Blood Flow Restriction Training 101 with Injury Armour
/in AirBands, Case Studies, Guest Spot /by VALDOriginally posted to Injury Armour September 23 2020. Written by Adam Rutter.
Adam has a diverse background within Physiotherapy. Ranging from treating professional athletes to patients suffering with chronic pain. His area of expertise lies within tendon pain, long standing pain conditions and sports injuries. Adam’s excels in creating engaging and varying rehab programmes for all conditions to ensure your motivation remains high.
Blood flow restriction training (BFR), Occlusion therapy, Kaatsu training.
Completely new phrases, or a staple of your exercise routine?
Irrespective of your familiarity you may be asking yourself these questions.
Why are they training with tourniquets on their legs?
Is that just for Bodybuilders?
Is that not Dangerous?
Would you be interested if I told you that BFR training means you can achieve the same strength and muscle size results from lifting lightweights compared to lifting heavy?
This blog post today aims to clear up common misconceptions, including answering the above questions. I will touch upon the science but most importantly suggest how you can implement BFR into your lifestyle or rehab journey to accelerate your results.
Irrespective of your views on going to the gym or lifting weights, strength training is good for you. Period.
If you are athletic, suffer with osteoarthritis or are 99 years old you stand to benefit from performing resistance training to increase your strength.
Being stronger can aid athletic performance, control joint stresses, and improve your posture. Not to mention it is fundamental to help the 99-year-old out of the chair or up from the toilet.
The American College of Sports Medicine recommends that adults perform regular heavy load resistance training using external loads of 60-90 % of 1 repetition maximum to improve maximal strength gains (Garber et al., 2011).
However, some of you may find the thought of pushing yourself that close to your maximal capacity intimidating.
Although I actively encourage progressive strength programmes for all, research has shown that within the elderly populations’ heavy strength training results in high rates of programme dropouts due to joint flair ups and muscle aggravations (Liu and Latham., 2010).
Lifting close to your maximum may also not be advisable for people who need to prioritise tissue healing, or whose pain is a primary limiting factor.
Introducing: Blood Flow Restriction Training
Originating from Japan in the 1970s but more recently gaining traction in the medical community BFR was devised from self-experimentation.
After kneeling for hours on his haunches whilst praying, Dr Yoshiaki Sako found that he had achieved a muscular pump in his calf muscles comparable with performing multiple sets of calf raises.
What ensued was years of trial and error.
A deep vein thrombosis.
But critically some interesting findings of muscular development.
The technology and safety of the process have developed significantly since then, but the principle remains the same.
Research has shown that when performed effectively BFR training can elicit amazing results and can be an invaluable tool for multiple groups of people.
It has been shown that similar strength and muscular size benefits can be found by lifting 20% of your one-rep max weight with BFR compared to traditional strength regimes without BFR (80-95% 1RM) (Gronfeldt et al., 2020).
And it is not just strength improvements.
Light Cycling with BFR has shown to elicit a greater aerobic fitness response compared to light cycling without BFR (Silva et al., 2019)
When BFR training is performed, limb venous returned is purposefully reduced/ inhibited using a cuff.
With the limb occluded the physiological effect of the exercise changes slightly.
Because the limb blood flow is altered, and blood oxygen is limited it causes preferential recruitment of your stronger/ faster muscle fibre types.
This is alongside a cell swelling response.
When combined, the overall effect is one of increased growth hormone production and increased protein synthesis (Loenneke, J. P. et al., 2012)(Yasuda. T., 2008)(Fujita, S.,2008)
In simple terms, it places the muscle in a greater stress state for less effort. Catalysing the effects you would usually see from lifting heavier loads. This equals greater strength, aerobic fitness, and muscle size.
See the table below for an example of how the session format should be designed.
Strength Session Protocol
Aerobic Session Protocol
Why do Physios use it?
A large amount of Physiotherapy is about returning a client’s strength or advancing their strength beyond where it was preinjury/ surgery.
However, there are times in which lifting heavy weights is challenging due to pain, inflammation, and tissue healing.
This is where BFR is invaluable.
I can get a client stronger, faster and with less risk of them flaring up their pain as we can get great strength results with less load.
