VCU DPT - Agents (Blood Flow Restriction)

with blood flow restriction, we want the body to think it is _______

doing high itensity exercise, despite the load applied not being enough to where it normally should

name some general effects of bloow flow restriction (4)

improved strength, motor unit recruitment, atrophy decreased

improved vasodynamics

improves bone mineral density

decreased pain

____% of 1RM for....

a) hypertrophy

b) strength

c ) BFR

a) 70-85%

b) 60-70% untrained, 80-100% trained

c) 20-30%

what is a good alternative to heavy loads in a rehab setting

Blood flow restriction

when we take a joint that can not be laoded highly, and load it at a load it can take but in the form of a higher stressor, what is one method of doing this

blood flow restriction

what are two main mechanisms for hypertrophy at cell level?

which is BFR targeting most

tension

metabolic stress ( this one)

does BFR target type 1 fibers or type 2?

explain why

type 2

since we are limiting blood flow, we are limiting oxygen. type 1 fibers love oxygen, so we limit the oxygen and we fatigue type 1. now, type 2 have to carry the load of the exercise

high load resistance training targets _________ stress

load load resistance training + BFR targets ___________ stress

mechanical

metabolic

BFR ________ blood flow

creates an _______ enviornment

this ___(increases/decreases)___ metabolic stress

now, we get ___(increased/decreased)____ recruitment of fast twitch muscle fibers

decreases

ichemic/hypoxic

increases

increased (the oxygen dependent fibers fatgiue, leaving these guys to finish the job)

which is better

low load resistance training

OR

low load resistance training + BFR

option 2

what is limb occlusion pressure

the internal pressure measurement that is required to occlude arterial blood flow the the limb

__________ is the internal pressure required to occlude arterial blood flow to the limb

limb occlusion pressure

what is the best way to get limb occlusion pressure if doing manually?

when should it be done?

best aa to use?

doppler ultrasound over distal aa

everytime you use it

UE is radial, LE is posterior tibial/dorsalis pedis

which measuremnt is higher, limb occlusion pressure or blood pressure

limb occlusion

do you need to measure limb occlusion pressure every day?

if yes, what are some factors leaning towards this?

if no, when SHOULD you retake it?

yes

time of day, hydration, meds

good news! we have found the limb occlusion pressure. it is 'LOP'. Now, we want to use BFR on a patients UE and LE.

What percentage of LOP should we use for both?

UE: 50% LOP

LE: 80% LOP

where does the BFR cuff go for LE? what % of LOP does it need

very proximal thigh, just inferior to greater trochanter

80% LOP

where does the BFR cuff go for UE? what % of LOP does it need

above biceps brachii muscle belly on humerus, inferior to the delt tuberosity

50% LOP

exercise prescription with BFR:

a) intensity

b) sets/reps

c) rest

d) exercises

e) time w/ cuff on

f) frequency

a) 20-40% 1RM

b) lot of reps, think 75 reps over 4 sets

c) 30-60 seconds between sets/exercises, couple minutes after it is off

d) 3-4 MAX

e) 20 min MAX

f_ 2-3x a week, not daily

is blood flow restriction safe?

research says yes, w main complaint being mm soreness

4 common side effects of blood flow restriction

delayed onset muscle soreness

numbness

dizziness

brusing

when shoudl you discontinue BFR (using clinical judgement)

numbness

pins/needles

SEVERE discomfrot

dizziness or lightheadedness

name some possible contraindications for BFR (6)

sickle cell anemia

clotting disorder

DVT

liver disease

estrogen use

immediately post op/immobility (risk of DVT)

name some precuations for BFR, things to know you should closely monitor (5)

hyperlipidemia

diabetes

obesity

renal disease

hypertension

(lot of things limiting normal function and healing)

research shows that for ___________ high load is better, but for ______ low load + BFR is equal/ maybe better

strength

hypertrophy

when ready to load the tissue normally, _______ is the best

if tissue can not be loaded normally, then ______ is a good option

high load RT

low load RT + BFR

is BFR safe on ACLs

can it be beneficial

it is safe for it

yes, it may be beneficial following ACL reconsturciton

t/f: BFR is shown to have no detrimental effects on ACL graft laxity following ACLR

t

may BFR actually help people with pain reduction and improved function following ACLR

yes

does BFR have been shown to decrease ant. knee pain?

if yes, what is significance of this?

if no, what other effect WAS shown instead?

yes

this means there is a lack of arthogenic muscle inhibition, quads shut down less

t/f: BFR has been shown to indirectly help quad activation by decreased arrthogenic muscle inhibition by decr. knee pain

trueq

is the research very strong on tissue that is PROXIMAL to the BFR cuff?

it is mixed on what it will do, but likely not hurt it

(study done using rotator cuff)

resistance training with BFR ___(may/may not)___ promote cardiopulm function and strength in endurance runners

state some effects if 'may'

state the reason why if 'may not'

may!

had better VO2max, knee strength, muscle mass

what are the effects of bone mineral density with BFR

BFR is shown to have better BMD!!!

can be put on passively with patient who has a distal fx

what patient populations is BFR best for and why

early post op, can not tolerate high laods

mid-late stage to reduce stress on knee w/ stregth training

when in the session should you do BFR for knee pain

beginning

will make tired, and can lower pain to help get more activation and movement

what are two key things for exercise selection with BFR

choose exercises they have done before and do many reps of them

choose only about 3 exercises, w/ 2 of the 3 hitting one muscle

- more is too fatiguing

what are the cardiovascular benefits to BFR

arterial walls get less stiff, so those w/ HTN or other CV diseases get the benefits of blood thinning and the walls thinning

in healthy population, what is best way to load tissue?

is BFr good for some populations?

are there benefits to tissue proximal to BFR cuff?

does BFr have CV beneifts?

high load RT (not low load + BFR)

yes! post op, elederly

there might be!

yes it does, helps thin blood and make walls less stiff

may BFR be used for recovery

it can be

- use bilat. with light CV exercise

BFR relatioonship to AMI

decreases pain, so should help wake quads up

what does it mean with BFr being a 'cardiovascular cleanup'

refers to blood thin/anti clot, and vessel softening

is more research bening done for benefits of BFR?

yes

can you use BFR early in the healing process or do you need to wait 6-8 weeks every time?

you can use early!!