 What’s up, everyone. One of the many treatment options that we offer at Athletes’ Potential is something called Personalized Blood Flow Restriction Training (PBFRT). This is something I remember being blown away about while in physical therapy school and seeing the results that research was showing. To put it simply, it’s one of the best evidence supported treatment options out there and we are thrilled to be able to offer it to the Decatur and greater Atlanta area. There are a ton of awesome benefits with PBFRT, but first let’s take a look at what exactly BFR is. PBFRT is the brief and intermittent use of a tourniquet in order to restrict the amount of blood flow from coming into your limb (arterial flow) while performing low-load resistance training. The way PBFRT works is it reduces the amount of oxygenated blood reaching a working muscle in order to trick your body into thinking it’s working at a higher intensity than it actually is. By using this form of engineered suffering, you’re able to use extremely light resistance and still get the same increases in size and strength as lifting at higher intensities with heavy weight! Exactly how this happens is laid out below:
Essentially, PBFRT is a true biohack that allows people to work at loads that are non-stressful on the tissue but still get improved size and strength. A true game-changer in the world of strength and conditioning. But just like everything else in the world of sports medicine, PBFRT has to be used appropriately and with the right population. Otherwise, you could risk wasting your time and resources. So, who exactly would benefit? Below are three of the most common scenarios that people see the best results. Post-Injury/Surgery: Muscle breakdown (atrophy) after a surgery or injury happens incredibly fast. For example, when you’re injured or you’re not allowed to put any weight through one of your limbs, in as little as two weeks that limb goes into a state of anabolic resistance and protein synthesis shuts down leading to a 30% loss of muscle mass in that limb! This is obviously extremely problematic and slows down recovery from an injury dramatically. However, with PBFRT we now have the ability to combat that significant muscle loss because we are able to use low intensity and weight levels that are safe and tolerable to the patient and get the same increases in muscle size and strength as lifting at 65% of your one rep max or higher. A great example of just how beneficial PBFRT can be for patients rehabbing from injury comes from Dr. Zach Long who was working with an elite level olympic lifter after tearing his ACL. With this type of injury, more than 65% of patients demonstrate quadricep weakness even a year out from surgery. However, Dr. Long’s patient’s surgical leg became one inch larger than his healthy leg in just three months time after his surgery! Sport Performance: PBFRT has shown numerous benefits to enhancing sports performance, but perhaps the most documented is the ability for athletes to maintain muscle size and strength without the dip in performance caused by muscle soreness. This is possible because there is no muscle tissue breakdown associated with PBFRT since the intensity is kept so low.
PBFRT has also been shown to have a profound effect on your aerobic capacity as well by increasing your VO2 max and capillary beds.
Recovery: Imagine this. You’re training for an upcoming triathlon and are starting to feel a little banged up from the volume pulling, or you’re gassed trying to prepare for a CrossFit competition, or maybe you’re midseason in soccer and have been trying to push through some nagging issues. Now, imagine during your recovery day you rode for just 15 minutes, at a pace well below a typical recovery ride pace, and we’re able to give your tendons that increased HGH we mentioned above, all while boosting your VO2 max AND letting your tissue continue to recover. Sounds pretty cool; right? We have people do that all the time here in the clinic and we are consistently seeing people hit PR’s and feel good doing it. Rehab, Performance, Recovery. That covers a vast majority of the population, and that’s on purpose. The research (over 600 published studies) is incredible and the results we are getting wiht people speak for themselves. However, as the old adage goes, “If all you have is a hammer, everything looks like a nail.” Personalized blood flow restriction training isn’t for everyone, and that’s okay. At Athletes’ Potential we firmly believe we have the most skilled doctors of physical therapy who can use a vast array of treatment options to help you reach your injury or performance goals. Whether you are training through a nagging injury or looking to improve your performance, we would love to help you achieve your goals. Give us a call at 470-355-2106 or fill out the contact request form below and we will be happy to contact you. Thanks for reading, Dr. Jake, DPT, CSCS
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Last week, we covered the training volume in part 1 of load management. If you missed it, go check it out. Today, we’re going to take a deeper dive into components of load management itself and what you as an athlete, coach or healthcare professional can do about it. I geek out on this stuff so get ready. Any injury ever: FORCE/LOAD > CAPACITY This means any force/load that exceeds the capacity of your tissue’s ability to withstand that force/load. Some examples:
Enter LOAD MANAGEMENT. The goal is simple: to protect you from injury and maximize performance Proper training must be prescribed. Over-training and under-training both increase risk of injury. You want to:
I’d be remiss to not give credit where credit is due: Tim Gabbett and company have been leading the front on this area and are really changing the way teams and athletes are handling training. Now, let’s define LOAD: It is broken down into 2 variables – external load and internal load
We use these two variables to create the: ACUTE: CHRONIC WORKLOAD RATIO (ACWR) This is also commonly referred to as FATIGUE compared to FITNESS. Fatigue being the acute workload and fitness being the chronic workload.
