Posted on 1/2/2019 by Grant Shanks, P.T., OCS
For many patients recovering from injuries and surgeries, a period of immobilization in a cast or sling and/or restrictions on weight-bearing and activity is necessary to ensure proper recovery and tissue healing. Immobilization and lack of use comes with a significant cost, though: decreased muscle strength and size, known medically as atrophy.
Even after the restrictions are lifted, it takes months to recover to pre-injury levels of strength and ability. However, recent research has led to exciting advancements in what is possible when it comes to regaining muscle strength, size and ability following injury and/or surgery. The development of Blood Flow Restriction training has opened up new doors for patients and the therapists who treat them.
What is Blood Flow Restriction (BFR) training?
Blood Flow Restriction (BFR) training uses external pressure – via a tourniquet – to reduce (restrict) arterial blood flow to working muscles and completely occlude (block) venous blood flow return to the heart. By doing so, one can achieve substantial hypertrophy (muscle growth), strength and endurance changes while using significantly decreased loads/weight. The gains in these areas of performance are consistent with what is typically observed with heavy load lifting.
To this point, the American College of Sports Medicine has shown that optimal muscle strength and hypertrophy can be achieved by lifting at high intensities, defined by their research as: eight-to-10 upper and lower body exercises, performed two-to-three times per week for six-to-eight weeks at intensities greater than 65 percent of the individual’s one repetition maximum (RM). Certainly, this is not possible for the immobilized/injured/post-surgical patient. Utilizing BFR, these same gains in strength and hypertrophy have been observed using only 20 percent of an individual’s one RM and in just two-to-three weeks.
How does BFR work?
While the exact mechanisms are not completely understood, it appears to be a combination of factors related to muscle physiology:
Decreased oxygen to the muscle causes a build-up muscle-building metabolic products.
A preferential recruitment of larger, fast-twitch muscle fibers.
An increase in growth hormone and stem cells following exercise with BFR.
Increased muscle protein synthesis via the extreme “muscle pump” following BFR.
BFR Leg What kind of device/equipment is used for delivering BFR?
By definition, anything that restricts blood flow is a tourniquet, which is considered a medical device and falls under FDA Class I regulations. In order to determine how much blood flow restriction to create in a limb (upper or lower extremity), an individual’s limb occlusion pressure (LOP) must be determined. In order to do this, a Doppler is used to assess for the presence or absence of a pulse.
Once enough pressure has been created by the tourniquet, the pulse will be absent. This amount of pressure is the LOP and then the working pressure is a percentage of this amount – either 80 percent for the lower extremity or 50 percent for the upper extremity. Machines that have a built-in Doppler are considered the gold standard. A hand-held Doppler could also be used.
Who would benefit from BFR?
Patients who are recovering from surgery to the upper or lower extremity and cannot bear weight, move their extremity and/or have been weakened by conditions may be good candidates to receive BFR. Some conditions include:
Total joint replacements
Rotator cuff repair/injury
Upper extremity fracture
Lower extremity fracture
Knee arthroscopy (knee scope)
Achilles tendon repair/injury
Shoulder labral repair/injury
Hip labral repair/injury
How do I know if BFR is right for me?
Your physical therapist will be able to go through the indications (reasons to perform) and any possible contraindications (reasons not to perform) BFR with you.
BFR is a new and growing area of rehabilitation, strength and conditioning and not all physical therapists have been trained and educated on the matter. Contact your local NovaCare or NovaCare Rehabilitation center to see if BFR is available.
By: Grant Shanks, P.T., OCS, area sports medicine coordinator for NovaCare in Tennessee. Grant also serves as center manager of our Mt. Juliet location.
NovaCare and NovaCare Rehabilitation are part of the Select Medical Outpatient Division family of brands.
Posted on 3/25/2019 by Mike Montez, M.S., ATC, CSCS
With an aging workforce, increasing health care costs and a continued demand for physically demanding jobs to be completed by humans, more and more companies are looking into providing their employees with access to an onsite injury prevention specialist.
The injury prevention specialist role is often filled by a National Athletic Trainers’ Association Board of Certification certified athletic trainer whose unique training, skills and abilities make a great fit for the job. Athletic trainers perform skills including immediate injury triage and care, biomechanics assessment, health and wellness education and strengthening/conditioning of active individuals.
Onsite athletic trainers work with industrial athletes who might be delivering online purchases, assisting with luggage at the airport or even cleaning a hotel room. The main goal of the industrial athletic trainer is injury prevention. Just like in sports, industrial athletic trainers “keep the worker in the game.”
Many individuals don’t know when to use ice or heat, how to stretch a tight muscle, basic nutrition needs for a physical job or even how lack of sleep can affect the body’s ability to heal, decrease motor coordination and increase blood pressure. That is where the role of the industrial athletic trainer comes into play.
Employees suffering a wide array of pain or discomfort from work-related and non-work related activities can seek out care from the onsite injury prevention specialist. Care may include assessing the individual, developing a plan of care and attempting to conservatively manage the issue through a combination of ice, heat, soft tissue massage, prophylactic, non-rigid taping and the application of a topical analgesic.
