Personalized Blood Flow Restriction: Oh S*&^, Not the “S” Word!

It’s been well researched and well documented that surgery is over utilized in the United States. Whether for your knee, back, shoulder, or ankle, it is far too common for people to rush to the operating table when, in many cases, conservative treatment (physical therapy) has been shown to have equal or better outcomes. Let's look at back surgery as an example. If you take 3 random people off the street who have absolutely no back pain, one of them is going to a “herniated disc” show up on an MRI scan. This means disc herniations may not always be the cause of someone’s low back pain, yet 500,000 people opt to have back surgery every year, often times with minimal or no relief.

That being said, there is obviously a time and a place for surgery. Depending on a number of different variables (age, activity level, mechanism of injury, etc), sometimes surgery can absolutely be the best treatment option for you. What most people fail to understand though is that surgery is the easy part...all you have to do is get stuck with an IV and the next thing you know you wake up in the recovery room. Returning to your previous level of performance is the hard part, and it’s the hard part primarily because of the incredible amount of muscle atrophy (loss of muscle mass) that occurs after a surgery. In as little as two weeks a surgically repaired limb goes into a state of anabolic resistance and protein synthesis shuts down, leading to a 30% loss of muscle mass in that limb. Because of this rapid and extreme loss in muscle mass, muscle atrophy has a profound impact on a patient's rehabilitation, and sometimes patients never fully recover.
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Historically, muscle atrophy has been a battle that physical therapists, athletic trainers, and strength coaches alike have struggled to win. Just the other day I was working with a patient who is extremely active and fit, but had a knee surgery over 15 years ago and still had a significant side-to-side difference in leg size. However, there’s a revolutionary piece of equipment that is taking the world of physical therapy by storm, on that’s allowing healthcare professionals to prevent this initial 30% loss of muscle mass from even happening in the first place, Personalized Blood Flow Restriction Training.

I go more into detail about what exactly Personalized Blood Flow Restriction Training (PBFRT) is in my previous article, but in a nutshell PBFRT is the use a modified surgical tourniquet to occlude a percentage of the arterial flow into a limb to trick your body into thinking it’s doing something much harder than it actually is.

So why is personalized blood flow restriction training so revolutionizing when it comes to surgery? It prevents the significant muscle atrophy from even happening in the first place.

In normal circumstances it takes 8-12 weeks of high intensity strength training (>65% of your one rep max) to get improved strength and muscle size from, you can see how this would be an issue for someone recovering from a surgery. When you have a surgery, you’re going to go through a period of time where it simply isn’t feasible, nor safe, to lift the weight required to increase muscle size. This is where PBFRT comes in. ​

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Say you’ve torn your ACL. With an ACL reconstruction, for the first few weeks the “strengthening” component of your rehabilitation will include simple exercises like seated knee extensions, mini squats, and heel raises. None of these exercises are going to make you a stronger functioning human, because none of these are at a high enough intensity level to cause the biological responses needed to increase muscle size and strength. However, if we put on a blood flow restriction device, and do these exact same exercises, we cause the following:

• Decrease Myostatin: A protein produced to inhibit muscle growth and development. If you want to know what it looks like to have little-to-no myostatin production, check out the picture above!
• Increase Anabolic Hormone Production: Occluding your limb creates an anaerobic environment, stimulating your fast twitch muscle fibers (the fibers responsible for power, speed, and strength), which leads to the increased levels of blood lactate, which leads to increased human growth hormone (HGH), insulin-like growth factor (IGF-1), and satellite cell production.
• Minimal to No Muscle Damage: This one is huge. Normally to train at the levels required to gain strength and size you get a significant amount of muscle tissue breakdown, which leads to soreness following a workout. However, because PBFRT utilizes such low loads you’re able to avoid this tissue breakdown, and by preventing this breakdown we’re able to improve strength without making hindering performance or functional capacity. ​

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​There are about 200 published research articles in 15 different countries that have demonstrate the benefits of personalized blood flow restriction training and we are seeing those benefits every day here in the clinic. Whether it’s helping someone who has years of atrophy as a result of surgery or we’re preventing the atrophy from even happening in the first place, the results we’re seeing are simply incredible. If you’re living in Atlanta, and you’ve had surgery or are struggling to get your strength back after a surgery, we’d love to help you. Give us a call at 470-355-2106 or fill out the contact request form and we’ll contact you.

Thanks for reading,


-Dr. Jake, PT, DPT