With technology nowadays, we have a number of ways to track this type of data. The most commonly cited method in the research is Session RPE (sRPE), which is time (total number of minutes) multiplied by the RPE for a given training session. The RPE is usually taken after a training session to gauge level of exertion/difficulty. This is measured as “arbitrary units” or “exertional units”. For example, in week 5, let’s say a soccer player practices one day for 60 minutes at an RPE of 8. That gives us: 60 x 8 = 480 units. She practices 4 times during week 5 with a similar intensity. This gives us our ACUTE WORKLOAD (4 x 480 = 1920 units) for week 5. Now we have to look at her CHRONIC WORKLOAD for weeks 1-4.
When we compare the two, you get: 1920/1808 = 1.06 Now what does this number tell us? This ratio helps delineate whether you as the athlete are prepared for the task at hand – what you’ve done compared to what you’re prepared for – that can be a running a marathon, doing a CrossFit Open workout, playing in a professional football game or doing parkour in your living room. In terms of injury risk, acute:chronic workload ratios within the range of 0.8–1.3 is considered the training ‘sweet spot’ where injury risk is at its lowest, while acute:chronic workload ratios ≥1.5 represent the danger zone. If you look at the trend of the curve before 0.80, you should notice the injury risk climbs back up – similar to a “U-shaped” curve. This relationship between workload and injury demonstrates that both inadequate and excessive workloads are associated with injury. Now let’s say from the example above that week 5 workload came out to 3500 arbitrary units. That would make the ratio: 3500/1808 = 1.94 No bueno. This athlete is at an increased risk of injury. When training load is fairly constant (ranging from 5% less to 10% more than the previous week) players had <10% risk of injury based on the study by Gabbett et al. However, when training load was increased by ≥15% above the previous week's load, injury risk escalated to between 21% and 49%. This is commonly represented by ‘spikes’ in acute load relative to chronic load. To minimize the risk of injury, we should limit weekly training load increases to <10%. There’s room to work within this, but a great starting point. Athletes accustomed to high chronic loads have fewer injuries than those accustomed to lower loads, and this supports Gabbett’s assertion that higher chronic loads can act as a protective effect against future injury.  These two graphs give a great depiction of what happens when load is applied appropriately:  Compared to excessive load and/or lack of recovery:  This is something I use every day with my patients and athletes. I’ll look at their training program and see if there is a mismatch in training volume and load management. We start here then look to optimize other components of injury and performance training such as stress management, tissue tolerance, biomechanics, physiology, strength, power, etc. At the end of the day, ask yourself this question: Is your body prepared for the demand of the task?
Cheers, Dr. Ravi Patel, PT, DPT, CSCS References:
With the CrossFit Open upon us and beach bod season approaching, people will be fitnessing. A LOT. With this, comes the opportunity for injuries to sneak up and leaving performance on the table. People typically blame certain factors for an injury or lack of performance:
While these factors are definitely important to consider, there’s one that gets overlooked and is quite often the culprit: TRAINING VOLUME I had a patient come in a month ago who was dealing with foot and ankle pain. It has been on and off for months, and she decided to get it checked out due to a recent exacerbation. She’s a ½ marathon runner who also does Orange Theory a few times a week. She was starting to increase her mileage for her ½ marathon coming up. I think you know where this is going… Before trying to change up her running mechanics, change her shoes or blaming it on “overpronation,” we had a conversation about her training volume. I asked her how her running mileage and volume been. In this discussion, she said she went from 3 miles to 6 miles within a weeks time. BINGO. She was confused as she had previously ran this much mileage in the past, BUT... it’s been a couple months. I also asked her about the first time she ever dealt with this same issue – she said she couldn’t really think of why it initially started – “maybe running form or my shoes?”. I asked her when she started Orange Theory – lightbulb went off. BINGO again. Let me be clear – there’s nothing wrong with her doing both running and Orange Theory. There is when your body is not prepared for the demand of these tasks. This was and is a volume issue, and if you’re reading this, think back to a previous non-contact injury and see if you can attribute any other factors playing into that specific injury – moreso volume in this case. Now, mobility, biomechanics, strength, etc., all play roles into whether we are operating as optimally as possible from a performance standpoint. For this patient, we did work on strength in certain areas and tweaked some things from a running standpoint, but the big component of her rehab was starting at a volume she could tolerate without pain or just a little, and progress forward from there. Training volume falls under the umbrella of Load Management (coming in Part 2) and is a big reason why injuries occur. Some common methods of measuring training volume include counting the number of sets to failure, the volume load (sets x reps x weight), distance, number of sprints, etc. Here are some terms to understand: Maintenance Volume (MV) – How much volume you