Pioneering Applications for Blood Flow Restriction

Modified from a popularized form of resistance training referred to as “KAATSU Training,” BFR therapy is a valuable tool that has been shown to acutely stimulate muscle anabolism and chronically increase muscle mass and strength when combined with low-intensity exercise in clinical trials Lower limb surgery patients experience muscle atrophy in the trunk and lower limbs, which decreases strength and function, and significantly increases the risk for re-injury. Current standard-of-care treatment options do not offer much support to minimizing early post-operative atrophy in the initial weeks following surgery. Hence, combating post-operative loss of muscle mass and function remains a challenge for rehabilitation specialists. In recent years, BFR therapy has garnered considerable attention from scientific communities and the media due to its numerous applications and potential benefits in muscular hypertrophy, strength and endurance. Combined with low-load resistance exercise, BFR can be used in various trainings for baseball and other sports to increase skeletal muscle mass. In healthy populations, BFR can be a methodology to decrease stress on the joints during strength training. However, BFR is particularly useful in populations that cannot lift heavy weight. It can accelerate recovery and prevent degeneration in post-operative, injured, or load-compromised individuals.

“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 now it has become a standard of care for all of our sports medicine physicians,” said Lambert. “Presently, we’ve branched BFR into older patient populations for total joint reconstruction. “We also believe this therapy has potential use in sports populations for those who are not injured—such as for maintaining muscle mass and strength during in-season play to prevent injury. Additionally, it can be used in certain patient populations that are at risk for post-surgery or post-treatment muscle loss, anyone who might be on extended bed rest, potentially patients undergoing cancer treatments, and patients with neuromuscular disorders. Our team took something from just a basic concept to rehabilitation tool that can be used in several different populations.” Applications of BFR are 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.” Lambert’s research relies heavily on analytics in addition to experiments, testing and clinical trials. His team is dedicated to creating better tools for recording and tracking patient outcomes—from developing different algorithms, software, and software applications to assess patient risks following surgery or rehospitalization to making different prediction models to determine patient outcomes based on pre-surgery data. All of which also helps inform physical therapists about patient-specific milestones for improvement, which in turn greatly aids in the patient recovery process. Houston Methodist patient and trail runner Cindy Babski came to the Center for Human Performance with a tibial double fracture. “Coming here, I had full confidence thanks to a great doctor and an amazing physical therapist, which counts for a lot. You can feel the coordination. They work very much in communion,” she said. “All of the exercises were tailored for my particular injury and getting me better as quickly as possible. It’s so perfected that I know that it has accelerated the healing of my injury and that’s fantastic.”