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johnny owens

on 15 August 2018

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Transcript of PAC12

350 grams
100 Drop Jumps (2 ft ht)
220 mmHg
3x5 on
5 min rests

Sham 20 mmHg
The increase in muscle fibre area in the BFR group was 30-40% during and after training.
To put this into perspective 12-16 weeks of heavy resistance training has demonstrated a 15-20% increase in muscle fibre area in untrained men. (Aagaard 2001, Kadi 2004, Olsen 2006)
Thank You!

Hiemstra LA, Webber S, MacDonald PB, et al. 2000. Knee
strength deficits after hamstring tendon and patellar tendon
anterior cruciate ligament reconstruction. Med Sci Sports
Exer 32:1472–1479.

DeVita P, Hortobagyi T, Barrier J. 1998. Gait biomechanics
are not normal after anterior cruciate ligament reconstruction
and accelerated rehabilitation. Med Sci Sports Exer

Paterno MV, Ford KR, Myer GD, et al. 2007. Limb
asymmetries in landing and jumping 2 years following
anterior cruciate ligament reconstruction. Clin J Sport Med

Bryant AL, Kelly J, Hohmann E. 2008. Neuromuscular
adaptations and correlates of knee functionality following
ACL reconstruction. J Orthop Res 26:126–135.

Webster KE, Feller JA. 2011. Alterations in joint kinematics
during walking following hamstring and patellar tendon
anterior cruciate ligament reconstruction surgery. Clin Biomech

Feller JA, Webster KE. 2003. A randomized comparison of
patellar tendon and hamstring tendon anterior cruciate
ligament reconstruction. Am J Sports Med 31:564–573.

Jansson KA, Linko E, Sandelin J, et al. 2003. A prospective
randomized study of patellar versus hamstring tendon
autografts for anterior cruciate ligament reconstruction. Am
J Sports Med 31:12–18.

Maletis GB, Cameron SL, Tengan JJ, et al. 2007.
A prospective randomized study of anterior cruciate ligament
reconstruction: a comparison of patellar tendon and
quadruple-strand semitendinosus/gracilis tendons fixed
with bioabsorbable interference screws. Am J Sports Med

Natri A, Jarvinen M, Latvala K, et al. 1996. Isokinetic
muscle performance after anterior cruciate ligament surgery.
Long-term results and outcome predicting factors after
primary surgery and late-phase reconstruction. Int J Sports
Med 17:223–228.

Palmieri-Smith RM, Thomas AC, Wojtys EM. 2008. Maximizing
quadriceps strength after ACL reconstruction. Clin
Sports Med 27:405–424. vii-ix.

Snyder-Mackler L, Delitto A, Bailey SL, et al. 1995.
Strength of the quadriceps femoris muscle and functional
recovery after reconstruction of the anterior cruciate ligament.
A prospective, randomized clinical trial of electrical
stimulation. J Bone Joint Surg Am 77:1166–1173.
Persistent Weakness
BFR vs Control for Knee Arthroscopy (4weeks)
3x week for 8 weeks
Leg Press and Leg Extension at 30% 1RM with BFR
Leg Press and Leg Extension at 70% 1RM without BFR

BFR group had a 93% greater reduction in pain with daily activity than the heavy lifting group (p=0.02)
BFR group had greater increase in knee extensor torque than the heavy lifting group (p=0.01)
1 Bout of LAQ with BFR at 80% LOP or without BFR
Pain Re-assessed immediately after & 45 minutes later
Significant reduction in AKP in BFR group
during squat, single leg squat and step-down test
immediately after and 45 minutes later. (p<0.017)
The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the Department of the Army or the Department of Defense. All patients have given their expressed written consent to be filmed and photographed for this presentation.

Medical Consultant:
Delfi Medical Innovations, Inc
Owens Recovery Science, Inc
Research Consultant:
Major Extremity Trauma Research Consortium
Johnny G Owens, MPT
3.1 pds
Our Patient's Need
to Be in Beast Mode!