need to maintain your gains Minimum Effective Dose (MED) – Smallest amount of stimulus needed to drive positive adaptation. If we are below this threshold, then there will be no adaptation. Maximum Adaptive Volume (MAV) – Here we are training at our optimal range of volume that we can adapt to and recover appropriately to drive optimal performance Maximum Recoverable Volume (MRV) – This is the absolute maximum volume that your body can handle and recovery from. Sometimes it’s necessary to pass this threshold from time to time, called overreaching, in order to elicit greater adaptations. Important point here is to make sure it is not often and that deloads are accompanying this high accumulation of volume to allow for supercompensation (the point of overreaching to get the training effect you want – improved strength, power, speed, etc.). When this is not appropriately monitored or constantly overreached without recovery, you open the door for injuries to occur and performance to suffer. (credit to Mike Israetel of Renaissance Periodization for this concept)  The way this is laid out is that you start with your MED, progress to MAV, then MRV to overreach. However, notice that you don’t dance with MRV often, nor do you want to.
Overtime, your MRV will increase, meaning you’ll get stronger and develop more work capacity, as long as you intelligently handle your training volume. A good rule of thumb is The 10% Rule - While there can be some variability here, staying within a 10% increase from the previous week tends to work well for a lot of people. It pushes that threshold in a progressive manner and allows appropriate recovery from the increased demand on the body. Next week, in Part 2, we’ll take a deeper dive into load management and training volume, explore exactly what this concept means, and how to practically apply it to yourself or athletes you work with. Cheers, Dr. Ravi Patel, PT, DPT, CSCS 
Breathing While structured breathing work may seem simple-even silly- to some, we know that it is a powerful tool for the pregnant and postpartum woman. Deep breaths have the ability to calm the nervous system which can affect muscle tension, heart rate, and blood pressure. Additionally, the respiratory diaphragm can mobilize muscles in the pelvis and back due to anatomical connections. Muscles, including those shown in the photo below, are big players in midline stabilization and support. A great place to start is the 90/90 breathing drill (seen below). Try this out for 10-15 breaths at the end of your day. Ask questions Many postpartum women do not know all of the details after birthing their baby. Some have told me they were not aware they had stitches down below until the 6-week check-up when the doctor wanted to make sure they were healing well! The check-up at 6 weeks can be quick so arrive with questions. It is helpful to know about any tearing, episiotomies, tools used during the birth, etc. These factors are all great to bear in mind as you return to exercise and daily functioning. Another question to ask-- “Is there a pelvic health PT that you would recommend?” They may know someone in the area or have worked with them prior. However, do not become discouraged if they don’t have a name to offer. A Google search for “women’s health PT” or “pelvic PT” should show professionals in the area. Compare websites and reviews to see if the PT would be a good fit for you and your goals! Pelvic Health Physical Therapy Once you have been cleared by the doctor for “usual exercise” and intercourse, I highly suggest visiting a pelvic health or women’s health PT. They will be able to further answer any questions about symptoms you may experience immediately postpartum and later. A pelvic PT is specialized on evaluation and treatment of the pelvic floor musculature. They can perform internal evaluations to test the strength and endurance of your pelvic floor, check for prolapse, address any soft tissue issues, etc. For the evaluation, the therapist will use a gloved finger to palpate muscles internally. While a great deal of information can be gathered from an internal evaluation, it is not necessary for visiting a pelvic PT. The therapist can then prescribe exercises to help relieve the symptoms and provide hands-on work to hips, back, sacrum and other involved areas. Your PT should be a huge help in getting you back to fitness postpartum! Other areas they can treat and improve are bowel/bladder issues, painful sex, and pelvic pain. Focus on healing and strength rather than weight loss Social media and advertising may be all about “getting your body back” and fixing “mummy tummy,” but that is not the focus when you are postpartum. The first step in returning to fitness is addressing foundational strength and continuing to heal from the pregnancy and birth. Your body will go through so many changes in the months following your pregnancy and the timeline is different for every single woman. Steer clear of programs that say at week 8 you do blank. It should all be self-paced and based on symptoms, your birth story, and prior activity level. Do you need help starting out? This was the number one question I received from women in the clinic. “What can I do? Where do I start?” So I developed programming to recover and rebuild your core after having a baby. Check out the THRIVE: Rebuild Bundle programming HERE.  Find a community for support
