Going with the Flow: An Inside Look at Blood Flow Restriction Rehab

Today's guest post comes from a former PT student of mine with a very strong first name: Brett Nowotny. (***His bio is below!)

If you've ever been through physical therapy, you may know that there is a definite set of tools in the tool bag that we use to get you to meet your goals and back to performing at your best. Whether it is exercises, soft tissue work with tools or our hands, dry needling, ultrasound, you name it, there are many different things that we can do. One new, and heavily researched, tool that is quickly taking the PT world by storm is called Personalized Blood Flow Restriction (BFR) rehab. This type of rehab is “fairly” new and is quickly becoming a household term, especially in our local Sioux Falls area.

What’s BFR?

If you haven’t heard of it, here’s a quick background: Personalized BFR is the application of a surgical grade tourniquet system and tourniquet cuff placed around the upper arm or leg to restrict a certain percentage of blood flow to that arm or leg during exercise with the intention to increase strength and build muscle. The cool thing about this type of rehab is that we use a really light weight (around 30% of your 1-repetition maximum) with the tourniquet pumped up but your muscles get the strength and muscle gaining benefit similar to training with really heavy weight (greater than and around 80% 1 repetition maximum). Here is a great link to learn more about this type of therapy.

Are You a Candidate for BFR?

If you or someone you know has just had a surgery, involving a muscle, ligament, specific joint, or even bone fracture, he or she may be a great candidate for BFR rehab. Surgeries such as ACL reconstructions, knee meniscus repairs, or most tendon repairs are all surgeries that will require a varying degree of physical therapy after surgery that BFR will definitely help get you through. Older friends or family members that may have a hard time doing their normal daily, leisure, or recreational activities may also be great candidates for BFR rehab. BFR can also be a useful tool for someone who is not injured and wants to improve their strength, muscle size, or athletic performance. BFR is being used each day to help improve the athletic performance of athletes from youth all the way to the professional level.

How Do You Get the Most Out of Your BFR Sessions?

This depends on why you are having PT in the first place and where you are at in the rehab process. When you go to see your physical therapist for BFR, you will probably see him or her around 2 – 3 times per week. This leaves 4 – 5 days outside of the clinic that you will need to make sure that you are being productive to get the most out of your BFR rehab. You need to make sure you are taking an active role in your rehab!

If you are someone that has just had surgery, such as a football player or gymnast with a recent ACL reconstruction, and you are within the first few days to weeks of your rehab, your job is to make sure you eat your PROTEIN! When you go through exercises with BFR, you will significantly increase your body’s ability to put on muscle by increasing muscle protein synthesis, so, we need to feed it by eating protein. This is VERY important after surgery because typically after an injury our body wants to get rid of the muscle around that joint. Muscle is hard to keep on the body when it’s not being used. For this reason, we want to stop the body from losing protein so we don’t lose a lot of muscle (and strength) for the later stages of rehab. So, if this is you, make sure after you do your BFR exercise, you eat your protein, around 2 grams per kilogram of bodyweight, that day while continuing to perform your muscle activation and range of motion exercises. For example, if you weight around 200 pounds, or 90 kilograms, you would need to eat around 180 grams of protein, spread evenly throughout the day.

In the middle to late stages of your rehab after surgery, eating your protein remains very important but the focus shifts to strength training the muscles you are targeting with BFR. This means that you will be going to your gym that you normally train at and getting back to lifting weights with moderate to heavy weights. This should also remain a high priority even if you didn’t have surgery. You may see a small benefit from BFR sessions, but the gains you will see when you take an active role in your PT will be dramatic.

A key thing to remember is that your PT can give you the tools and education necessary to get better but it is your responsibility to get yourself better the 4 – 5 days per week that you won’t being seeing him or her!

BFR can be a great tool to utilize in physical therapy if you're an athlete post operative or looking to improve muscle size and strength. Taking more of an active role in your PT at home and in the gym will lead to a much better outcome. BFR will allow you to keep your strength and muscle size through the entire rehab process leading to a better outcome and possibly quicker transition back to your sport. If you feel you would benefit from BFR, find a local certified clinician in your area by visiting this link.

Good luck!

Brett

***Brett graduated from South Dakota State University with a Bachelor's in Exercise Science in 2014. He then went on to earn his Doctorate in Physical Therapy from The College of Saint Scholastica in Duluth, MN in 2017. He sees a number of different orthopedic conditions but takes a special interest in sports medicine patients and return to sport for ACL patients and overhead athletes. For this reason, a majority of his caseload is knee and shoulder injuries. He has taken a few specialty certifications including Personalized Blood Flow Restriction Rehab through Owens Recovery Science and is a certified Astym provider. He is a member of the American Physical Therapy Association as well as the American College of Sports Medicine. His personal interests include spending time with his wife Ashley and his chocolate lab Murphy, exercise in all forms, lake life, and caffeine.