In fact, when compared to low load training alone BFR is preferential for patients recovering from ACL surgery and Osteoarthritis (Hughes et al., 2017a).
This is even more advantageous as BFR has been shown to work with exercises that can be performed very early postoperatively whilst still in bed (Kubota et al., 2011)(Gorgey et al., 2016).
This method is known as passive BFR and we will be releasing a video very soon to highlight how it Is best performed.
Additionally, BFR has been shown to decrease pain when exercising. Specifically, if you are suffering from Patellofemoral Pain Syndrome (Korakakis, Whiteley and Giakas, 2018). This may result in an increased range of exercises being available for you to perform, or returning to normal exercises sooner than you expected.
So, if we go back to those initial questions people may ask about BFR.
Why are you training with tourniquets on your legs/arms?
BFR allows for greater strength, size and aerobic fitness adaptations by lifting relatively light weights compared with traditional strength routines
Is it just for Bodybuilders?
Although this can be a great tool for bodybuilders, BFR training can be a useful tool for many different populations. Ultimately this exercise method best serves people who are either at risk of high load training/ cannot access heavy loads or want to vary their programming.
In short. Athletes, rehabbers, astronauts, and the elderly.
Is it Dangerous?
The safety of BFR has been extensively reviewed and has shown to provide no greater risk than heavy load training (Loenneke, J. P. et al., 2011; Loenneke, J. P. et al., 2014). Although for appropriate selection I would advise that you get in contact with a health professional who has experience of working with the modality as there are some screening questions to go through beforehand.
Watch this space for prescriptions of how to apply this form of training into your routine and how we use it to rehab clients.
References:
Available here.
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Originally posted to Injury Armour September 23 2020. Written by Adam Rutter.
Adam has a diverse background within Physiotherapy. Ranging from treating professional athletes to patients suffering with chronic pain. His area of expertise lies within tendon pain, long standing pain conditions and sports injuries. Adam’s excels in creating engaging and varying rehab programmes for all conditions to ensure your motivation remains high.
Prior to setting up Injury Armour Adam has worked in professional football and with international athletes of varying sports- from Bobsled to Rowing. In addition he was the head Physiotherapist for The Western Storm supporting them to two Kia super league victories. Adam has also worked for the NHS as a specialist Physiotherapist within a complex clinic alongside working within Private practice.
Improving client engagement and outcomes with ForceDecks
/in Case Studies /by VALDDr. Jacob Canright, PT, DPT, is a Sports Medicine Specialist and Physical Therapist at The Lab, a new clinic powered by Genesis Health located in the Quad Cities area.
In this case study, Jacob shares insight into how ForceDecks are currently used to assess clients, and how they have proven themselves to be an effective tool for improving client outcomes and securing new business.
Both athletic trainers and physical therapists at The Lab utilize ForceDecks for injury prevention, physical rehabilitation, and post-surgical rehabilitation.
How The Lab uses ForceDecks
Currently, both athletic trainers and physical therapists at The Lab utilise ForceDecks for physical rehabilitation, post-surgical rehabilitation, and importantly, injury prevention.
Dr. Jacob Canright explains;
“We’ve been working to develop our own test battery, incorporating the ForceDecks. As part of it, we’ll be able to run our clients through a series of baseline tests, say during pre-season, and then on an ongoing basis annually. Through these tests, we can identify any sort of risk or try stratifying that risk to determine whether a client may need additional treatment.”
Genesis Sports Medicine also offers free screening sessions with ForceDecks to identify any conditions or potential risks that might lead to injury.
“We wanted to develop a good sports medicine program within our facilities and within our area and wanted to look at different equipment that helped us to be able to paint the best picture and the best understanding of how people are performing and what kind of concerns may come up” said Jacob.
Reporting and communication with other healthcare providers
Ultimately, ForceDecks have allowed Genesis to strengthen communication between clients and external healthcare providers.
Jacob explains;
“ForceDecks help us identify those cases where somebody may be passing typical return to sport tests, but when we look at their ForceDecks data, we realize that what looks good on paper isn’t really that good.