Returning to group classes or running groups can be challenging because you will not be jumping right back into the level you were previously exercising. Having a group of women who understand your needs and have been or are currently at the same stage as you is tremendously beneficial. If this sounds like something you would be interested in, please join my Back to Fitness Postpartum Facebook page. We have posts nearly every day and a lot of great discussions- some serious and some silly! Once you return to group classes, be sure that the trainer knows you are postpartum and if there are any symptoms with movements. If they offer other movement suggestions that still do not feel great, then modify further! Symptoms (leaking, pain, heaviness in the vagina) are a signal to decrease the workload by resting or modifying or both! Getting back to fitness postpartum can be challenging but it is not impossible! With a holistic plan and support you will be able to recover and rebuild to get back to your favorite activities. If you are looking for help with learning more about postpartum fitness, the pelvic floor and how to reach your goals, then please reach out at Athletes’ Potential. Thanks for reading, Dr. Jackie, DPT  Why is this topic so important to me? It’s because I’ve personally been through this process. Twice. And it’s one of the hardest things I’ve had to do in my life. Successful return to sport after anterior cruciate ligament (ACL) reconstruction requires optimal physical AND psychological recovery. The psychological component is quite often overlooked. Fear, emotion, and poor self-esteem can have profound effects on patients' compliance, athletic identity, and readiness to return to sport. An athlete can be physically prepared for return to sport, but if there is fear or anxiety associated, then this process should be prolonged. If you’re a clinician, parent, or athlete reading this, here are four key areas to consider: 1. Psychological Distress:
 This is where education and setting the expectations is huge. When working with an athlete, it’s important to consider this as a part of rehab. Who wouldn’t have anxiety or emotions when they can no longer play their sport and get their knee operated on. It’s completely normal. Rather than hiding it, have a conversation with your athlete. Educate them on what to expect before, during and after the procedure and for rehab. Assure them that everything will be okay and that they will get back to their sport. When an athlete knows what to expect, there’s less psychological distress associated with the process, which can significantly impact the success of the rehab and return-to-play process. 2. Self-Efficacy:
3. Locus of Control:
4. Athletic Identity:
 In addition to the 4 areas above, an objective measure can be very beneficial to quantify where the athlete stands from not only a physical perspective, but psychological. That’s where the ACL-Return to Sport after Injury scale (ACL-RSI) can be helpful. The ACL-RSI is a great outcome measures to assess athletes' emotions, confidence in performance, and risk appraisal in relation to return to sport.
Recognizing positive and negative psychological responses to injury is the first step in initiating treatment and potentially modifying beliefs through psychological interventions. It is important to identify patients who are at risk for poor outcomes because targeted psychological interventions may be successful. If you know of an athlete going through this injury and recovery process, don’t forget that there’s more to it than just what you can see. Cheers, Dr. Ravi, DPT Sources: - Christino MA, Fantry AJ, Vopat BG. Psychological Aspects of Recovery Following Anterior Cruciate Ligament Reconstruction. J Am Acad Orthop Surg. 2015;23(8):501-9. - Sadeqi M, Klouche S, Bohu Y, Herman S, Lefevre N, Gerometta A. Progression of the Psychological ACL-RSI Score and Return to Sport After Anterior Cruciate Ligament Reconstruction: A Prospective 2-Year Follow-up Study From the French Prospective Anterior Cruciate Ligament Reconstruction Cohort Study (FAST). Orthop J Sports Med. 2018;6(12):2325967118812819. - Ardern CL. Anterior Cruciate Ligament Reconstruction-Not Exactly a One-Way Ticket Back to the Preinjury Level: A Review of Contextual Factors Affecting Return to Sport After Surgery. Sports Health. 2015;7(3):224-30. -Schub D, Saluan P: Anterior cruciate ligament injuries in the young athlete: Evaluation and treatment. Sports Med Arthrosc 2011;19(1):34-43. Melissa A. Christino, MD, et al  Here’s what we know:
That last bullet point is a HUGE problem. How do we know when an athlete is ready? Traditional return-to-sport criteria are mainly focused on the time after ACLR and knee-specific impairments, while the return-to-sport decision-making process is only made at the hypothetical “end” of the rehabilitation period. When is this “end” point? When the patient runs out of insurance-covered visits? When the ortho clears them based on a 5-minute exam? When there’s no longer a government shutdown? This “end” point is completely made up and very subjective. That is why we need more concrete, objective measures to allow these athletes return to sport at a high level with the lowest risk of re-injury.  Dingenen et al. proposes: “an optimized criterion-based continuous and multifactorial return-to-sport approach based on shared decision making, with a focus on a broad spectrum of individual sensorimotor and biomechanical outcomes, within a biopsychosocial framework.” I could not agree more.  This means that we need to get away from time- and isolated-based assessments and look at this from a holistic 360 degree view, taking into account not only the biological factors of the athlete, but psychosocial factors as well. Since there are many individuals involved in this process, it takes a team to make the outcome truly successful. This team consists of the individual, their family, physical therapist, athletic trainer, orthopedic surgeon, sport coach, strength coach, etc.
