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 Select Physical Therapy or NovaCare Rehabilitation center to see if BFR is available.
By: Grant Shanks, P.T., OCS, area sports medicine coordinator for Select Physical Therapy in Tennessee. Grant also serves as center manager of our Mt. Juliet location.
Select Physical Therapy and NovaCare Rehabilitation are part of the Select Medical Outpatient Division family of brands.
Posted on 10/24/2018 by NovaCare Rehabilitation and Select Physical Therapy
Every October, the American Physical Therapy Association (APTA) hosts National Physical Therapy Month to recognize how physical therapists and physical therapist assistants help restore and improve motion in people's lives.
This October, the APTA’s focus is once again on the risks of opioid use and that physical therapy is a safe alternative for managing pain. The APTA wants you to #ChoosePT… and so do we!
According to a recent study, researchers found that patients who started physical therapy within three days of receiving an acute low back pain diagnosis were less likely to use advanced imaging, specialist care and opioids than those who started physical therapy later.1
In another study, physical therapy as a first treatment strategy resulted in 72 percent fewer costs for the patient within the first year. Patients were less likely to receive surgery and injections, and they made fewer specialists and emergency department visits within a year of primary consultation.2
You can determine your need for physical therapy and choose which physical therapist you want to help manage your care before seeing a doctor. Whether you have neck pain from sleeping wrong, lower back pain from gardening, an ankle sprain or tennis elbow, our experts can create a plan of care specific to you and your rehabilitation goals.
To give you an idea of the importance and value of physical therapists, here are five quick things our team can do for you:
Physical therapists are trained diagnosticians. Seeing a physical therapist before you see a doctor, get an X-ray or start medication is a great way to get a jump-start on an injury or condition. You do not need a physician’s referral to start physical therapy with our clinical experts... visit us today!
Physical therapists can help with a cardiovascular program and improve your sport performance. Wish you were a runner but get out of breath on the way to the mailbox? Want to take your game to the next level on the field? Start now with a physical therapist and/or athletic trainer!
Physical therapists treat balance disorders. If you or a family member has had issues with falling and/or dizziness, make sure it isn’t something more complex. A balance test with a physical therapist is a great way to put aside fears, improve strength and coordination and lessen symptoms.
Physical therapists treat neck pain and headaches, too. We can isolate the tightness in cervical muscles and figure out what may be causing tension headaches. By getting to the root cause of headaches, physical therapists can often stop them before they start.
Physical therapists can survey your jobsite. Wonder if your desk and chair is the right height? Is the floor hurting your feet from standing all day? Talk to your employer about onsite ergonomic evaluations and then talk to us! Physical therapists can evaluate your worksite and make recommendations that will reduce pain and the chance of injury.
Our licensed physical therapists will work directly with you to get you on the road to recovery. Contact a center near you today to request a complimentary consultation and experience the power of physical therapy.
Posted on 9/26/2018 by Anne Marie Muto, OTR/L, CHT
Now that students have a few weeks of school under their belts, their backpacks – which were relatively light from a few school supplies – are now filling up. Not only are children feeling the weight of nightly homework, but also the weight of their book, binder and electronic-filled backpacks.
Aside from considering the right cartoon character/super-hero, color and cool factor, the backpack should also be the right fit. In honor of National School Backpack Awareness Day, here are few things to keep in mind when picking out a backpack:
The width should be about the same size as the student; the length should be no longer than the torso (trunk or central part of the body) and not hang more than four inches below the waist. Remember to check the bag each year, especially for younger children who are experiencing growth spurts.
Select a backpack that has a padded back, two padded shoulder straps and a waist strap to help evenly distribute the weight from the shoulders to the body’s core and hips. The extra padding will help protect students’ neck and shoulders which are rich in blood vessels and nerves and when constricted can cause pain and tingling in the neck, arms, and hands.
Finally, choose a backpack that is light-weight and has multiple compartments which can help distribute the weight more evenly. It’s also a good idea to think about picking a backpack with reflective material or adding reflective tape for younger students.
After picking out the perfect backpack, students should also be reminded on how to properly wear and pack their “shoulder shadow.”
Always wear both shoulder straps to distribute the weight evenly. Using one only shoulder strap can cause too much leaning and threaten to curve the spine.
Adjust the shoulder straps so the pack fits snugly across their back. When possible, pack lightly and carry only items that are required for the day.
Never allow a student to carry more than 15 percent of their body weight. For example, if a child weighs 100 pounds, the backpack should not weight more than 15 pounds.
When organizing the content of the backpack, distribute the weight evenly by packing the heaviest items toward to the center and lower portion of the bag to keep the weight off their shoulders.
Finally, here are a few tips to keep in mind to help lighten the load:
Ask if textbooks are available digitally, or if extra books are available to leave at home.
Consider having a “homework box” at home that contains schools supplies (pens, pencils, ruler, markers, highlighters, etc.) to reduce the amount of unwanted weight in a backpack.
