Low load resistance training with blood flow restriction decreases anterior knee pain more than resistance training alone. A pilot randomised controlled trial

Korakakis, Vasileios; Whiteley, Rodney; Giakas, Giannis

doi:10.1016/j.ptsp.2018.09.007

Cited by 57 publications

(63 citation statements)

References 21 publications

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“…Low intensity exercise performed with BFR has recently been shown to trigger hypoalgesia. In patients with anterior knee pain, Korakakis et al [43,44] investigated the effect of four sets of low intensity open kinetic chain knee extension exercise with BFR on knee pain prior to a physiotherapy session. Knee pain was measured during several exercises using a numerical pain rating scale.…”

Section: Bfr Exercise and Hypoalgesiamentioning

confidence: 99%

“…An immediate and clinically significant reduction in knee pain was observed following BFR exercise, which was sustained after a 45minute physiotherapy session. Chronic reductions in knee pain over the course of a resistance training programme have been observed with low intensity BFR exercise [30,31], which may be driven by less pain during BFR exercise [33,103] and repeated exposure to the acute hypoalgesia effect [43,44] as seen in noninjured populations [47]. Given that hypoalgesia appears to be augmented by higher intensity (and longer duration) exercise and is not typically observed with low intensity exercise, it is important to explore the potential mechanisms driving hypoalgesia with low intensity BFR exercise.…”

Section: Bfr Exercise and Hypoalgesiamentioning

confidence: 99%

“…With BFR exercise, it is thought that stimulation of group III and IV afferent fibres increases sympathetic nervous activity to increase perception of pain/discomfort [109]. Given the considerable level of muscle pain that is characteristic of BFR exercise, the exercise itself may act a noxious conditioning stimulus to activate descending inhibitory pathways [43,44]. Related to this, the importance of exercise-induced metabolites in pain perception through activation of group III and IV nociceptive afferent neurons has been described [92][93][94].…”

Section: Bfr Exercise and Hypoalgesiamentioning

confidence: 99%

“…Recent evidence shows EIH occurs when low intensity exercise (e.g. ≤30% 1RM) is performed with BFR [43,44]. A single bout of low intensity knee extension exercise with BFR was found to reduce anterior knee pain immediately post-exercise.…”

Section: Introductionmentioning

confidence: 95%

“…A single bout of low intensity knee extension exercise with BFR was found to reduce anterior knee pain immediately post-exercise. This moderate to large effect was sustained for a minimum of 45 minutes [43,44]. For load compromised and rehabilitating populations with chronic pain that cannot withstand high intensity exercise or low intensity exercise to failure, BFR exercise would therefore have a dual effect for pain and other adaptations.…”

Section: Introductionmentioning

confidence: 99%

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Low intensity blood flow restriction exercise: Rationale for a hypoalgesia effect

Hughes¹,

Patterson²

2019

Medical Hypotheses

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Exercise-induced hypoalgesia is characterised by a reduction in pain sensitivity following exercise. Recently, low intensity exercise performed with blood flow restriction has been shown to induce hypoalgesia. The purpose of this manuscript is to discuss the mechanisms of exercise-induced hypoalgesia and provide rationale as to why low intensity exercise performed with blood flow restriction may induce hypoalgesia. Research into exercise-induced hypoalgesia has identified several potential mechanisms, including opioid and endocannabinoid-mediated pain inhibition, condition pain modulation, recruitment of high threshold motor units, exercise-induced metabolite production and an interaction between cardiovascular and pain regulatory systems. We hypothesise that several mechanisms consistent with prolonged high intensity exercise may drive the hypoalgesia effect observed with blood flow restriction exercise. These are likely triggered by the high level of intramuscular stress in the exercising muscle generated by blood flow restriction including hypoxia, accumulation of metabolites, accelerated fatigue onset and ischemic pain. Therefore, blood flow restriction exercise may induce hypoalgesia through similar mechanisms to prolonged higher intensity exercise, but at lower intensities, by changing local tissue physiology, highlighting the importance of the blood flow restriction stimulus. The potential to use blood flow restriction exercise as a pain modulation tool has important implications following acute injury and surgery, and for several load compromised populations with chronic pain.

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Section: Bfr Exercise and Hypoalgesiamentioning

confidence: 99%

Section: Bfr Exercise and Hypoalgesiamentioning

confidence: 99%

Section: Bfr Exercise and Hypoalgesiamentioning

confidence: 99%

Section: Introductionmentioning

confidence: 95%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Low intensity blood flow restriction exercise: Rationale for a hypoalgesia effect

Hughes¹,

Patterson²

2019

Medical Hypotheses

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The effect of low‐load resistance training with blood flow restriction on chronic patellar tendinopathy — A case series

et al. 2020

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Heavy controlled loads of tendon with prolonged time under tension remains the treatment-ofchoice in tendinopathy rehabilitation. The use of low-load resistance exercise (LL, in combination with blood flow restriction (BFR) has been advocated as a clinically important rehabilitation tool for persons not tolerating high muscle-tendon loads. Similar or improved clinical outcomes have been reported after LL-BFR compared to conventional rehabilitation following various types of knee injury, and also compared to load-matched, free-flow exercise.LL-BFR augments muscular adaptations and is comparably effective for inducing muscle hypertrophy and strength gains compared to heavy-load resistance training. The present study aimed to investigate the feasibility and effect of LL-BFR as a rehabilitation tool in individuals with chronic unilateral patellar tendinopathy. The results demonstrated that (i) 3 wks LL-BFR was well tolerated with moderate-large pain improvements (Likert), (ii) pain scoring (NRS) was reduced by 50 % during single-leg decline squat testing, and (iii) tendon vascularity diminished by 31 % following 3 weeks (9 sessions) of LL-BFR. These novel data demonstrate substantial clinical and structural tendon improvements with short-term (3 wks) LL-BFR, which warrant further research into the potential efficacy of LL-BFR as a clinical rehabilitation tool in patients with chronic tendinopathy.

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Early Postoperative Role of Blood Flow Restriction Therapy to Avoid Muscle Atrophy

Patterson¹,

Hughes²,

Owens³

2019

Return to Sport After ACL Reconstruction and Other Knee Operations

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Low load resistance training with blood flow restriction decreases anterior knee pain more than resistance training alone. A pilot randomised controlled trial

Cited by 57 publications

References 21 publications

Low intensity blood flow restriction exercise: Rationale for a hypoalgesia effect

Low intensity blood flow restriction exercise: Rationale for a hypoalgesia effect

The effect of low‐load resistance training with blood flow restriction on chronic patellar tendinopathy — A case series

Early Postoperative Role of Blood Flow Restriction Therapy to Avoid Muscle Atrophy

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