Upper-extremity blood flow restriction: the proximal, distal, and contralateral effects—a randomized controlled trial

Bowman, Eric N.; El-Shaar, Rami; Milligan, Heather; Jue, Gregory; Mohr, Karen; Brown, Patty; Watanabe, Drew M.; Limpisvasti, Orr

doi:10.1016/j.jse.2020.02.003

Cited by 31 publications

(57 citation statements)

References 48 publications

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“…stress or pharmaceutical means increased satellite cell activity and anabolic signaling that may chronically increase satellite cell differentiation and muscle growth via a calcineurin-dependent signaling pathway. With similar findings to the present work, Bowman et al 5 observed increased limb circumference and strength gains after 6 weeks of BFR-LIX training of the rotator cuff and upper extremity when comparing 2 training groups (BFR vs non-BFR). Notably, the BFR group used in that study trained with 1 arm under occluded conditions (60% LOP) and 1 arm without occlusion.…”

Section: Muscle Mass Developmentsupporting

confidence: 90%

“…33,40 For example, Brumitt et al 7 observed no difference between training with or without BFR during 8 weeks of twiceweekly side-lying dumbbell ER (30/15/15/15 repetitions; 30% of 1RM) with regard to changes in strength and supraspinatus tendon thickness (measured via ultrasonography). This is in contrast to both the present investigation and the investigation performed by Bowman et al, 5 whereby multiple exercises were used. Additionally, in the present study, participants exercised to fatigue on the final set.…”

Section: Muscle Mass Developmentcontrasting

confidence: 82%

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Blood Flow Restriction Training for the Shoulder: A Case for Proximal Benefit

et al. 2021

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Background: Although blood flow restriction (BFR) is becoming increasingly popular in physical therapy and athletic training settings, little is known about the effects of BFR combined with low-intensity exercise (LIX) on muscles proximal to the site of occlusion. Hypothesis/Purpose: Determine whether LIX combined with BFR applied distally to the shoulder on the brachial region of the arm (BFR-LIX) promotes greater increases in shoulder lean mass, rotator cuff strength, endurance, and acute increases in shoulder muscle activation compared with LIX alone. We hypothesized that BFR-LIX would elicit greater increases in rotator cuff strength, endurance, and muscle mass. We also hypothesized that the application of BFR would increase EMG amplitude in the shoulder muscles during acute exercise. Study Design: Controlled laboratory study. Methods: 32 healthy adults were randomized into 2 groups (BFR group, 13 men, 3 women; No-BFR group, 10 men, 6 women) who performed 8 weeks of shoulder LIX (2 times per week; 4 sets [30/15/15/fatigue]; 20% maximum) using common rotator cuff exercises (cable external rotation [ER], cable internal rotation [IR], dumbbell scaption, and side-lying dumbbell ER). The BFR group also trained with an automated tourniquet placed at the proximal arm (50% occlusion). Regional lean mass (dual-energy x-ray absorptiometry), isometric strength, and muscular endurance (repetitions to fatigue [RTF]; 20% maximum; with and without 50% occlusion) were measured before and after training. Electromyographic amplitude (EMGa) was recorded from target shoulder muscles during endurance testing. A mixed-model analysis of covariance (covaried on baseline measures) was used to detect within-group and between-group differences in primary outcome measures (α = .05). Results: The BFR group had greater increases in lean mass in the arm (mean ± 95% CI: BFR, 175 ± 54 g; No BFR, –17 ± 77 g; P < .01) and shoulder (mean ± 95% CI: BFR, 278 ± 90 g; No BFR, 96 ± 61 g; P < .01), isometric IR strength (mean ± 95% CI: BFR, 2.9 ± 1.3 kg; No BFR, 0.1 ± 1.3 kg; P < .01), single-set RTF volume (repetitions × resistance) for IR (~1.7- to 2.1-fold higher; P < .01), and weekly training volume (weeks 4, 6-8, ~5%-22%; P < .05). Acute occlusion (independent of group or timepoint) yielded increases in EMGa during RTF (~10%-20%; P < .05). Conclusion: Combined BFR-LIX may yield greater increases in shoulder and arm lean mass, strength, and muscular endurance compared with fatiguing LIX alone during rotator cuff exercises. These findings may be due, in part, to a greater activation of shoulder muscles while using BFR. Clinical Relevance: The present study demonstrates that BFR-LIX may be a suitable candidate for augmenting preventive training or rehabilitation outcomes for the shoulder.

