Muscle weakness and atrophy are common impairments following musculoskeletal injury. The use of blood flow restriction (BFR) training offers the ability to mitigate weakness and atrophy without overloading healing tissues. This approach requires consideration of a wide range of parameters and the purpose of this manuscript is to provide insights into proposed mechanisms of effectiveness, safety considerations, application guidelines, and clinical guidelines for BFR training following musculoskeletal injury. BFR training appears to be a safe and effective approach to therapeutic exercise in sports medicine environments. While training with higher loads produces the most substantial increases in strength and hypertrophy, BFR training appears to be a reasonable option to bridge between earlier phases of rehabilitation when higher loads may not be tolerated by the patient and later stages that are consistent with return to sport performance.
The cardiopulmonary system plays a pivotal role in athletic and rehabilitative activities following anterior cruciate ligament reconstruction, along with serving as an important support for the functioning of other physiologic systems including the integumentary, musculoskeletal, and nervous systems. Many competitive sports impose high demands upon the cardiorespiratory system, which requires careful attention and planning from rehabilitation specialists to ensure athletes are adequately prepared to return to sport. Cardiopulmonary function following anterior cruciate ligament reconstruction (ACLR) can be assessed using a variety of methods, depending on stage of healing, training of the clinician, and equipment availability. Reductions in cardiovascular function may influence the selection and dosage of interventions that are not only aimed to address cardiopulmonary impairments, but also deficits experienced in other systems that ultimately work together to achieve goal-directed movement. The purpose of this clinical commentary is to present cardiopulmonary system considerations within a multi-physiologic systems approach to human movement after ACLR, including a clinically relevant review of the cardiopulmonary system, assessment strategies, and modes of cardiopulmonary training to promote effective, efficient movement.
The body of literature on tendinopathy management has come a long way in the last few decades and a variety of changes in the clinical approach have emerged from this research. One particular approach that shows promise has been called “heavy slow resistance” (HSR), and this has been the subject of investigation in a number of randomized controlled trials. While the premise for this approach is defensible, a critical examination of the implementation of these HSR protocols results in some concerns when compared to basic exercise science principles. This article lays out some considerations that will help future investigators to improve their exercise prescription approaches in this area.
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