That’s been our biggest issue with a lot of return to sport tests – they don’t necessarily give the whole picture – just because you can be within a percent of your unaffected limb, doesn’t mean that all of the quality is there that needs to be there to reduce that risk of re-injury.”
By identifying these otherwise hidden factors, practitioners at The Lab can paint a clearer picture of a client’s condition, and offer their recommendations to coaches, sports medicine physicians, orthopaedic surgeons, and the like with greater certainty and authority.
Engaging clients with ForceDecks
ForceDecks have proven themselves to be an effective marketing tool for The Lab, helping to improve customer experiences and outcomes, along with securing new business.
Currently, free screening sessions with ForceDecks are being offered to clients in order to identify any conditions or potential risks that might lead to injury.
Jacob explains “while marketing through Facebook and Google is beneficial, we believe that in-person contact and building relationships by allowing potential clients to witness first-hand what the technology can do is the most important thing – they will market it themselves at that point.”
Further, as ForceDecks can be used to measure balance, they have also been incorporated into the everyday care of clients.
An effort that has garnered an increasingly positive response from clients.
“Everyone who gets to see and try out the ForceDecks really likes it because of its ability to show data in real-time” said Jacob.
It’s with this visualization of data that clinicians at The Lab can instantaneously transition between assessment and treatment.
“If a client performs a test, and we find that they’re landing rigid through one side, we can justify that they need to work on their eccentric strength with some eccentric loading type activities.”
Summary
The addition of ForceDecks has provided clinicians at The Lab with more objective data on their clients’ rehabilitation and physical wellbeing.
By providing clients with instant insights backed by objective data, clinicians at The Lab can prescribe exercise and rehabilitation activities with greater accuracy and certainty, ultimately leading to greater client satisfaction.
Interested in learning more about ForceDecks?
For further information on how ForceDecks can help your clinic, visit our ForceDeck’s page – here.
Download this case study as a PDF:
Integrating Blood Flow Restriction training into post-surgical rehab programs
/in Case Studies /by VALDMovement Rx is a cutting-edge physiotherapy and sports medicine clinic located on the Moreton Bay Peninsula in Queensland, Australia.
Damian, co-founder of MovementRx, is an experienced clinician with over a decade’s worth of experience in private practice, along with extensive sports physiotherapy experience having worked directly with various professional sporting teams throughout his career.
Read on to learn more about Damian’s application of Blood Flow Restriction (BFR) and AirBands for post-surgical rehabilitation in his practice.
How have you integrated Blood Flow Restriction (BFR) training into your rehabilitation programs?
BFR offers a great way to help reduce muscular atrophy post-surgery/injury in a load compromised area.
We frequently use BFR with patients who are immobilised and are unable to bear weight or have weight-bearing restrictions to increase the effectiveness of low load/demand exercises.
These may include significant ankle sprain, lower limb fracture, surgical fixation of a syndesmosis, ACLR, arthroscopic knee surgery, hip surgery (labral trim or repair).
BFR can also be an effective tool in the rehabilitation of degenerative conditions of the hip, knee, or ankle.
Again, allowing a form of resistance training that produces strength gains whilst minimising load bearing of a degenerative joint can lead to some great success.
We’ll often also use BFR as an intermediary training tool to help settle pain and swelling, develop some muscular strength and endurance which can then be transferred to more traditional training.
What does a typical session utilising BFR look like?
A BFR training session for the patient described above usually follows some manual therapy to reduce swelling and improve range of motion.
Then, the cuff is appropriately fitted and the occlusion pressure is set.
Once set, the patient will circuit through 3-4 specific exercises at a rep range pre-determined based on their stage of healing, level of pre-injury fitness, and how familiar they are with BFR and RPE.
Do you only apply BFR in your clinic, or do you prescribe at-home BFR exercises as well?
Given the nature of load-controlled exercises, exposing our patients to the BFR stimulus more frequently ultimately leads to greater results.
So, we encourage our patients to use BFR as a part of their at-home or independent rehabilitation to maximise the effectiveness of their efforts.
Now with the availability of AirBands, the ease of use has made this far more practical and accessible to more of our clientele.
