PREFACE
Blood Flow Restriction Training: Current and Future
Applications for the Rehabilitation of Musculoskeletal Injuries
MAJ John S. Mason, PT, DSc, SCS, CSCS,* Johnny G. Owens, MPT,†
and LTC William J. Brown, PhD, RN, FNP-BC*
cience continues to examine interventions to improve fit-
S on current best evidence for the adaptations being seen via
Downloaded from https://journals.lww.com/techortho by BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1AWnYQp/IlQrHD3fB7RKAmTm9Ruf1qHUeyq6DdKwqRWdqGURlM/ieUSrkQ= on 11/16/2019
ness, delay age-related decrements in physical function and
facilitate healing and recovery after injury. These factors, or
lack thereof, directly affect not only quality of life, but also the
overall health care financial burden. With a surging population
of seniors 65 years and older, which will swell to over 98
million by 2060, the need for interventions that may mitigate
senescent changes could not be timelier. Orthopedic surgeons
face many challenges in providing care to not only an aging
population, but also to a younger subset that is highly active
and engaged in a variety of high-impact sports. Therefore,
interventions that can positively affect patient health-related
outcomes from the time of injury throughout the rehabilitation
process are highly warranted.
This special issue will examine a novel but increasingly
popular intervention, blood flow restriction (BFR) training. BFR
training utilizes an automated pressure cuff placed on the proximal
limbs to restrict blood flow and, when combined with light resist-
ance exercise, produces a variety of positive physiological effects.
BFR shows potential as an adjunct strategy postinjury or surgery to
improve general physical conditioning, target muscle weakness
around affected joints and hasten recovery. Moreover, BFR may
also benefit the geriatric patient by mitigating age-related decre-
ments in physical function. The following 6 articles will provide the
reader with important information about the science, safety, and
implementation of BFR training.
From a health and safety perspective, Dr Loenneke and
colleagues provide a thorough review of the mechanisms and
science behind BFR training. Although the mechanisms are not
fully understood, this paper serves as a well-crafted summary
From the *Womack Army Medical Center; and †Owens Recovery
Science Inc., FT Bragg, NC.
The views expressed herein are those of the authors and do not reflect the
official policy of the Department of the Army, Department of Defense, or
the U.S. Government.
J.G.O. is a medical consultant for Delfi Medical Innovations, Inc and
research consultant for METRC.
The authors declare that they have nothing to disclose.
Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.
Techniques in Orthopaedics$  Volume 33, Number 2, 2018
Copyright r 2018 Wolters Kluwer Health, Inc. All rights reserved.
BFR. Similarly, Dr Cahalin and colleagues have expanded the
review on safety to higher risk patients with hypertension. With
the aging baby boomer population likely to continue to seek
orthopedic care, this article describes what is currently pub-
lished and the scientific understanding of applying BFR in the
hypertensive patient.
A primary concern during periods of disuse is the ensuing
muscle atrophy that occurs. Dr Lambert and colleagues describe
the potential ability of BFR to upregulate muscle protein metab-
olism and anabolic signaling to slow or reverse the catabolic
postsurgery/injury state. Dr Hackney and colleagues discuss BFR
as an intervention to mitigate age-related muscle loss (sarcopenia)
and strength (dynapenia) within an aging population that can be
implemented both preoperatively and postoperatively to hasten
recovery following orthopedic procedures.
Anterior cruciate ligament (ACL) reconstruction is a com-
mon orthopedic surgery. Dr Patterson and colleagues describe
the application of BFR after ACL reconstruction. There are
currently multiple clinical trials worldwide assessing the addition
of BFR to ACL rehabilitation. This paper describes the rationale
for the addition of BFR postsurgically, the state of the current
evidence and a sample clinical protocol. Finally, Dr Bradner and
colleagues have provided a thorough review on the reported side
effects and safety of BFR.
As this technique becomes more widespread, it is important
for clinicians to understand the current applications, limitations,
and safety considerations in order to effectively apply this
modality to appropriate patients. Finally, we would like to thank
all the authors for their time and contributions to this symposium.
www.techortho.com | 71