Blood Flow Restriction Training and Return to Play Following Knee Surgery

Knee arthroscopic surgery is a common treatment for meniscal, cartilage, bone, and ligament injuries. Following surgery, a period of unloading to allow tissue to heal and pain and swelling to subside results in muscle atrophy, weakness, and inhibition, which in turn impairs physical function. Surgery must be combined with detailed rehabilitation to enable the patient to return to their pre-injury level of activity and function while minimizing the risk of re-injury and early-onset knee osteoarthritis. Blood flow restriction training is a novel training method which involves restriction of blood flow in the exercising limb during low-intensity exercise. This mode of training is a powerful rehabilitation tool that can be used from the early post-surgery phase of recovery and throughout rehabilitative training until the individual returns to their pre-injury level of activity and function. Blood flow restriction can be applied passively without exercise, as an adjunct to non-exercise modalities such as neuromuscular electrical stimulation, and in combination with resistance and aerobic exercise to elicit several beneficial adaptations to the muscular and aerobic systems. Current evidence suggests that when an individual is limited to low-intensity exercise, addition of blood flow restriction results in superior adaptations compared to low-intensity exercise alone. Importantly, the adaptations appear to be comparable to high-intensity exercise in many cases. However, blood flow restriction training may have a greater effect on improving physical function and reducing pain and swelling, particularly in the early phases following knee arthroscopic surgery. The possible applications to rehabilitation following knee surgery are discussed herein.