How do you explain the benefits of BFR training to skeptical or hesitant clients and get them on board with the idea?
It’s quite normal for a client to be hesitant when a physiotherapist presents a model of training that they’re unfamiliar with, especially one that describes occluding blood flow.
So, we take the time to explain in detail why we believe it will be an effective tool for their recovery, the modes with which it works, and as always, the risks.
Then, a practical demonstration of how it is applied often follows.
Finally, we’ll often provide some material to read or videos to watch to help them understand and make the most informed decision.
And as is the case with all rehabilitation, providing the patient with the autonomy and right to make that informed decision is often vital to their success.
If they are truly hesitant we will move on to another form a rehabilitation.
Delivering remote physiotherapy services to Musculoskeletal and Neuromuscular patients
/in Case Studies /by VALDAndy Curtis is an Extended Scope Physiotherapist and Clinical Director for The Medical Group in the south of England.
Spread across 21 clinical sites, Andy’s teams use TeleHab from VALD Health to deliver remote physiotherapy to their MSK and neuro patient population, and HumanTrak in clinic,
for 3D motion and biomechanical assessment.
The case study originally featured on the Chartered Society of Physiotherapy and can be found here.
What physio services do you provide?
Musculoskeletal and Neuromuscular Physiotherapy.
We have an extensive team of physios from newly-qualified to regional leads, working through Bristol, Bath, Newport, Reading, Didcot, Cheltenham, and Bournemouth.
As a result, we work with a wide spectrum of conditions from sports and work-related injury, to long-term conditions, medicolegal cases, growth development issues, and home visits for mobility or independent living needs.
What tools are you using to deliver your physio services digitally?
We’ve used several exercise prescription and video consultation platforms over the recent years but settled on using TeleHab by VALD.
This is a platform we were introduced to as we also use VALD’s HumanTrak system in clinic for 3D motion and biomechanical assessment, and found it to be intuitive, simple to initiate a video consultation and can easily move through to program builder to send home exercise plans following either a virtual or face to face session.
How have these services replaced face to face contact?
We have used virtual sessions previously for patient preference, as a follow-up or progression session, but currently, it has become more readily used for the ‘virtual first’ aspect of our COVID-19 workflow.
TeleHab has allowed us to effectively manage many cases entirely virtually, and make the reasoned decision to complete a face to face session without risk to the patient or team member.
What is the clinician’s experience of using the digital tools?
Overall, very positive, but it’s not like working directly with a patient.
Healthcare is very humanistic and requires trust and rapport, which seems to be a little longer in developing through virtual means.
However, once built, the blend of virtual and face to face is very effective.
Also, with App-based exercise prescription being more informative and interactive, patient adherence seems to be up too – it helps to be able to track their progress via the app, making them a little more accountable than the offline methods do!
It is more difficult to complete a thorough assessment, for obvious reasons, via virtual consultation, but generally, where there is a will there is a way! Physio is about problem-solving after all.
Any top tips to others exploring using digital tools in physio services?
Use a system that minimises the time wastage during a session.
Some platforms have a convoluted process of going from appointment time to consultation invite to starting the consultation.
The more well thought out platforms are slick at this, and this is one reason we opted for the TeleHab system.
Ensuring simple workflow but within data security requirements is the key to good user experience, I think.
Also, look into how the aftermarket support is.
TeleHab has a really in-depth exercise library, but on occasion, when something bespoke we would like to use is not there, or not easily searched for, we have had the support on hand to complete an effective patient outcome regardless.
Interested in learning more about TeleHab?
For further information on how TeleHab can help you and your clinic, visit our TeleHab page – here.
Using HumanTrak to take the guess work out of performance assessments
/in Case Studies /by VALDDr. Nadia Jones is a Physical Therapist and Co-owner of Physiolete Therapy and Performance in Alabama.
Nadia graduated from The University of South Alabama with her Doctorate in Physical Therapy in 2016, completing a sports residency at The University of Alabama’s Recreation Center and passing her sports specialty exam in 2017.
Through her experience and knowledge base, Nadia aims to keep clients achieving quality outcomes and staying in the game.
How do you use HumanTrak as part of your performance assessment?
