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Melanie Cole (Host): Physical Therapists at Henry Mayo Newhall Hospital have an arsenal of new therapies and equipment that can help patients get stronger, restore mobility, and resume their normal lives, including a cutting-edge treatment, called blood flow restricted rehabilitation. My guest today is Marina Stockton. She's a Physical Therapy Supervisor at Henry Mayo Physical Therapy. Marina, tell us what is BFR, blood flow restricted rehabilitation? What is the history of it? What is it?

Marina Stockton (Guest): The blood flow restriction therapy is a technique that is now becoming more common in the outpatient physical therapy realm. It's using a specialized tourniquet system during exercise to help the growth and strength response in muscles after surgeries or after reconditioning. It originally was designed and implemented with the military. They have been using it since about 2010 with their limb salvage patients and amputation patients that they were having difficulty getting these people strong enough to move forward. They found that when you restrict blood flow during exercise, you actually create a hypertrophy effect similar to what you get when you do heavy lifting.

Host: Tell us how that works. How do you get that hypertrophy effect?

Marina: They're still trying to determine the different causes of it. What they're suspecting — some of the theories out there are that when you're reducing the blood flow to the muscle groups below the tourniquet, we are seeing an increase in fiber type recruitments; there's a metabolic accumulate effect. There's activation of muscle protein synthesis, and then there's cell swelling. All of those things help to grow the muscle. It allows for a muscle to get stronger under low, low weight.

Host: Wow, that's so cool. Tell us what kind of conditions can it help, and what areas of the body you use it most often?

Marina: It can help a variety of different conditions. We're seeing it most commonly right now, in our clinics with our postoperative patients, particularly patients who have had ACL reconstruction, meniscus, ankle surgeries. We've seen it, and we're using it with our shoulder surgeries. A little bit with our elbow patients that have either had an injury to the elbow or have had surgery. We're seeing it kind of across the board for different things. We are starting to use it with some of our geriatric population for those who are really deconditioned and have a lot of problems doing heavy weight-bearing exercises — squats, lunges, those type of things — that help the muscles in our legs get stronger, but they can't tolerate them because it's painful. This gives us an opportunity to do those types of exercises that are easy on their joints, but they still get the benefits of the strengthening.

Host: Can it even help athletes and be a revolutionary tool to decrease the time that it takes to return to a sport postoperatively if they've had, as you say, ACL repair or reconstruction? Is it working well for athletes?

Marina: Yeah, it is. I know that they are probably using it in a lot of the sports performance realms because the response is immediate. You're going to see — after you do it the first time, you see the muscles getting larger. That cell swelling, you actually physically see it happen, so those effects that take so long when we're doing heavy lifting are actually much quicker with the BFR.

Host: And before we discuss who is a candidate and who isn't — and I told you, Marina, that I am an exercise physiologist — is there a concern among physical therapists in the industry that this could be a misused technique that bodybuilders or people like that might misuse this technique. If so, what do you think of that?

Marina: Yeah, I think that's one of the concerns that we have across our profession. We want to really make sure that people understand that this is something you need to go to someone who has been trained to use it. The particular system we use — the machine is done so that it is safe. There are precautions in the machine so that things are not going to go wrong. You will see bodybuilding — and if you've ever been in the gym occasionally, you see people who have attempted other sorts of restricting blood flow — tying things around muscles to create a similar effect. There's no way to really monitor how much blood flow is going through or not going through, and that can be dangerous. There is that concern, but at least what we're using in the clinic, the system is very safe.

Host: You mentioned geriatric patients, and we spoke about athletes. Who is not a candidate for this type of technique? Who would you say is at high risk and you just wouldn't do it?

Marina: It's anybody who's going to come in, whether young or old, who have had any issues with blood clots in their legs before, any sort of circulation or peripheral vascular compromise, any issues with sickle cell anemia, infections, any kind of tumor or cancer below the tourniquet, open fractures. We don't want to do this on anybody who is fresh out of surgery. We want to try to make sure that we're avoiding this with people who have any type of clotting issues, any skin grafts that are down below the points of where we're applying the tourniquets, vascular grafting, severe hypertension, crush injuries, and any post-traumatic — like hand reconstruction, we try to stay away from using that.

Host: What's the special education you need to do this technique?

Marina: This particular unit that we have it's through the Owens Recovery Science Incorporation. They have a specific training module that they send your staff to or your staff goes through. All of our clinicians in the Henry Mayo Outpatient Clinics actually have gone through — that are using it — have gone through this course, learned all of the precautions, the contraindications, how to apply it, the effects that are happening, and how to progress a patient using it.

Host: How long – you said we could see the muscle right after just one bout of exercise with it — how long do you use it? How long does it take to see results that carry over?

Marina: You're looking — for the carryover, we've seen it as quick as a couple of weeks using it two or three times out of the week. Say for instance, somebody who's had an ACL reconstruction and we're really using it to help with their quadriceps muscle to get that strong again, we can use it for upwards of six to eight weeks depending on the type of exercise that we're doing and where they're at in their actual rehab process. If we start it early, they may use it for anywhere from six weeks to eight weeks. If we're starting it later, then it may not be as long.

Host: Marina, tell us what kind of results you've seen when you've been using it.

Marina: I have seen actually some really positive changes with — obviously, with our postoperative, young, athletic population. They respond really quick with it. They like the new, hip kind of stuff, so they really buy into it. Where I'm really excited, I'm seeing changes have been in my geriatric population with patients who we have struggled on and off with trying to get them stronger. Now, having used it, they're able to see this strength, this muscle starts to come back that they haven't seen in years. They're starting to be able to do things with less pain because we've been able to get the muscles stronger where we've been challenged before, and we haven't been able to do that.

Host: What other kinds of therapies do you offer at Henry Mayo Physical Therapy?

Marina: We offer — we treat most general orthopedic conditions. We have a hand therapist, so we do hand and elbow therapy. We have pelvic floor specialists, lymphedema specialists. We do have cancer rehabilitation specialists. Your basic, general orthopedic surgeries, chronic low back pain, neck pain, all of those types of orthopedic problems.

Host: Wrap it up for us because this is such an interesting topic, and I really hope that they listeners share this with their friends that they know that may have issues that you've mentioned — because what a cool technique. Wrap it up, what you would like them to take forward with this about BFR.

Marina: I think BFR is just one of the many things that our skilled therapists can use to individualize somebody's rehab program here, at Henry Mayo. It's something that I think people are afraid at first, just by the name if it — by its nature — but it can provide so many positive benefits for people to really improve their function, to improve their quality of life, which is really what we strive for in rehab. That's really what we want is our patients to be able to have a better quality of life.

Host: That's great information, and as I said, what a cool topic. Thank you so much, Marina, for coming on and explaining something new to the listeners that could help them in their physical therapy. If you'd like more information on blood flow restricted rehabilitation, you can go to HenryMayo.com, that's HenryMayo.com. You're listening to It's Your Health Radio. I'm Melanie Cole. Thanks so much for tuning in.