There is a recent trend among physiotherapy providers treating their patients, including injured workers and claimants, using blood flow restriction therapy (BFRT). Although you may have heard of this trend recently at the Summer and Winter Olympics or heard of the path traveled by now-retired Washington Commanders quarterback Alex Smith. , and the use of this procedure, this therapy actually dates back to the 1960s. Yet despite the popularity of this treatment for nearly sixty years, from a layman’s perspective, the therapy has remained largely unchanged.
What is BFRT and what are its intended uses? What are the potential issues to consider when processing workers’ compensation claims and reviewing medical records and medical bills? We’ll take a look.
What is Blood Flow Restriction Therapy?
BFRT has been defined as the application of pressure to a part of the body, usually the arms or legs, through the use of a cuff while maintaining blood flow to the part of the body in question. The goal of this technique is to allow patients to make greater gains while lifting lighter loads and therefore reduce stress on this part of the body. In other words, BFRT restricts blood flow to the muscles of the body in question through a tourniquet-like device that then allows those muscles to get stronger through higher reps while using lighter weights. It’s a very popular technique with professional athletes, including Dwight Howard, Jadeveon Clowney and actor Mark Wahlberg.
How it works?
The theory behind BFRT is that by restricting blood flow to the area, a person can build muscle faster while using less weight. For example, suppose an individual performs barbell curls. In this case, as they perform the “push-up” with blood flow restriction armbands applied, the oxygen in that area continually decreases as the muscle-building parts of the body begin to work in overdrive.
More recently, this therapy has been designed to be particularly effective in people who have atrophied or “eroded” muscles due to inactivity while bedridden or confined to a wheelchair for an extended period of time.
Does it work?
Whether BFRT works is a complicated question. Research suggests that while lighter weights are joint-sparing and allow you to perform more reps, they may prevent ligaments and tendons from growing further and do not promote building heavy muscle.
As mentioned above, BFRT gained notoriety around the time an ESPN episode of “E 60” aired about pro quarterback Alex Smith, who was in rehab at the Center for the Intrepid, a rehabilitation center belonging to the United States Department of Defense. Alex Smith suffered a compound leg fracture while playing for the Washington Commanders in 2018 which ultimately resulted in 17 surgeries to repair his leg. During his rehabilitation process, Alex Smith heard of Johnny Owens, owner of Owens Recovery Science, who worked on the Center for the Intrepid. Mr. Owens used BFRT to help our military service blast injury victims build muscle without traditional weightlifting. Alex Smith implemented BFRT in his recovery, which brought him back to playing in the NFL in 2020.
While clearly a success, a recent study of thirty-five subjects randomly assigned to implementing blood flooding restriction and not implementing the technique found that “the B[lood] F[low] R[estriction] protocol used in this study did not increase rotator cuff strength in the subjects. In other words, there was no difference in strength gains between the groups.
Is it practical?
A few internet searches will tell you that a BFRT machine is available for purchase between $119.00 and $5,000.00. Ongoing research suggests that a person can “tinker” with the technique using resistance bands. However, the latter technique is strongly discouraged by those who support this type of therapy.
Physiotherapists who maintain practices where they treat patients involved in litigation say the devices are relatively small and seem fairly easy to use, similar to a TENS unit, which can be “prescribed” for home use with a cost which can be high. -variant. However, medical professionals warn that it would be best to exercise caution when issuing this equipment, given the associated dangers that may accompany them. Let’s not forget that this is a therapy that cuts off blood flow to various parts of the body, and it would seem that the application of a professional is necessary.
Where do we go from here?
Apart from weightlifting and to help build muscle, BFRT is being experimented with in various fields to see the effect on workers’ compensation. For example, a clinical trial that began January 15, 2019 and is expected to be completed by December 31, 2022 by the Duke University Sports Sciences Concussion Clinic is investigating the effects of BFRT during post-concussion physical therapy and exercise for help in faster recovery. Another area used by BFRT is blood platelet plasma therapy which uses BFRT to increase stem cells in the blood to allow muscles and joints to speed up the healing process.
Searches from physical therapy providers in Pennsylvania advertising the use of BFRT do not result in a plethora of positive results. However, those that appear all seem to advocate its use for conditions such as fractures, inflammatory muscles, knee reconstruction, rotator cuff repair, osteoarthritis and postoperative weakness.
Given the fairly general description of the uses of BFRT, we can expect to see a slight increase in the implementation of this modality and have an understanding of what it is and how it is designed to be used. will go a long way in monitoring workers effectively. ‘ claims for compensation.
Discussions with many clients have revealed that this processing and associated invoices have yet to arrive on their desks. Yet, with many blood flow restriction systems classified as a “pneumatic tourniquet” by the FDA, the device in question only needs to be listed and not FDA approved because it is defined as a Class I device and is 510(k) exempt. Given this, and the fact that physical therapists do not appear to be required to have any type of certification to implement these devices, we anticipate that these devices will be part of injured worker training regiments as soon as possible and will follow similar lines of take-out TENS units.
This is still a relatively new type of treatment that requires objective case studies and associated data analysis. For insurers and employers across our Commonwealth, this is certainly something to watch. Should this happen, the first line of defense would be to investigate the equipment used and the costs associated with it. Of course, the results of this treatment are also a factor to consider. If you have a patient who is implementing this treatment at a moderately low cost, the fact that this treatment is relatively new may not be the predominant factor in refusing treatment. Brumitt J, Hutchison MK, Kang D, Alterado SGD, Berg T, Nguyen BP, Neumiller C, Reynoso R, Stickell J. “Rotor cuff strength is not increased by blood flow restriction training ” Phys Ther Sport. Nov 2021;52:305-311. doi: 10.1016/j.ptsp.2021.10.013. Published online October 23, 2021. PMID: 34742029.  https://clinicaltrials.gov/ct2/show/NCT03695042  In short, a Class I device is a device that has “minimal potential harm to the user,” while a 510(k) is a premarket submission that a medical device manufacturer submits to the FDA to show that the device it markets is safe. and efficient.