More often than not, an employee’s symptoms resolve within a few visits. If not, the industrial athletic trainer will discuss potential next steps in the process which could include following up with a doctor for further treatment. The industrial athletic trainer also serves as a referral source for other available services which may include dentistry, registered dietitians, follow-up with the employee’s primary care physician/specialist or even psychological consults.
Think of the industrial athletic trainer as a one-stop shop for all your health and wellness needs while on the job. The service is free (paid for by the employer) and is designed to keep the workforce healthy, happy and safe!
For more information regarding services for the industrial athlete through the Select Medical Outpatient Division’s WorkStrategies Program, please call 866.554.2624 or email [email protected] today.
By: Mike Montez, M.S., ATC, CSCS, WorkStrategies coordinator for NovaCare’s Southern California community. He serves as the site supervisor with our OnSite Program at Delta LAX and offers more than 15 years of experience. He is a graduate of Cal State University Long Beach.
Posted on 9/13/2017 by Andrew Piraino, P.T., DPT, OCS, CSCS
Low back pain is common. It’s so common that about 80 percent of adults will at one point experience this condition. It ranks among one of the top reasons to see a physician and costs the United States more than $100 billion dollars every year.
When faced with an episode of low back pain, it’s easy to go into crisis mode. You may be routed through various specialists and receive various imaging tests, such as X-rays and MRI. These tests can reveal scary findings, such as “herniated discs,” but don’t panic.
First, many of these findings are normal. Researchers have found that in adults without low back pain, two of out three have an abnormality at one disc or more. This makes imaging of limited use, unless something like a fracture is present that needs surgical management. Physicians agree; the American Academy of Family Physicians recommends against any imaging for low back pain for the first six weeks unless serious signs are present, such as trauma.
Often, you may be referred for physical therapy. You may have some familiarity with various exercises and hands-on treatment provided by therapists. But why is physical therapy unique, and what exactly does it do?
Physical therapists today are doctoral-level trained specialists in human movement, completing four years of undergraduate education, three years of doctoral training and often further residency or fellowship training in addition to board certification. Poor movements and postures can cause low back pain and, therefore, physical therapists are optimally equipped to address the cause of the problem rather than treating the symptoms. Just like the song lyrics to ‘Dem Bones,’ each area of the body affects another, which is what physical therapists are trained to observe and address.
For example, take a truck driver who has worsening low back pain with sitting in his truck and bending (pictured below). While a massage at his back area makes him better temporarily, his pain always returns several days later. A physical therapist may look at this driver and find he has tight hamstrings (the muscles on the back of the thigh). Every time he straightens his right leg to reach his pedal, his tight hamstrings pull his back into a bent position (Figure B). And so, all day long, as he drives, his back is bent over and over while he operates the gas and brake pedals. Try sitting up straight and then straightening your knee. You may find it’s hard to do!
Low Back Pain
A - Driver at rest.
B - Driver's hamstring pulls on his pelvis and bends his back whenever he tries to use the pedal.
C - Driver after physical therapy treatment to improve his hamstring flexibility... no more dysfunction!
While physical therapy may provide hands-on treatment to alleviate pain, it would also include exercise to decrease stiffness of his hamstrings, which would allow him to move without causing his back to compensate every time (Figure C). Therefore, our truck driver is able to sit and drive all day without pain. Rather than seeking symptom relief, he now knows what caused the pain, and the exercises and positioning to prevent it from returning.
This is a simple example, but it appreciates the entire body’s contribution to movement and pain, rather than focusing on the area of pain alone. Hopefully this demystifies what physical therapists do, and how they work to optimize each person’s movement and prevent their painful condition from returning!
If you are experiencing low back pain, please call one of our conveniently located centers in your area to experience the power of physical therapy today! For more information and to watch a brief informational video, please click here.
Andrew PirainoBy: Andrew Piraino, P.T., DPT, OCS, CSCS, treats at NovaCare in Pasadena, TX and is involved with our orthopaedic physical therapy residencies at the market and national level. He completed doctorate and residency training at the University of Southern California in 2012 and 2013, respectively, and is board certified in orthopaedics. Andrew specializes in orthopaedic movement dysfunction across the lifespan, from young, recreational athletes to adults with complex multi-system involvement.
Posted on 3/5/20 Haley Taffera
Whether it’s on the athletic field, a job-site or in one of our outpatient centers, our athletic trainers are counted on to be the frontline support for injury prevention, treatment and ongoing management of care for athletes, workers and patients and customers. In honor of National Athletic Training Month, we asked our National Director of Sports Medicine John Gilmour, M.A., ATC, to share how our incredible team of athletic trainers makes an impact in the lives of thousands of people across the country on a daily basis. View the video here...
Be sure to visit our Facebook, Twitter and Instagram pages throughout the month of March as we recognize and celebrate our colleagues.