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Blood Flow Restriction Therapy for Stimulating Skeletal Muscle Growth: Practical Considerations for Maximizing Recovery in Clinical Rehabilitation Settings

Lambert, Bradley, S., PhD*,†; Hedt, Corbin, DPT*; Moreno, Michael, PhD*,†; Harris, Joshua, D., MD*; McCulloch, Patrick, MD*

doi: 10.1097/BTO.0000000000000275

Inactivity following injury and surgery due to pain, instability, or immobilization results in loss of muscle mass and function. As a result, both risk of reinjury and overall recovery time are a prime concern for clinicians and therapists trying to minimize these deleterious effects. While resistance exercise has been demonstrated to be highly effective in combating loss of muscle mass and function, it is often not advised for postoperative or injured patients because of elevated risk of injury or exacerbating existing injury sites. Low-intensity resistance exercise (<30% 1 repetition-maximum) performed with mild to moderate blood flow restriction (BFR) has been observed to elicit beneficial anabolic and functional responses in skeletal muscle that are governed by mechanisms that regulate muscle protein metabolism and myogenesis similar to the responses following high-intensity resistance exercise. On the basis of these findings, practical applications of BFR in clinical and sport settings have been developed to mitigate skeletal muscle loss following injury and accelerate rehabilitation. However, many aspects of the physiological effects of BFR therapy in rehabilitation settings remain unclear. This review provides current information regarding skeletal muscle responses to BFR with a focus on skeletal muscle protein metabolism, anabolic signaling, applied outcomes, and applications in the clinical setting.

*Orthopedic Biomechanics Research Laboratory, Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston

Biomechanical Environments Laboratory, Department of Mechanical Engineering, Texas A&M University, College Station, TX

The authors declare that they have nothing to disclose.

For reprint requests, or additional information and guidance on the techniques described in the article, please contact Bradley S. Lambert, PhD, at or by mail at Department of Orthopedics and Sports Medicine, Houston Methodist Hospital Outpatient Center, 6445 Main Street, Houston, TX 77030. You may inquire whether the author(s) will agree to phone conferences and/or visits regarding these techniques.

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