![]() 3, 6, 7 When BFR is used as an adjunct to postoperative rehabilitation, it has been suggested that exercises performed at lower loads (20%-50% of 1 repetition maximum) can promote muscle hypertrophy similar to traditional strengthening protocols while reducing pain and adverse joint loading. ![]() The induced anaerobic environment has been reported to promote muscle hypertrophy by initiating cell signaling 2 and hormonal changes 1, 3 that stimulate protein synthesis, 2, 4 proliferation of myogenic satellite cells, 5 and preferential activation and mobilization of type II muscle fibers. This ultimately reduces oxygen delivery to muscle cells during low-resistance exercises. Exercise volume, including the number of sets and repetitions, should focus on building muscle endurance, using a high number of repetitions and short rest periods between sets, and patients should be transitioned from low-load activity exercises during the restricted weight-bearing phase to building muscle strength by body-weight closed kinetic chain exercises when advanced to weight-bearing protocols.īlood flow restriction (BFR) therapy occludes venous outflow while restricting arterial inflow 1 by the application of an extremity tourniquet. This value is then adjusted by the personalized tourniquet pressure percentage, which can be configured between a minimum of 40% and a maximum of 80% this will ultimately configure the pressure value that will be applied to the thigh during exercises. ![]() BFR begins by determining the limb occlusion pressure, which establishes the minimum pressure required to stop the flow of arterial blood (unique to each patient). BFR is performed by a personalized tourniquet system, which is connected to a tourniquet cuff through a hose, ultimately applying a specific pressure value, tailored to each patient. BFR therapy can only be used for improvements in the immediate postoperative condition and counteracting muscular atrophy, and it carries the additional risks of increased muscular pain and prolonged swelling. BFR works by reducing or totally occluding blood flow to the targeted muscles, creating an anaerobic environment, promoting muscle hypertrophy through stimulation of protein synthesis, myogenic satellite cell proliferation, and type II muscle fiber activation and mobilization. Video 1 Blood flow restriction (BFR) can be used to reduce the severity of muscular atrophy that may occur owing to non–weight-bearing conditions and to increase muscular strength through low-level resistance.
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