Blood Flow Restriction Training in Rehabilitation Patients

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)