Encourage kids to use their locker or desk frequently throughout the day instead of carrying an entire day’s worth of books. Only bring home the books which are truly required for homework or studying each night.
Pick up the backpack using proper lifting techniques, encouraging students to bend at their knees and use both of their hands when lifting the bag to their shoulders. It may not be a bad idea for students to participate in back-strengthening exercises to assist in building up muscles required to carry a backpack.
We hope you have a fun and healthy year at school! Happy learning!
By: Anne Marie Muto, OTR/L, CHT, from NovaCare Rehabilitation’s Broomall and Boothwyn, PA centers. Anne treats patients dealing with upper extremity injuries and is a preferred provider for the Graston Technique.
NovaCare Rehabilitation and Select Physical Therapy are part of the Select Medical Outpatient Division family of brands.
Posted on 9/11/2018 by Brian Brewer, CPT
School is back in session and fall sports are underway! From the gridiron to the soccer field to the volleyball court, athletes of all levels are hitting the field. With increased play, however, there is also an increased risk for injury.Categories: Physical Therapy
Did you know that there are movement assessments designed to assess ACL injury risk? Within Select Medical’s Outpatient Division*, we provide movement assessments using dorasaVi wireless wearable sensors to measure exactly how individuals move. This technology allows our highly trained clinical team objectively analyze body movement and muscle activation, utilizing a test called the Athletic Movement Index, or AMI. With this testing, we are able to accurately determine an athlete’s ability to safely perform higher level movements, such as cutting, pivoting and deceleration, all of which can lead to ACL injury if not performed efficiently.
The ACL is one of four ligaments in the knee that provide joint stability. Roughly 70 percent of ACL injuries during high-risk sports are non-contact injuries, meaning no collision occurred when the ACL tore. As an athlete begins to tire throughout the course of a game or event, their efficiency in movement begins to suffer, their mechanics become faulty and their risk for injury is heightened. If we can recreate these conditions during movement assessments, we are more able to determine an athletes risk for ACL injury. The AMI is a test that simulates the fatigue factor that plays a role in ACL injuries.
The AMI runs the athlete through a battery of movements, designed to assess core strength and stability, hip strength and mobility and efficiency moving through single-leg movements, such as a single-leg squat and a single-leg hop. The single-leg movements analyze the movement of the knee, whether it is collapsing inward or outward past neutral and the degree of loading, or depth, that the participant is able to go to, both of which are important indicators in assessing ACL injury risk. If the knee is not staying neutral during single-leg movements, then there is weakness in the hip, specifically the gluteus medius muscle, which is leading to inefficient movement. The higher the speed that the knee is moving out of neutral, the higher the risk of ACL injury there is. Similarly, if the athlete is not loading deep enough, and that is coupled with a high speed of displacement, then their risk is increased even more. Through strengthening the hips and core effectively and deliberately, based on the test results, clinicians can help reduce an athlete’s risk of injury dramatically.
Our exclusive ACL Play it Safe Program is an ACL prevention program, designed specifically to go hand-in-hand with the AMI and address the faulty mechanics that lead to ACL injuries. The program consists of a mobile application, with pre- and post-practice exercises and drills to be performed. Additionally, there is an ACL Play it Safe Kit that consists of equipment designed to improve strength and conditioning of the muscles responsible for controlling mechanics during dynamic movements that can cause injuries.
The pre-practice exercises are dynamic warm-ups that should be used to increase flexibility and mobility in the hips, knees and ankles:
High knee with calf raise
These pre-practice exercises should be performed for 15 yards down and back, two times each. This will help to warm-up the hips and knees, and prime them for efficient movement.
The post-practice exercises utilize the TheraBand CLX, TheraBand Ankle Cuff and TheraBand Stability Trainer. These should be done after practice when the athlete is tired. If an athlete can strengthen and train with proper mechanics while they are tired, then it will be that much easier for them to perform efficiently on the field when they reach the same level of fatigue. There is a multitude of post-practice exercises, with some listed below:
CLX spiral technique
TB cuff side stepping with kicks
Single leg toss on stability trainer
CLX plank with kicks
All of the post-practice exercises are designed to help strengthen the core and gluteus medius muscle and prevent a displacement of the knee during dynamic movements. Of course, as with any exercise routine, static stretching and/or foam rolling should also be performed following the completion of the program.
Through objective analysis of muscle activation and subjective observations of movement, clinicians are able to determine ACL injury risk with high accuracy. If we can address poor mechanics of movement through assessment prior to when an athlete takes the field and introduce them to ACL Programs designed to addressed these poor mechanics, we can start to minimize lost time on the field, see an increase in performance and help athletes be more confident in their sport.
*NovaCare Rehabilitation and Select Physical Therapy are part of the Select Medial Outpatient Division family of brands.
By: Brian Brewer, CPT, is a strength and conditioning specialist for NovaCare Rehabilitation in Annapolis, Maryland.