Blood circulation restriction coaching is a superb method to have the ability to assist folks achieve power in a low load surroundings. So utilizing BFR after knee surgical procedure is a superb concept.
However there are just a few other ways we use blood circulation restriction coaching after surgical procedure. Listed here are some ways in which we apply BFR after knee surgical procedure.
To view extra episodes, subscribe, and ask your questions, go to mikereinold.com/askmikereinold.
#AskMikeReinold Episode 276: Utilizing BFR After Knee Surgical procedure
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Present Notes
Transcript
Scholar:
Proper. So we received, “Utilizing BFR after knee surgical procedure”. Tom from Maryland, “I lately bought Mike and Dan Lorenz’s on-line course on blood circulation restriction coaching. And I’m excited to begin utilizing BFR with my sufferers. I’d love to listen to the way you all make the most of BFR in a postoperative affected person. Possibly talk about a case instance of a knee surgical procedure affected person and the way you began utilizing BFR and the way you progressed it over their rehab.”
Mike Reinold:
Superior. Good job Eric. I prefer it. Yeah. You recognize what? I truly assume that’s a reasonably frequent query. We see that so much on-line, like on social media, you guys in all probability seen that a bit bit too is I feel everyone’s … blood circulation restriction traits getting extra widespread, proper? BFR is unquestionably extra widespread, however I feel lots of people lack the creativity of precisely learn how to apply it. And I don’t blame him. It’s new. You don’t wish to do it mistaken. You don’t wish to waste time. You don’t wish to like, have any security issues. So, Dan Lorenz and I, that teamed up for that course. Form of discuss this a bit bit on a regular basis is that lots of people want a bit steering.
Mike Reinold:
So now we have some case research in our course and stuff like that. However I like this query from Tom right here the place he’s like, look, simply stroll me by way of like how you’ll apply it to anyone and we will form of go from there. So I don’t know if anyone, I do know now we have just a few folks simply off the highest of my head. I do know, Dan’s doing it on a pair folks. Dave’s doing it on a pair folks. I haven’t been a sector proper now. Len’s finished some ACL. So, why don’t we every take turns and simply share, when did you begin utilizing it? How’d you begin utilizing it and the way’d that progress over time? Like as case research, however Dave, you wish to begin it off?
Dave Tilley:
Yeah, positive. So I feel in all probability essentially the most traditional one which I lately had was only a soccer participant, ACL hamstring graft. And I feel we began in all probability like three or 4 weeks. The doc was actually simply fearful about incisions. So as soon as the incisions closed they usually felt snug, we had been capable of do it as a result of they’re fearful in regards to the strain, clearly popping some stitches or stuff. So it was like three or 4 weeks after, however I noticed her perhaps like week two when she was there. So the primary week was form of extra simply primary schooling and swelling, however we had been fairly quick on doing it for BFR and stem collectively. And I truly began her at like 60% limb occlusion strain as a result of I used to be a bit nervous about, clearly she’s by no means finished it earlier than. The response is excessive she’s exercising for the primary time after surgical procedure, she’s doing stem with the BFR.
Dave Tilley:
So we began at 60% and simply did all her open chain stuff. After which a few of her hit manuals that we had been doing like manually. So she did all of her, leg raises, all her stuff over the aspect of the desk and the hands-on stuff with me. And that was it. That was actually all we did for the primary couple days after then we added like the burden shifting the shut chain, mini squat she began to do together with her protocol. And I might say it form of began as the majority of her train. Like just about to the time in remedy she was utilizing that. After which as we simply went by way of the pure 4, 6, 8 week development as much as like perhaps when she was within the fitness center, she began doing stuff within the fitness center round like 10 weeks or 12 weeks.
Dave Tilley:
I simply began placing on the finish of her rehab as like a burnout set. So she would simply do quad and at that time, after her hamstring graft, we had been doing a number of hamstring and quad stuff collectively. So it went from form of all her workouts in the direction of, growing the limb occlusion strain as much as 80 when she may deal with it. After which lastly simply doing like a burnout set of quad, hamstring, calf stuff on the very, very finish. And yeah, she’s doing very well and he or she’s eight months now, however she did have a pair instances the place she received a bit lightheaded and we needed to like form of chill a bit bit, however total she crushed it and he or she’s doing very well now.
