The world of rehabilitation following surgery, especially knee surgery, is ever evolving. Years ago following an ACL repair a person was placed in a cast and was non weight bearing for an extended period of time. Jump to today and you will be in a brace for a short period of time, but for the most part it is recommended to start weight bearing, range of motion and protected strengthening immediately following surgery. Although rehab following knee surgery has for the most part become more of an accelerated approach, there are times when it is necessary to limit range of motion and weight bearing following surgery. For example, following a meniscus repair or cartilage repair, you will be non weight bearing for a period of time. No matter what the surgery, the research is consistent in showing that a person loses a significant amount of strength and muscle mass, in particular the quadriceps muscle.
In a situation where a person is non weight bearing for two to three weeks, they can loose up to 300 grams of muscle mass (approximately the size of a human heart)! Along with the decrease in muscle mass there are other issues that put a person behind the eight ball when trying to gain back their strength and function. Research shows that there is a decrease in protein synthesis following surgery. Protein synthesis is an important part of how our body maintains muscle size and strength as well as assisting with recovery of our injured tissues.
In order to minimize muscle loss, strength loss and decreased protein synthesis one usually needs to perform high intensity training, meaning 65-75% of one repetition max (1-RM) three to four days per week. The issue is that following surgery a person is not able to participate in this type of high intensity training due to surgical restrictions and the need for healing to occur. Although low intensity rehab exercises are necessary to help restore range of motion and appropriate coordination of muscle contraction and movement patterns, we have not been able to provided a true strengthening component for our surgical patients. That is until now. With the introduction of the use of blood flow restriction (BFR), rehab specialists now have a tool that allows these patients to perform low level rehab exercises and still get similar effects of high intensity training that help stimulate muscle growth, minimize strength loss and helping increase protein synthesis as well as promoting natural tissue healing factors to assist in recovery.
Five Reasons you should be adding BFR to your post operative recovery!
Promote release of natural growth factors needed for tissue healing and muscle growth ☞ Using BFR during even low intensity exercise creates lactic acid in muscle. Lactic acid is what causes that “muscle burn” that you feel after completing a hard workout. Lactic acid is important because it signals our body to release other factors in our body, most importantly growth hormone and insulin like growth factor. These are two major players in our body’s process of healing and recovery. Without BFR, one would need to rely on performing high intensity training to get similar effects of lactate production.
- Not able to exercise, No problem ☞ By simply inflating the tourniquet system used in BFR, muscle cells are stimulated to increase protein synthesis and ultimately decrease the risk of post operative disuse muscle atrophy (muscle shrinking). Studies have shown that following two weeks on non weight bearing, those who used BFR drastically decreased muscle strength losses and thigh circumference. This means that if you are going to be unable to put weight through your leg due to a surgery, the application of BFR can potentially help prepare you for a quicker recovery due to less loss of leg strength along with promoting release of specific growth factors as mentioned above.
- Maintain endurance ☞ Once healing time and range of motion allow, performing BFR while on the stationary bike can assist in maintenance/improvement in cardiovascular endurance. Studies have shown that low intensity biking can not only improve your VO2 max (maximum amount of oxygen consumption during exercise) but also shows improvement in lower body muscle strength and size.
- Promotes use of fast twitch muscle fiber units ☞ Usual rehab exercises live in the slow twitch muscle fiber world. Slow twitch fibers are the first muscle fibers to be used during lower level exercise and are commonly known to be more of an endurance muscle type. In order to improve strength, power and muscle size a person must be able to perform exercise that will use fast twitch fibers. Fast twitch fibers are known to be power muscle fibers used during running, jumping and lifting heavy weight. Early on in recovery from injury you are going to be forced to use lower intensity exercise which primarily uses those slow twitch fibers. Now, with the addition of BFR, rehab experts now have a tool to allow you to tap into the fast twitch muscle fibers even when you are limited due to injury!
- Possibly reduce amount of muscle scarring/fibrosis following injury ☞ There is a protein in our body that is known as myostatin. One of myostatins main roles is to turn off muscle growth, its other role is to allow for scarring of tissues following injuries. Scarring of muscle tissue is our bodies way of providing a quick fix to muscle to allow us to continue to perform activities while continued healing occurs over time. Performing high intensity training provides a short term decrease in myostatins effectiveness, which is great, as that is how we get bigger with lifting heavy weights. However, if you just injured yourself, your rehab expert would not suggest that you go perform high intensity training to assist in decreasing the scar tissue formation. Now, if you have access to BFR, you can perform low intensity exercise and still get the effect of decreasing the short term affect of myostatin and therefore, reducing the amount of tissue scarring that occurs and assisting in the regeneration/healing process.