I like to use HumanTrak as a pre-participation exam, to see if clients are “ready” for their respective sport.
So I use the HumanTrak prior to performing barbell lifting assessments to help guide me in what I may see with functional lifts.
I also like to use it mid/late in physical therapy for a progress note as the HumanTrak helps me spot objectives that I can’t see with my own eyes.
How long does an assessment normally take and is it something you charge for separately?
The HumanTrak usually takes me about 15 minutes to complete.
Then I usually spend an additional 5-15 minutes educating clients on their metrics.
I charge about 1-2 units of therapeutic activity depending on the amount of time I spend educating a client, taking them through a movement, and issuing homework to improve deficits.
What sports/activity do you provide assessments for and do you do different tests depending on the sport?
I tailor the tests I use based on the client.
If they are a lower extremity dominant athlete, like a soccer player, I don’t always do the upper-body tests.
For most of my golfers, basketball players, Olympic lifters, and general PT patients I usually choose a wide array of assessments.
What is the client experience with HumanTrak, does the visualisation help to engage them with their program/rehab?
I think seeing the pictures with the objective is super helpful for clients.
The numbers sometimes help them to “see” things that they’ve never noticed before–this holds true for myself!
It also allows us to set goals for the next HumanTrak assessment if we use it for a progress note or other form of re-assessment.
Technology is not the answer, but it should be part of the answer
/in Case Studies /by VALDWhen clinics are looking to invest in technology, the question Matthew Roodveldt, Product Director at VALD Health, gets asked is: “Will technology bring in more clients and make my clinic more profitable?” His answer: “Good question, the answer is no, not alone; however, it can be part of a holistic approach.”
Human measurement systems can be a powerful tool in helping clinicians make decisions based on objective data as well as an opportunity to engage and empower clients with their rehabilitation or performance assessment and training programs. With that said, implementing new technology systems can be challenging for many clinics.
It’s a common misconception that this technology is only affordable and useful for elite sporting teams or research centres, universities and hospitals, but Matthew Roodveldt Product Director at VALD Health says they are experiencing increasing demand from private practices for this technology.
Clinicians have been collecting data via manual tests for decades. What are the benefits of using human measurement technologies?
In the past, assessing strength and power has been subjectively quantified by using manual tests of resistance and functional movement tests such as squatting or jumping. Other clinicians can replicate this type of data collection, but the reliability between clinicians is blurred. With human measurement technologies, data can be captured objectively and transferred from clinician to clinician.
With a vast scope of metrics which can be captured. How do clinicians know what meaningful data is?
From our background in providing technology to elite sports professionals, we know from research that certain metrics can assist clinicians in making decisions around injury risk reduction and programs to improve strength and power. In a general population setting, while we still have the same injuries that athletes sustain, we have less normative data to work with, and decisions are made based on what’s normal for the individual. Therefore we use exercise protocols to guide clinicians in completing tests to ensure they are reliable and repeatable.
Not all metrics will suit your situation, so pick what works for you in your environment. When choosing tests to perform, consider the individual’s needs and the measurements which will help you monitor progress.
No technology out-of-the-box will make your clinic more profitable.
How can a clinic owner ensure they are getting ROI from technology?
One of the most significant barriers in clinics adopting new technology is the perceived cost and unknown value. I have heard of countless technology systems claiming objective data is the way of the future and will make your clinic more profitable and engage your clients. Still, I can honestly say, no technology out-of-the-box will make your clinic more profitable.
We work with many clinics to implement our human measurement systems and ensure they are getting value from their investment. This is achieved by much more than the data and reports. Data is only one piece of the puzzle in the retention of clients, access to new clients, a competitive advantage, and a broader scope of services and packages.
First and foremost, data is the bridge of communication between client, clinician and other providers. If a client returns for similar treatment, you will have objective data on hand that can be used to quantify further recovery, similarly if they see another provider.
Collecting quantitative data will allow you to compare against existing norms and help to create a personalised recovery plan for your clients. This also offers a competitive advantage; you will have a unique offering that you can add to your services and packages. Some savvy clinics offer initial data collection complimentary at their local sporting clubs and gyms. Once you have an individual’s benchmark data, you are the only practitioner who can help them get back to what their ‘normal’ is post-injury.
