Blood Flow Restriction (BFR) Training and Your ACL Journey

Problems with ACL Rehab

Outside of professional sports settings, low levels of return to activity performance and high re-injury rates are common in ACL Rehabilitation in the UK. Currently, less than a third of ACL patients return to sports within 12 months of their surgery, and less than 50% of patients ever reach their pre-injury level of performance. Failure rates are as high as 30% in the UK, with younger patients being more at risk than their older counterparts. This is likely due to their higher expectation of recovery, and their higher level of sports and activities.

How could BFR Training help me?

Regaining quad and hamstring strength is a significant issue post ACL surgery, and has been seen as a major predictor of whether the athlete will return to their sport. The loss of quad muscle is a contributor to the acute disability and mobility issues in the months post-injury/surgery. Blood Flow Restriction (BFR) Training is a treatment method of increasing muscle growth in the early phases of ACL rehabilitation. High levels of patients don’t achieve limb strength symmetry after ACL surgery, which reduces their chances to return to sport. High failure rates in ACL rehab may stem from poor loading of the joint due to pain and lack of programming, which begins immediately post-surgery, and this poor rehab approach continues for the whole rehab journey.

How will my training be improved by BFR?

Although a common procedure, ACLR surgery remains a complex and technically demanding surgical intervention that typically leaves athletes in considerable levels of pain, with limited range of motion and high levels of muscle atrophy. For this reason, it is unrealistic to believe that the athlete will be able to lift weights heavy enough to grow muscle in their quads and hamstrings. The research suggests that BFR training methods can be effective in producing these changes within skeletal muscle while using lighter weights. The BFR cuff restricts the injured limb while training, and the pressure is maintained at a level that allows sufficient arterial inflow whilst restricting venous outflow, creating an ischaemic or hypoxic environment enhancing the training effect by accelerating metabolic stress. This allows the ability to perform low load resistance training and produce similar outcomes to high load resistance training.

Conclusion

Reducing knee extensor weakness and thigh muscle atrophy is pivotal in promoting optimal outcomes post ACL reconstruction. Fundamental mechanisms that promote muscular strength and hypertrophy include mechanical tension, metabolic stress and muscle damage. During the acute stages post ACLR, patients are limited in their ability to tolerate high levels of mechanical tension and muscle damage due to pain, limited range of motion, swelling and arthrogenic muscle inhibition (pain-related weakness) that prevent the knee from being heavily loaded. BFR training may provide a solution to ongoing quadriceps muscle weakness and thus improve return to performance and re-injury rates. This can be achieved by allowing maximal levels of metabolic stress to occur within the muscle at very low loads which is practically achievable in the acute ACL patient. 

If you have any questions on our BFR Equipment, our ACL Rehabilitation Packages, or you have any questions about MVMNT in general, then feel free to contact via email.

- Jay Towolawi, Specialist Sports Physiotherapist and MVMNT Founder.