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Blood Flow Restriction Training Post ACL Reconstruction

After ACL reconstruction, gaining back strength can take up to a year or more. It requires constant effort and training but for the first few months following surgery, only minimal loads and exercises are safe for patients to perform due to the ACL graft healing process and the large amount of muscle atrophy following surgery. Blood Flow Restriction training or BFR is a great tool to use in your rehabilitation program in order to get some huge strength benefits without requiring the patient to lift heavy loads. It is safe, easy, and has minimal stress to the knee joint, making it perfect to integrate into your ACL rehabilitation.

BFR requires a blood flow restriction cuff. Many Physical Therapy clinics have a unit or you could purchase your own cuffs for at home use. I have been using the Occlusion Cuff and really like it. It is portable, easy to use, and gives the same amount of compression as the higher end units in Physical Therapy clinics.

So what is Blood Flow Restriction training?

BFR training uses a restriction cuff placed around the limb in order to prevent the venous return and maintain arterial inflow to that limb. Basically, the blood pools in your surgical leg allowing a greater stimulus for Type 2 muscle fibers.  It is putting the muscles into hypertrophy similar to if you were training at 70% of your 1RM but you only have to use low loads (20-30% of 1RM), allowing an increase in muscle activation, and an increase in protein synthesis (allowing for more muscle building capabilities). This is a much safer way to get the same result while reducing risk of injury. Some studies even show BRF training can have positive effects on healing bone and soft tissue because of the arterial inflow, giving the leg amble blood flow to heal.  BFR training can be used in resistance training or while walking or cycling.

How do I start BFR training?

When performing BFR training, secure the cuff or band around the proximal end (top of your leg closest to your hip) of your surgical leg. Pump up the pressure to about a 7-10 in regards to tightness. Feeling a little tingle is okay but don’t wrap it so tight that you get any numbness in the limb. The idea is to go to failure with your repetitions. By the end of the exercise you should barely be able to perform another repetition. Most Post Op patients will start off with no added weight but advance to a very light load as needed when you gain strength. Remember, we are training with only about 20-30% of your 1 repetition maximum.

Try this routine.

 

Prone Hamstring Curls

Set 1: 30 reps – 30 second rest

Set 2: 15 reps – 30 second rest

Set 3: 15 reps – 30 second rest

Set 4: 15 reps – 30 second rest

Take off cuff.

 

Squat to Bench & Stand

Set 1: 30 reps – 30 second rest

Set 2: 15 reps – 30 second rest

Set 3: 15 reps – 30 second rest

Set 4: 15 reps – 30 second rest

Take off cuff.

 

Leg Extension ( only extend the knee to about 90% to prevent patella pain)

Set 1: 30 reps – 30 second rest

Set 2: 15 reps – 30 second rest

Set 3: 15 reps – 30 second rest

Set 4: 15 reps – 30 second rest

Take off cuff.