Mike Reinold:
Superior. Effectively, so, once you began that originally, Dave, you simply did your regular set rep scheme that you simply’d usually do. Proper? And primarily what you probably did is you took your regular, early postoperative stuff and also you simply added blood circulation restriction to it, however you didn’t change the set rep scheme. Is that correct?
Dave Tilley:
Yeah, as a result of in my thoughts, and I imply, clearly like to listen to everybody’s opinion, however I really feel like there’s so much to get to early on. There’s a lot stuff to do in an hour between guide stuff, vary of movement, swelling, comfortable tissue, all of the train. There’s a lot stuff I wish to get to biking, that I’d fairly form of simply have it on there as like a low stage stimulus than being all proper on three by 30 for each single quad set, leg increase, that’s going to be so much. And I feel prefer it simply will get to love 20 minutes of limb occlusion strain, that you simply’ll wish to go over. So I used to be simply cautious about that.
Mike Reinold:
Yeah. I like that. After which as she progressed, such as you stated, you began doing it extra in the direction of the top, however then you definitely had been specializing in fatigue at, on the finish. I like that. Superior. All proper, who else desires to share how they used it as like a case with anyone? I do know lots of people have been doing it. Who desires to go subsequent? Dan?
Dan Pope:
Certain. Yeah. I agree largely with Tilley. I feel one of many massive query marks in my head is when is it okay to begin? You recognize? And I feel it form of comes down to a few various things. One we’re form of scared about circulation, clots, that sort of factor. And I feel for almost all of oldsters, it’s we don’t actually know when it’s secure to begin. I feel ensuring the wound is therapeutic appropriately is necessary. And a number of docs perhaps don’t need you to begin BFR till somebody’s truly ambulating, which goes to be fairly robust for, let’s say like a postop meniscus restore when somebody’s non-weightbearing for a time frame. So I don’t have an incredible reply for you, however I might say you wish to begin BFR as quickly as doable. The one caveat I’ll say, and I’ve made this error previously is that BFR is hard off and also you’re taking somebody that basically hasn’t exercised a lot for a time frame.
Dan Pope:
They’re in all probability painful earlier than the surgical procedure they usually’re deconditioned from the surgical procedure. After which if you happen to ask them to do units to failure at first, you actually might harm them. So you must be a bit cautious. What I’d love to do is I’ll truly begin folks within the train that I wish to do BFR on finally, and I’ll slowly ramp up the repetitions. And in the event that they’re tolerating that properly, then I throw the BFR on. However that being stated, I feel you’re combating this battle of, all proper we wish to defend the surgical web site, however the longer we wait to load this space, the weaker they’re going to be long run, the tougher it’s going to be to get again the atrophy or the muscle mass they misplaced.
Dan Pope:
So I might say you wish to begin as quickly as you’ll be able to however when you begin making use of it begin straightforward and ensure they’re responding properly, they’re not getting a number of swelling. They’re not getting extra painful. The vary of movement remains to be progressing. Effectively, that being stated, and I’m going to piggy again on Tilley. I feel a number of PTs I hear are likely to make this error is that BFR is nice for low stage stress to the physique, which is phenomenal within the early phases of rehab. These people should not going to have the ability to tolerate a number of stress generally as a result of we wish to defend the surgical web site, but when we do an excessive amount of, we’re simply going to piss the world off after which set ourselves again. So it’s phenomenal early stage, however as soon as somebody’s capable of load, I attempt to make that transition over to loading as quickly as we’re capable of, as a result of once more, we wish to get again to a sport particular exercise and we have to defend the surgical web site.
Dan Pope:
However the different half is that we wish to get began as quickly as we will with out irritating that space. So BFR finally ends up changing into adjunct finally. So, when somebody’s capable of tolerate extra squatting, lunging, deadlifting, these sort of issues, I truly wish to attempt to load these issues with out BFR. After which I’ll put some BFR on the finish of this system and I’ve a affected person proper now, a post-op meniscus restore. She’s an influence lifter and he or she has fallen in love with BFR coaching and he or she does it twice every week, nonetheless on prime of all of different coaching she loves it. She’s doing very well and he or she’s PR in her squad and all the pieces and tributes a number of that to BFR. However I feel the massive majority of her success comes from her coaching first. And the BFR is just a bit small adjunct at that time, ?