(or at least like the rats)
Blood Flow Restriction Rehabilitation: Mechanisms and Clinical Application
Knee Moment at Loading Response

ACSM guidelines Recommend Novice and Intermediate Lifters Use 75-85% 1 Rep Max for Strength and Hypertrophy 12-16 weeks.

ACSM Position Stand. Progression Models in Resistance Training for Healthy Adults. Med Sci Sports Exerc. 2009;41(3):687-708.

No Alternative ACSM Lift Light-Weight Guideline!
Muscle Metabolites/Muscle Activation
Myocyte Swelling
Metabolite Stress
Reduced SV
1) What are the possible side effects/overall safety profile?

2) An evidence/scientific based approach to apply BFR to maximize safety and reproducible outcomes.

"Despite the substantial risk of postoperative deep venous thrombosis in orthopaedic extremity surgery, use of a pneumatic tourniquet does not appear to be an independent risk factor"
"Paradoxically, tourniquet deflation is associated
with thrombolytic activity."
Blood Markers for Coagulation
(D-dimer and Fibrinogen)
Acute Studies
Nakajima, T., H. Takano, M. Kurano, and H. Iida. 2007. “Effects of KAATSU Training on Haemostasis in Healthy Subjects.” Of KAATSU Training …. jstage.jst.go.jp.
24 Hours of Bed Rest
8,000 ft Simulated Altitude
Young Healthy
Madarame, H., M. Kurano, and H. Takano. 2010. “Effects of Low intensity Resistance Exercise with Blood Flow Restriction on Coagulation System in Healthy Subjects.” Clinical Physiology
Elderly Subjects
Fry, C. S., E. L. Glynn, M. J. Drummond, K. L. Timmerman, S. Fujita, T. Abe, S. Dhanani, E. Volpi, and B. B. Rasmussen. 2010. “Blood Flow Restriction Exercise Stimulates mTORC1 Signaling and Muscle Protein Synthesis in Older Men.” Journal of Applied Physiology 108 (5): 1199–1209.
Ischemic Heart Disease
Madarame, H., M. Kurano, K. Fukumura, T. Fukuda, and T. Nakajima. 2013. “Haemostatic and Inflammatory Responses to Blood Flow-Restricted Exercise in Patients with Ischaemic Heart Disease: A Pilot Study.” Clinical Physiology and Functional Imaging 33 (1): 11–17.
Manini, T. M., J. F. Yarrow, T. W. Buford, B. C. Clark, C. F. Conover, and S. E. Borst. 2012. “Growth Hormone Responses to Acute Resistance Exercise with Vascular Restriction in Young and Old Men.” Growth Hormone & IGF Research: Official Journal of the Growth Hormone Research Society and the International IGF Research Society 22 (5): 167–72.
Chronic Studies
4-Weeks of Training
Clark, B. C., T. M. Manini, R. L. Hoffman, P. S. Williams, M. K. Guiler, M. J. Knutson, M. L. McGlynn, and M. R. Kushnick. 2011. “Relative Safety of 4 Weeks of Blood Flow-Restricted Resistance Exercise in Young, Healthy Adults.” Scandinavian Journal of Medicine & Science in Sports 21 (5): 653–62.
12-Weeks Training in LE in Elderly
Yasuda, T., K. Fukumura, T. Fukuda, Y. Uchida, H. Iida, M. Meguro, Y. Sato, T. Yamasoba, and T. Nakajima. 2014. “Muscle Size and Arterial Stiffness after Blood Flow-Restricted Low-Intensity Resistance Training in Older Adults.” Scandinavian Journal of Medicine & Science in Sports 24 (5): 799–806.
12-Weeks Training in UE in Elderly
Yasuda, T., K. Fukumura, Y. Uchida, H. Koshi, H. Iida, K. Masamune, T. Yamasoba, Y. Sato, and T. Nakajima. 2014. “Effects of Low-Load, Elastic Band Resistance Training Combined With Blood Flow Restriction on Muscle Size and Arterial Stiffness in Older Adults.” The Journals of Gerontology.
4-Weeks After Knee Arthroscopy
Tennent, David J., Christina M. Hylden, Anthony E. Johnson, Travis C. Burns, Jason M. Wilken, and Johnny G. Owens. 2017. “Blood Flow Restriction Training After Knee Arthroscopy: A Randomized Controlled Pilot Study.” Clinical Journal of Sport Medicine
Stimulation of the Fibrinolytic System?
No changes in fibrinogen, d-dimer or CRP acutely after 1 bout or after 4 weeks.

