and prevent compression problems. In addition, a doppler and digital monitor are utilized in order to maximize safety.
Loenneke JP, Wilson JM, Marin PJ, et al: Low intensity blood flow restriction training: a meta-analysis. Eur J Appl Physiol. 112(5): 2012; 1849-1859
Nielsen JL, Aagaard P, Bech RD, Nygaard T. Hvid LG, et al. Proliferation of myogenic stem cells in human skeletal muscle in response to low-load resistance training with blood flow restriction. J Physiol. 590(17): 2012; 773-782.
