Another BFR Success Story: ACL Tear in a High School Football Athlete
For a high school football captain with a bright future ahead of him, senior year can be extremely critical. Maintenance of physical and mental health becomes absolutely crucial, along with a high degree of discipline to avoid other “extracurriculars” that typical teenagers engage in. What happens when the captain of the team, who checks all of the previously mentioned boxes, goes down in the second game of the season on a punt return with a torn ACL?
This case study involves a 17-year-old high school football player who underwent an ACL reconstruction with patellar graft and medial meniscus repair after suffering a non-contact ACL rupture in week two of his senior year. His intentions were to have the season of his life to finish out high school and then play football in college. He came to me 1 week post op with a brace locked in extension with specific orders from the surgeon to remain non-weight bearing. I reached out to the surgeon and asked if he would be on board with blood flow restriction (BFR) training. He agreed, and off we went!
Pillar 1: Passive BFR
We started with quad sets with 60% LOP. The patient loved the feeling of “working hard” and having to overcome discomfort while keeping calm. We soon increased the pressure to 80% LOP and added NMES to his quad sets. The patient was hooked on both the sensation of BFR as well as the results. We noticed significant improvements in quadriceps activation and knee extension ROM.
Pillar 2: Aerobic Training
We then moved onto Pillar 2 and used a stationary bike. We kept the pressure at 80% LOP and started with 5 min of gentle cycling. As you can probably imagine, we soon were up to 10 and 15 min on the bike!
Pillar 3-4: Resistance Exercise and High Intensity Training
Pillar 3! The fun part! The patient and I were both extremely excited to begin BFR leg extensions. We completed a typical strengthening program including squats, step ups, heel raises, etc. and finished the session with BFR leg extensions. That only lasted a few visits until we added BFR leg presses, too. All was tolerated well and the patient could see how much progress he was making.
Once we were able to tolerate heavy loads, we dropped the BFR and continued with traditional heavy load resistance training and agility ladder drills. In the end, this patient made a full recovery and gained a new perspective from having gone through the experience.
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****Remember, the use of BFR training should not be based solely on a success story. The decision to use BFR, or any treatment for that matter, should be based on the pillars of evidence-based practice.