For the last several years, advanced technologies and equipment at the Center of Human Performance offer Houston Methodist the opportunity to test and enhance human physical performance. The information gathered is applicable to athletes and patients alike—to aid rehabilitation and prevent injuries.

As the name suggests, BFR therapy is a methodology to restrict blood flow. External pressure is applied using a specialized automated pressure cuff in the upper arm or thigh which restricts vascular flow via direct compression when activated. The automated pressure cuff can also be outfitted with a Doppler probe to determine the degree of vascular occlusion. It uses partial occlusion of blood flow to mimic the stress response of high-intensity exercise in a way that helps preserve muscle and bone and can be performed at exceptionally low intensities, which is optimal for a post-surgery patient. Modified from a form of resistance training called “KAATSU Training,” BFR therapy has been shown to stimulate muscle anabolism and increase muscle mass and strength when combined with low-intensity exercise in clinical trials. BFR therapy has garnered considerable attention from scientific communities and the media in recent years due to its many applications and potential benefits in muscular hypertrophy, strength and endurance. Combined with low-load resistance exercise, BFR may be used in various sports training to increase skeletal muscle mass. In healthy populations, BFR is an applied methodology to decrease stress on the joints during strength training. However, BFR is particularly useful in populations that cannot lift heavy weights.

“Blood flow restriction therapy was still under investigation and not commonly utilized as a standard of care for rehabilitation before we started looking at it in 2017. We’ve performed extensive research on this topic and it has now become a standard of care for all of our sports medicine physicians,” noted Lambert. “Presently, we’ve branched BFR into older patient populations for total joint reconstruction." Applications of BFR is also being explored in patients following wrist fractures, and those with Achilles tendon rupture repair. Much remains to be explored about the mechanisms of action at the cellular level in response to BFR. “We’ve now looked at blood flow restriction therapy in collegiate baseball players, and some of the protocols that we've come up with are now standardized for the Houston Astros and several major league baseball teams, particularly for the shoulder and elbow,” Lambert added. “Major League Baseball has funded a good portion of this research through grant funding, so there is potential for this therapy to be used to combat unloading muscle loss associated with disuse in spaceflight and other numerous applications.”

For the next two years, 120 Division I Rice University athletes will participate in a concussion study with Houston Methodist researchers to identify reliable and novel concussion biomarkers in their gut microbiomes in ways that standard brain imaging cannot.

Sponsored by the NFL Players Association, this project will advance a 2022 study that explored the gut-brain connection in contact-sports student-athletes and identified biomarkers for concussions within the athletes’ gut microbiomes. Although the study, initially involving 33 football players, was cut short by the COVID-19 pandemic, it was the
first study to show a measurable drop in certain bacteria found in the stools of athletes without concussions compared to those who had suffered sports-related concussions. It also found a connection between inflammatory proteins found in the blood and the ratio of good and bad gut bacteria of athletes who suffered concussions.

“This larger study will give us a clearer understanding and measurement of concussions and their association with gut microbiota functions, and whether these are gender-dependent,” said Sonia Villapol, PhD, Assistant Professor, Neurosurgery, who leads the study with Kenneth J. Podell, PhD, John M. O’Quinn Centennial Chair in Concussion Research and Care. The study is part of the Center for Human Performance, a Houston Methodist and Rice University partnership, to advance research and education to prevent injuries, improve rehabilitation, enhance performance and speed athletes’ return to life, work and sports. Dubbed “Gut Microbiome Markers of Sport-related Brain Concussion,” the study will include 80 Rice male and female athletes from collision/contact sports (football and soccer) and 40 athletes from non-contact sports, including swimming, track and field, and tennis. Researchers will collect blood and stool samples throughout the two-year study and use machine learning and advanced microbiome sequencing to analyze the data.

Researchers hope that analyzing the gut microbiomes of these college athletes can lead to the development of personalized treatments for concussions and a system that can be used on the field to detect early signs of mild traumatic brain injury through markers in the microbiome.