Blood Flow Restriction Training in Rehabilitation Patients
Blood Flow Restriction Training in Rehabilitation Patients
Occlusion training, resistance exercise performed with a specialized venous tourniquet, leads
 to beneficial changes in muscle at low resistance and minimal stress on the nearby joint.
 This novel resistance training has the potential to greatly improve extremity muscle strength
 gains for rehabilitation patients who are unable for medical reasons to perform high
 resistance exercise. Our study will explore this with specific rehabilitation populations:
 post-operative knee scopes, post-operative anterior cruciate ligament (ACL) reconstruction
 patients who have acute post-operative changes in thigh muscle function and chronic thigh
 weakness. The primary outcome is to achieve accelerated functional thigh recovery with
 outcome measures including thigh strength, validated questionnaires, and validated functional
 testing. Occlusion training can enhance rehab patients outcomes, reduce the cost of care, and
 improve the skills and efficiency of care providers.
Occlusion training is the restriction of venous outflow from an extremity with the use of a
 tourniquet during weight-training or resistance exercises. The technique is a safe and
 effective method of improving strength through muscle hypertrophy in healthy, active
 individuals (1-7). The technique has also been shown to be safe and effective in patient
 populations with various comorbidities (8).These strength gains can be achieved while
 training with loads as low as 20% of an individual's one repetition maximum (1RM). This is
 contrary to the American College of Sports Medicine (ACSM) weight-training guidelines that
 state muscle hypertrophy can only be achieved when an individual lifts loads close to 80% of
 the 1RM (9).

 The purpose of this project is to compare occlusion resistance training to traditional
 resistance training methods for rehabilitation patients. This will include both an acute
 post-operative ACL reconstruction cohort and a chronic thigh weakness cohort. Post-operative
 lower extremity weakness as well as chronic muscle weakness after trauma correlate with lower
 functional performance.(10,11) We will treat the patients and follow these two cohorts
 simultaneously.

 Specific Aim 1: To determine if occlusion training will accelerate the recovery of thigh
 muscle function and strength in post-operative anterior cruciate ligament (ACL)
 reconstruction as compared to a standard post-operative rehabilitation protocol.

 Specific Aim 2: To determine if occlusion training will increase quadricep and hamstring
 muscle function for battlefield wounded warriors with severe thigh weakness as a result of
 trauma or volumetric muscle loss as compared to standard ACSM resistance training guidelines.

 Specific Aim 3: To determine if occlusion training will accelerate the recovery of thigh
 muscle function and strength in post-operative soft tissue knee arthroscopy as compared to a
 standard post-operative rehabilitation protocol.
Inclusion Criteria:

 -  One of the following: (1) s/p ACL reconstruction within the last three months prior to
 initiation of study training, (2) s/p knee arthroscopy within the last 2 weeks prior
 to initiation of study training, (3) S/p lower extremity trauma, unilateral with thigh
 weakness of at lest a 20% deficit compared to contralateral side and at least 6 months
 out from most recent trauma or surgery

 -  Fluent in English and able to consent

 Exclusion Criteria:

 -  Contralateral lower extremity involvement resulting in less than normal range of
 motion, muscle strength, or daily pain greater than 5/10.

 -  Pregnancy, verbal reporting

 -  Recent history of deep vein thrombosis, within the 12 months or on active treatment

 -  History of endothelial dysfunction, peripheral vascular disease, hypertension,
 diabetes, or people prone to capillary ruptures (bruising) (determined by verbal
 reporting by the patient)

 -  Active Infection

 -  Cancer (current diagnosis)