Monday Medical: Maintaining muscle with blood flow restriction therapy |

Monday Medical: Maintaining muscle with blood flow restriction therapy

Susan Cunningham
For Steamboat Pilot & Today

One major challenge when recovering from an injury or surgery is the loss of muscle that often results.

For instance, just three weeks after an ACL reconstruction surgery, patients can lose up to 30% of their quadricep muscle mass, making the road to recovery long and hard.

But with blood flow restriction therapy, physical therapists have a tool for preventing muscle loss and helping patients get back to regular activities faster.

“With an injury or surgery, you’re going to have muscles that atrophy quickly because they’re not being utilized and protein synthesis drops significantly,” said Dave Grinnell, a physical therapist and board-certified clinical specialist in orthopedics at UCHealth SportsMed Clinic in Steamboat Springs. “But we’re seeing evidence that blood flow restriction therapy is very effective in preventing that. A lot of studies have shown it truly works.”

Building muscle without the strain

In blood flow restriction therapy, a pressurized cuff that acts like a tourniquet is placed on either the bicep or the thigh, and is then tightened to restrict blood flow.

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Next, the patient performs a series of low-impact exercises, such as lifting a light weight. The resulting lack of oxygen in the muscle causes a buildup of byproducts from working cells, mimicking the impact of an extremely hard work-out. The brain responds by stimulating growth hormones to help maintain muscle mass in the area.

“You’re not having the load and mechanical strain that you would with heavy lifting, but you’re stressing the muscle because of the oxygen deprivation,” Grinnell said. “Post-injury or surgery, it helps maintain protein synthesis and muscle mass, without the mechanical stress.”

A decadeslong approach

The concept of partially blocking blood flow to promote increased strength has been around for decades. It has been extensively studied and used in the military to help patients with limb trauma maintain muscle mass.

In the past, ropes and bands have been used to limit blood flow, but now, electronic tourniquets are used to safely and reliably restrict blood flow at a specific level.

A wide range of uses

Patients who have an injury to a limb, such as a shoulder, wrist, elbow, ankle or knee, may be candidates for blood flow restriction therapy.

“There’s so much you can do with it, whether you’re treating an ankle or knee sprain, or injuries to the shoulder or wrist,” Grinnell said. “We use it on a lot of folks, as long as there are no contraindications.”

While studies have shown that the therapy does not cause an increased risk of blood clots in normal patients, it isn’t recommended for patients who have issues such as poor circulation, diabetes, hypertension, an active infection, cancer, obesity, compromised kidney function or who take medications that increase risk of blood clots.

Quick but effective

Before treatment, Grinnell places the tourniquet on the thigh or upper arm to take an initial pressure reading. From that, it calculates how much to tighten to restrict the proper amount of blood flow.

Grinnell then leads patients through six to seven minutes of exercises with the tourniquet on, following a specific schedule of repetitions followed by short rest periods.

It may not take long, but it is intense.

“Whether you’re just lifting the weight of your leg or doing a simple bicep curl, you can feel completely exhausted,” Grinnell said. “Folks will say, ‘I’ve never felt my muscle burning so badly.’ But then, when you take it off, it feels fine.”

While many of Grinnell’s patients have loved the therapy, some have felt it is especially hard. But, when they see the benefits of using it, they’re able to push through.

“The bottom line, it’s safe and it’s effective,” Grinnell said. “And it helps you progress through your rehab journey.”

Susan Cunningham writes for UCHealth Yampa Valley Medical Center. She can be reached at

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