tPA (a fibrinolytic protein) was significantly increased after BFR and HIT training.
The authors concluded
“ Regarding the theoretical risk associated with blood clotting...an acute bout of these exercises enhances fibrinolytic potential without elevating the thrombolytic potential."

Nakajima, T., H. Takano, M. Kurano, and H. Iida. 2007. “Effects of KAATSU Training on Haemostasis in Healthy Subjects.”
Madarame, H., M. Kurano, and H. Takano. 2010. “Effects of Low intensity Resistance Exercise with Blood Flow Restriction on Coagulation System in Healthy Subjects.” Clinical Physiology
Stegnar, M., and M. Pentek. 1993. “Fibrinolytic Response to Venous Occlusion in Healthy Subjects: Relationship to Age, Gender, Body Weight, Blood Lipids and Insulin.” Thrombosis Research 69 (1): 81–92.
Thrombolytic Events and BFR?
Tourniquets are regulated as Class I medical devices by the FDA.

FDA Defines FULL or PARTIAL Vascular Occlusion Falling Under This Guideline.
Addition of BFR to a 30% 1RM resistance training program was effective in increasing leg press and knee extensor strength in women at risk for knee OA, in comparison with the same program without BFR.

In comparison with training without BFR, addition of BFR to 30% 1RM resistance training for 4 weeks did not confer significantly greater increases in leg press or quadriceps strength in older men with risk factors for symptomatic knee OA.
"Data suggest that if the load is less than 30% of maximum, then a higher restriction pressure (80% arterial occlusion pressure) may be required to induce muscle growth similar to traditional high load resistance exercise".
"If so, higher pressures may be necessary in clinical applications where injury or postoperative restrictions limit the amount of resistance applied".
Hughes, Luke, Ben Rosenblatt, Bruce Paton, Jim McEwan, Jeswin Jeyasurya, and Stephen Patterson. 2017. “Investigation of Cuff-Limb Interface Pressure during Blood Flow Restriction Exercise.” Physical Therapy in Sport: Official Journal of the Association of Chartered Physiotherapists in Sports Medicine 28 (November). Elsevier: e10.
Center for the Intrepid
Memorial Herman Houston
Methodist Houston
St Mary's UK
University of Missouri
University of Michigan
University of Kentucky
Beaumont Healthcare
Cartilage/Meniscus Repair
West Point
Ft Bragg
Ft Bliss
Femur Fractures
Carolinas Medical Center
Methodist Indiana University
MetroHealth Medical Center
Washington University/Barnes Jewish
University of Texas Houston
University of Maryland
Center for the Intrepid
Walter Reed
Wrist Fractures
Center for the Intrepid
Achilles Tendinopathy
Ft Bragg
Chronic Ankle Instability
Methodist Healthcare Houston
Center for the Intrepid
Hamstring Injuries
Univ of Southern California
Mitochondrial Density
North Texas Univ
Cardiac Risk Factors
Univ of Miami
Stem Cells/Orthobiologics
Andrews Institute
Professional Workers Comp
Lowest pressure to have an effect.
"the women may have achieved a greater %BFR at
the same level of cuff tightness as the men".
Full transcript