A New Way To Build Muscle

An Innovative Therapy Helps Patients Gain Strength And Stability.

Name any professional sports team—baseball, basketball, football or hockey—and it’s likely that players who have suffered injuries have benefited from a special strength-training technique. Called Blood Flow Restriction (BFR) therapy, it involves using a tourniquet to partially block blood flow to a person’s arm or leg during weight training. “Research shows that it’s not only safe, but it also helps to strengthen muscles faster,” says Nicole Cleffi, PT, DPT, a physical therapist at RWJ Sports Physical Therapy at Princeton, a facility affiliated with Robert Wood Johnson University Hospital (RWJUH) Somerset.

Blocking blood flow to a limb causes the muscles to work in a low-oxygen state. Substances such as lactic acid and other metabolites build up, spurring the body to release growth hormones. This leads to the growth of more muscle fibers and, ultimately, greater strength. At the same time, “BFR therapy triggers the body to form more capillaries, or blood vessels,” says Dr. Cleffi. “This increases the supply of oxygen so muscles can work more efficiently.”

A Novel Treatment

RWJ Sports Physical Therapy has offered BFR since September 2019. It’s especially beneficial for people who can’t tolerate heavy weight lifting, such as those who are recovering from surgery, have suffered an injury or are deconditioned, says Dr. Cleffi. She typically uses the technique to treat sports-related injuries (anterior cruciate ligament, or ACL, rotator cuff and elbow) after patients have had surgery. Recently, Dr. Cleffi began using BFR therapy to treat patients with multiple sclerosis (MS) and osteoarthritis.

In October 2019, a patient who had weakness in her right leg due to MS sought care from Dr. Cleffi. She was tripping frequently because she couldn’t lift her foot properly while walking. The patient was an ideal candidate for BFR therapy. “She will continue to lose muscle mass over the years due to MS, and it’s frequently hard to combat that,” says Dr. Cleffi. “This seemed like a perfect opportunity to see if we could help her build muscle.”

Dr. Cleffi designed an 18-week course of twice-weekly treatments. First, she placed a device that resembles a blood pressure cuff around the patient’s leg and inflated it, blocking roughly 60 percent of blood flow initially. Over the course of 18 weeks, Dr. Cleffi gradually increased the pressure so that 70 percent of blood flow was blocked. Next, she led the patient through a series of hip, knee and ankle exercises—including squats and leg lifts with ankle weights attached—lasting approximately 25 to 30 minutes in total. The cuff is deflated for one minute between each exercise to restore blood flow to the area.

The patient was grateful for the opportunity to try BFR therapy. “The treatment resembles how your arm feels when you’re having your blood pressure taken and the cuff is at maximum pressure,” she says. “It’s astonishing how difficult the workout is.”

Impressive Results

Six weeks into the treatment, Dr. Cleffi assessed the patient’s progress. “There was a big improvement in the strength of her right leg and some improvement in the left leg as well,” she says. Her endurance increased, and she sleeps better. “We weren’t expecting that,” says Dr. Cleffi.

The patient was discharged from therapy in February. “She’s done fantastically well,” says Dr. Cleffi. “She’s made tremendous gains in strength, her balance has improved, and she hasn’t tripped.” The patient is feeling so strong that she’s able to return to one of her favorite activities—jogging. “I’ve noticed a significant difference when I walk and break into a jog,” she says. “I’m not worried about falling anymore.”

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