Mike Reinold:
Proper. Yeah. Effectively stated there, Dan, I feel that’s nice. And to your level on the security, I imply, I feel we nonetheless just about advocate, wait a pair weeks for the incisions to settle down, the swelling, to settle down, the analysis out reveals the security it’s there. It’s secure. There aren’t correlations with clots and stuff like that. So security’s there. However what I actually like that you simply each form of stated, Dave stated he begins with 60% limb occlusion strain, for instance, for the decrease physique, which is form of within the medium vary, proper? So actually not on the excessive finish. And Dan form of stated one thing related the place we form of like ease into it, proper? I see lots of people make the error the place let’s simply say it’s a early postop, let’s say it’s a patellar tendon graft ACL.
Mike Reinold:
And so they go to a BFR course they usually say that, properly, I’m speculated to do 4 units of 30 reps, 15, 15, 15 reps. That’s the protocol. Proper? And, they usually’re doing that week two with knee extension after patellar tendon graft ACL, proper? And that’s like 75 wraps, with not essentially a heavy load, however once you add the limb occlusion strain that that will increase the fatigue and that will increase primarily the perceived load, to the tissue. Proper. So we see lots of people, however blindly making use of it like that. So I really like what you guys each stated is ease into it. Proper. It’s an adjunct and it’s one thing that you simply wish to slowly apply. I feel that’s form of improbable and be sure to’re doing common load too. Proper. Like, Diwesh and I, we discuss this on a regular basis after we discuss our coaching packages within the fitness center, however we like to coach all qualities of athleticism, proper?
Mike Reinold:
So let’s say power and energy, for instance, I feel it’s the identical factor with load right here. You possibly can argue that BFR is one sort of stimulus, however we additionally have to do heavy load for tissue, proper? With decrease set rep schemes as properly, and if you happen to do them each in a single session, you would argue, you’re engaged on two units of qualities directly, and for each power features in addition to tissue capability loading. So, I feel that’s form of neat too. So anybody else wish to share their expertise? I do have one too, however I wish to, simply ensure that everyone, anyone has something totally different so as to add or is that fairly related?
Lenny Macrina:
I used to be simply curious if anyone has an opinion on diminishing returns, that means like, do you ever simply pull it out as a result of they’re eight months out of an ACL, 10 months out of ACL, 18 months out of an ACL. And also you’re like, man, I’d fairly simply have them do 5 units of 5 deadlifts, squats and what’s anyone doing, 20 pound knee extensions of BFR. Is there ever a time the place it’s like, simply not price it anymore? You recognize what I imply?
Dave Tilley:
That’s precisely what I did with a affected person that I used to be speaking about up till six months, we had been doing like burnout units and at six months I used to be like, now we have a lot stuff now we have to do with like chopping, agility, and velocity. Prefer it was inconceivable to suit all of it in an hour. Actually, she was there for like an hour and 45 minutes. I’m like, we will’t do anymore. And he or she was lifeless. She was crushed after her exercise.
Lenny Macrina:
Proper. Yeah. So, I can see that’s simply so fatigue from all the pieces else. Like, you’re identical to including this new … like they simply received nothing left within the tank. I can see that. I simply didn’t know if there was some extent the place it was identical to, we simply doing it to get that stimulus. And do now we have sufficient weight on them? Do now we have an excessive amount of weight on them? Are they hurting, diminishing different issues, different talents to do throughout the session? And I don’t know. I’m all the time attempting to determine that out in my sufferers that I apply it to like my ACLs and different issues, however I imply, we might not know. I used to be simply curious if anyone had a …
Mike Reinold:
Effectively, it is sensible to me. Like if you happen to go by what Dan simply form of stated, and if you’re nonetheless utilizing it in later phases, you’re nonetheless doing a little heavy load with out occlusion and a few of this collectively. I feel it comes down to love, as well as, clearly, do you could have sufficient time? Is it crucial factor to make use of in your time? Possibly it simply comes all the way down to do they nonetheless have power, deficits? Are they nonetheless behind? And as soon as they’re not behind, then you definitely simply transition to a traditional coaching program. Proper.
Lenny Macrina:
Proper. As a result of I don’t know if I’d fairly do 90 pound knee extensions versus 20 kilos to 4 units of fatigue versus simply actually overload if I’m doing a knee extension, for instance, after an ACL. I’m all the time torn, I assume we don’t have 90 kilos of knee extension. So, [crosstalk 00:13:53].
