On today’s episode we’re rebooting our most popular episode of all time which focuses on rehabilitation of ACL surgery with Candace Townley Cox, a Doctor of Physical Therapy and body movement expert at Evolution Physical Therapy. 

We’re going to continue our discussion with Candace Townley Cox and focus on rehabilitation of quad function and lower extremity mobility after surgery.
We start with a systematic review from the August 2022 issue of AJMS titled The Effects of Blood Flow Restriction in Patients Undergoing Knee Surgery. 

Now, we did a whole episode on blood flow restriction therapy or “BFR” with Dr. Eddie Chang back in October of 2021. If you haven’t already listened, go check it out! In brief, BFR involves the use of a cuff or tourniquet system positioned at the upper part of the limb to restrict venous blood return while maintaining arterial inflow. Restriction of venous outflow leads to an anaerobic – or oxygen depleted – environment similar to that of higher-intensity training. This anaerobic environment is hypothesized to promote muscle hypertrophy through a combination of cell signaling and hormonal changes, effectively leading to muscle mass and strength gains at lower intensity training – ideal for our post-op patients.

Lawrence Wengle and colleagues at the University of Toronto performed this review of 11 papers and concluded that the use of BFR led to significant improvements in quad muscle mass, quantified by cross-sectional area of the muscle, and quad strength after knee surgery. Patient reported outcomes were not significantly different between those who used BFR and those who did not. Lastly, in the two studies that used BFR pre-op, no significant benefit was found.