2015 ISAKOS Biennial Congress ePoster #2613

Blood Flow Restriction Rehabilitation for Extremity Weakness: A Case Series

Christina Marie Hylden, MD, Fort Sam Houston, TX UNITED STATES
Travis Burns, MD, San Antonio, TX UNITED STATES
Daniel Stinner, MD, San Antonio, TX UNITED STATES
Johnny Owens, PT, San Antonio, TX UNITED STATES

Center for the Intrepid, San Antonio, TX, USA

The FDA has not cleared the following pharmaceuticals and/or medical device for the use described in this presentation. The following pharmaceuticals and/or medical device are being discussed for an off-label use: Hokansen , Inflatable Tourniquet and Insuflator

Summary: Blood flow restriction therapy is a rehabilitation modality which can improve muscular strength and overall function in post-traumatic patients with significant pre-rehabilitation muscle weakness.




Blood flow restricted (BFR) training, the brief and partial restriction of venous outflow of an extremity during low load resistance exercises, is a safe and effective method of improving strength in healthy, active individuals. A relatively unexplored potential of this adjunctive modality lies in treating patients with severe musculoskeletal trauma, persistent weakness despite traditional therapy, and early post-operative strengthening.


This case series describes patients with chronic quadriceps and hamstring weakness who received an intervention of BFR at low loads, 20% of 1 repetition max, to restore strength.

Study Design: A case series of seven patients with traumatic lower extremity injuries from one hospital.

Procedures: Seven patients were treated at one medical center with the same BFR protocol. All patients included in this series had isokinetic dynamometer testing that showed persistent thigh muscle weakness, 35-75% peak torque deficit in either knee extension or flexion as compared to the contralateral lower extremity, despite previous rehabilitation with traditional therapy. The patients underwent two weeks of therapy with BFR training: a pneumatic tourniquet set at 110mmHg while performing leg extensions, leg press, and reverse leg press. All affected extremities were re-tested after two weeks (six treatment sessions). Dynamometer measurements were done with flexion and extension at two speeds: 90 and 300 degrees per second. The data recorded included peak torque normalized for body weight, average power, and total work.


All seven patients demonstrated improvements in peak torque, average power, and total work for both knee flexion and extension, with power being the most improved overall. Peak torque improved an average of 13-37%. Average power improved an average of 42-81%, and total work improved an average of 35-55%.


BFR therapy at low loads can affect improvement in muscle strength in patients who are unable to perform high-resistance exercise or patients that have persistent extremity weakness despite traditional therapy.