Mike Reinold:
Do you could have 90 pound ankle weight? That’s fairly good.
Lenny Macrina:
Precisely.
Mike Reinold:
You simply began a Twitter firestorm proper there. I really like that half. So I’ll simply share briefly form of like my expertise too. Similar to Dave and Dan, however as we undergo this, we study so much. Proper. So I’ve an incredible affected person proper now. That’s, he tells us his signs fairly properly. I’ll depart it at that. We’ll simply depart it at that. However in a great way, like in anyone that’s articulate about how they’re feeling on a regular basis, a bit bit extra on the cautious aspect, however in a great way. Proper. So post-op, metastasectomy, we began about two weeks. We began utilizing it identical to Dave with neuromuscular stem throughout his desk train.
Mike Reinold:
No change within the set rep scheme, simply because it was progressing. That was form of the very first thing we did. Then bear in mind, it’s a metastasectomy, proper? It’s not like a patellar tendon graft or one thing. So fairly shortly after that, as soon as his volitional or voluntary management of his quad was fairly good, I had him begin doing knee extensions with it. After which we began utilizing knee extensions with extra of a fatigue sort protocol, like a 30, 15, 15, 15 protocol. However I didn’t begin that method, proper? As a result of I wished to verify we had volitional quad management. First, as soon as we had that, we began including that to this system to form of get some power features. So a few issues that we’ve finished with him over time, which we form of discovered is we began doing a little like isometric, mid thigh pulls on our drive plates.
Mike Reinold:
And we began doing that in the direction of the center portion of his program. If we did the BFR previous to that, his means to carry out the isometric mid thigh pulls on the drive plate was down of in all probability about 20, 30, generally even 40% like Mike and I noticed that with this explicit individual. His means to supply drive on the drive place was so down, as a result of he was so drained. So I truly discovered that I feel we had been tiring him out. Mike stated the identical factor form of made the identical pivot in this system. We’re tiring him out too early in this system, so we shifted the BFR in the direction of after all the pieces. Generally folks get fully fatigue, one train, generally they don’t. So, we put it in the direction of the top and he’s form of doing extra of a traditional program now.
Mike Reinold:
However then on the finish, like Dave, he’s doing that form of fatigue protocol, then he’ll trip the bike with it. We’re protecting it beneath 20 minutes. He’s nonetheless getting a bit little bit of the advantages of that. However we thought that was actually fascinating. The opposite factor that lots of people have stated, however this explicit individual talks about this too, is when he does it with the neuromuscular stem, he’s far more drained on the finish than when he does it with out the neuromuscular stem. So maintain that in thoughts too, BFR plus neuromuscular stem in these early phases, it’s not only for volitional management, nevertheless it helps get extra of the muscle tissue to contract maybe. And if he’s extra drained, it’s positively getting extra of like a physiological response. So form of maintain that in thoughts as properly.
Mike Reinold:
So, these are good few examples. I feel that’s nice. I imply, I feel this is a vital episode over folks simply getting began with BFR is that you simply don’t simply blindly observe a protocol. It’s a must to use some frequent sense and BFR is simply one thing we will simply add. Proper? You possibly can simply add to form of identical to complement what you’re at the moment doing. You don’t essentially have to alter your set rep schemes or what you’re doing or the train choice. You possibly can simply make it a part of your course of. Then because the individual evolves, you’ll be able to form of decide and select when to make use of it, perhaps when to cut back and do some heavy load stuff too. However I feel what we’re attempting to get throughout right here is that it’s a complement, there’s plenty of methods to use it. And I feel if we use our brains with a bit of expertise by way of this, it’s going to be way more profitable, proper?
Mike Reinold:
Each time there’s one thing new in your arms, in your clinic, everyone tries to make use of it the identical method on a number of totally different folks. And then you definitely discover, areas that it really works properly, areas that perhaps it doesn’t and the way you refine it. I feel that was a bit little bit of our evolution of how we refined it. So hopefully that helps you as properly. So, superior. So, nice episode. Thanks guys for the solutions. That was an excellent case. Tom, that was an excellent query, I respect that. Once more, when you have a query like that, head to mikereinold.com, click on on that podcast hyperlink, you fill out the shape to ask us questions and please go to Apple Podcast, Spotify price, assessment, subscribe, and we’ll see you on the subsequent episode. Thanks a lot.