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Section: Muscle Mass Developmentsupporting

confidence: 90%

Section: Muscle Mass Developmentcontrasting

confidence: 82%

Blood Flow Restriction Training for the Shoulder: A Case for Proximal Benefit

et al. 2021

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“…However, recent studies have highlighted promise in benefit to the proximal structures as well. [12][13][14][15] When considering the shoulder or hip, one can appreciate the delicate balance in mobility and stability required by the proximal limbs. The glenohumeral and scapulothoracic regions provide a complex synergy of muscle actions in an effort to push, pull, and rotate to an exceedingly high degree, especially with high-level sports such as throwing, gymnastics, and weight-lifting.…”

mentioning

confidence: 99%

Blood Flow Restriction Enhances Rehabilitation and Return to Sport: The Paradox of Proximal Performance

Hedt

McCulloch

Harris

et al. 2022

Arthroscopy, Sports Medicine, and Rehabilitation

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The use of blood flow restriction (BFR) within rehabilitation is rapidly increasing as further research is performed elucidating purported benefits such as improved muscular strength and size, neuromuscular control, decreased pain, and increased bone mineral density. Interestingly, these benefits are not isolated to structures distal to the occlusive stimulus. Proximal gains are of high interest to rehabilitation professionals, especially those working with patients who are limited due to pain or postsurgical precautions. The review to follow will focus on current evidence and ongoing hypotheses regarding physiologic responses to BFR, current clinical applications, proximal responses to BFR training, potential practical applications for rehabilitation and injury prevention, and directions for future research. Interestingly, benefits have been found in musculature proximal to the occlusive stimulus, which may lend promise to a greater variety of patient populations and conditions. Furthermore, an increasing demand for BFR use in the sports world warrants further research for performance research and recovery. Level of Evidence: Level V, expert opinion.

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“…In both upper-and lower-extremity BFR, more proximal muscle groups (gluteus maximus, shoulder [deltoid/rotator cuff], and pectoralis major) have been shown to have greater levels of recruitment as compared with controls. [19][20][21][22][23] This is hypothesized to occur in response to the early fatigue of synchronous muscle groups distal to the occlusion site and has important implications in BFR's use after procedures or injuries where a tourniquet cannot be applied proximally.…”

Section: Physiology/mechanism Of Actionmentioning

confidence: 99%

“…Evidence of BFR's benefit for muscle groups proximal to the site of occlusion also has expanded its potential use for shoulder and hip procedures, but before advocating for routine prescription from arthroscopy to arthroplasty, further evidence of clinical benefit is needed. [19][20][21]59 Safety Considerations While remarkable to see the influence of scientific evidence on athletic performance, some caution is warranted given the risks associated with inappropriate BFR usage. This is especially true, given uncertainty regarding its effectiveness in scenarios in which pressure is applied via less-precise methods than pneumatic tourniquets with calibrated pressures.…”

Section: Postoperative Rehabilitationmentioning

confidence: 99%

Blood Flow Restriction Therapy and Its Use for Rehabilitation and Return to Sport: Physiology, Application, and Guidelines for Implementation

Cognetti

Sheean

Owens³

2022

Arthroscopy, Sports Medicine, and Rehabilitation

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Blood flow restriction (BFR) is an expanding rehabilitation modality that uses a tourniquet to reduce arterial inflow and occlude venous outflow in the setting of resistance training or exercise. Initially, this technique was seen as a way to stimulate muscular development, but improved understanding of its physiologic benefits and mechanism of action has allowed for innovative clinical applications. BFR represents a way to decrease stress placed on the joints without compromising improvements in strength, whereas for postoperative, injured, or load-compromised individuals BFR represents a way to accelerate recovery and prevent atrophy. There is also growing evidence to suggest that it augments cardiovascular fitness and attenuates pain. The purpose of this review is to highlight the physiology and evidence behind the various applications of BFR, with a focus on postoperative rehabilitation. While much remains to be learned, it is clear that blood flow restriction therapy stimulates muscle hypertrophy via a synergistic response to metabolic stress and mechanical tension, with supplemental benefits on cardiovascular fitness and pain. New forms of BFR and expanding applications in postoperative patients and athletes hold promise for expedited recovery. Continued adherence to rehabilitation guidelines and exploration of BFRs physiology and various applications will help optimize its effect and prescription. Level of Evidence: V, expert opinion.

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Upper-extremity blood flow restriction: the proximal, distal, and contralateral effects—a randomized controlled trial

Cited by 31 publications

References 48 publications

Blood Flow Restriction Training for the Shoulder: A Case for Proximal Benefit

Blood Flow Restriction Training for the Shoulder: A Case for Proximal Benefit

Blood Flow Restriction Enhances Rehabilitation and Return to Sport: The Paradox of Proximal Performance

Blood Flow Restriction Therapy and Its Use for Rehabilitation and Return to Sport: Physiology, Application, and Guidelines for Implementation

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