Engaging clients through data will help to promote buy-in and build rapport. Data can enhance the client experience in three key ways. Data visualisation can assist in educating clients and get their buy-in. It can be tough for a client to see their progress through subjective analysis or numbers alone. With the use of visuals, clients can see how they have improved throughout their experience. We know from past research that people may be at higher risk of sustaining injuries when they are below recommended values. By using data, we help to educate clients and set small achievable targets along their recovery journey. Setting goals for long term rehab makes it more attainable for your client to see the light at the end of the tunnel and understand the work they need to do to reach full recovery.
Lastly, data reports can help to keep the client informed of their progress (while also allowing for quick reference points for clinicians) and help to keep additional members of an allied health team informed of a client’s progress.
Do I need to be a data scientist or sport scientist to interpret data?
While a small amount of relevant knowledge is needed to understand particular metrics (such as hip adduction strength), you don’t need to have a data or sport scientist readily available to help interpret the data. Data visuals help to collate and simplify the information, allowing for quick and easy understanding for the practitioner and the client.
Matthew’s 5 tips for implementing new technology
- Do your research, choose a provider that aligns with your business
- Achieve buy-in of stakeholders
- Map out a plan for adoption
- Build the right team for the job
- Continue the communication with your provider and team
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Originally posted in Allied Magazine Issue 18, August 2020. Written by Matthew Roodveldt.
Matthew Roodveldt is Product Director at VALD Health. Matthew has an undergraduate degree in human movement and worked in research for human movement studies and physiotherapy. Following this, Matthew has spent the last ten years managing a software development group and is combining this experience with an in-depth understanding of the needs of the healthcare market.
How TeleHab is being used to prescribe exercise programs at Ballarat Swim Club
/in Case Studies /by VALDKirsten is a highly experienced coach with complimentary professional qualifications in Exercise Physiology, Sports Science and strength and conditioning.
Kirsten has nearly completed her PhD which is investigating the effects of training load on shoulders injuries in swimmers.
With her sound knowledge base Kirsten is both passionate and well equipped to support swimmers at all stages of development.
How are you using TeleHab?
From a prescription point of view, I work with mostly age group athletes who require a large amount of AAROM movements, shoulder strengthening, and basic strength exercises. The videos have been great, and the platform has been easy to use. Particularly during a lockdown period. I have been able to prescribe a variety of programs for our different levels and age groups, as well as different needs such as injury prevention and general strength and conditioning. The videos and exercise information have meant that all the athletes are getting visual cues, and can also send through videos for feedback.
How did you prescribe programs before TeleHab?
I spent a lot of time writing up individual programs for our swimmers. I would write the programs and then try to find appropriate images and videos to assist with technique cues for times I wasn’t able to be in the gym with them. This has saved me a lot of time, and the quality and consistency of their training has improved with the instructional videos and the smartphone apps. The range of exercises have been adaptable for athletes who have access to equipment and those who don’t – in the current climate it has been a lifesaver.
COVID restrictions have meant a lot of teams/squads have had to adjust their training. How has TeleHab helped with this?
As we are in a rural area of Victoria, so have been lucky enough to be back in the pool and with some access to the gym. However we have recently just gone back into lockdown, so I have a series of programs planned to release through the app. We also have a number of Strength and Conditioning coaches prescribing programs for our senior athletes, it is extremely useful to streamline these programs onto the one Telehab platform both from a coaching team communication perspective as well as consistent teaching cues for the athletes.
Delivering physiotherapy services at the height of COVID-19
/in Case Studies /by VALDMatt Whalan, Physiotherapist & Sports Scientist has been a partner at Figtree Physiotherapy since 2005 and has been extensively involved in Sports Physiotherapy in the Wollongong area.
Matt recently completed his PhD in injury prevention in football in addition to his Honours degree in Exercise Science & Rehabilitation and Masters in Physiotherapy.
Through his experience and knowledge base, Matt has an active and hands-on approach to rehabilitation to get you back on track as fast as possible.

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