Remember – A single component alone (i.e. time) is not enough to determine whether someone is ready. All of the components below could have the box checked except the last one and this athlete would still not be ready. I hope this provides some insight to you if you are going through this process as an athlete, parent, or clinician looking to return to sport.
Cheers, Dr. Ravi Source: Dingenen B, Gokeler A. Optimization of the Return-to-Sport Paradigm After Anterior Cruciate Ligament Reconstruction: A Critical Step Back to Move Forward. Sports Med. 2017;47(8):1487-1500. Have you ever been in the middle of a workout and feel an ache or pain? It’s completely normal if it’s something small and goes away. It’s another story if it continues to bother you or increase in pain. Sometimes we just do too much (or too little) and it pisses off some part of our body. You may start to realize it’s impacting the way you move and you may even avoid a particular movement that causes the pain altogether. Often times, people see this as a sign to take some time off and rest. This may be the case in some instances, but it’s not always the best solution. Some people go to a healthcare professional to find out what’s going on. Quite frequently, they’re told to stop that activity or exercise. We hear it all the time from new patients. “Squats are bad for your knees.” “Running will wreck your body.” “Stop doing CrossFit. You’ll get hurt.” But, what if you’re an Olympic weightlifter who has a competition coming up? What if you’re a runner who loves a good 5k? What if you have a stressful job and CrossFit is your outlet to relieve that stress? Come on, healthcare - we can do better. If these are your goals, we want to help you get there. Here’s 5 different ways to train around pain and decrease stress on that painful area:
MAIN GOAL: MAKE THE LEAST CHANGES POSSIBLE TO THE MOVEMENT Now, let’s break down each one of these using knee pain with front squats as an example.
Here are a few other examples for you:
Here’s the overall concept: Pain comes on --> scale back movement slightly --> train movement --> adapt --> progress difficulty --> adapt --> back to prior level --> continue training pain-free --> hit PR I believe that any great coach or physical therapist should be able to modify and progress/regress any movement or activity. If you have given these methods a shot and pain continues to impact your life, then find a healthcare professional who understands your goals and doesn’t tell you to stop.
Cheers, Dr. Ravi, PT, DPT, CSCS It’s been well researched and well documented that surgery is over utilized in the United States. Whether for your knee, back, shoulder, or ankle, it is far too common for people to rush to the operating table when, in many cases, conservative treatment (physical therapy) has been shown to have equal or better outcomes. Let's look at back surgery as an example. If you take 3 random people off the street who have absolutely no back pain, one of them is going to a “herniated disc” show up on an MRI scan. This means disc herniations may not always be the cause of someone’s low back pain, yet 500,000 people opt to have back surgery every year, often times with minimal or no relief. That being said, there is obviously a time and a place for surgery. Depending on a number of different variables (age, activity level, mechanism of injury, etc), sometimes surgery can absolutely be the best treatment option for you. What most people fail to understand though is that surgery is the easy part...all you have to do is get stuck with an IV and the next thing you know you wake up in the recovery room. Returning to your previous level of performance is the hard part, and it’s the hard part primarily because of the incredible amount of muscle atrophy (loss of muscle mass) that occurs after a surgery. In as little as two weeks a surgically repaired limb goes into a state of anabolic resistance and protein synthesis shuts down, leading to a 30% loss of muscle mass in that limb. Because of this rapid and extreme loss in muscle mass, muscle atrophy has a profound impact on a patient's rehabilitation, and sometimes patients never fully recover. Historically, muscle atrophy has been a battle that physical therapists, athletic trainers, and strength coaches alike have struggled to win. Just the other day I was working with a patient who is extremely active and fit, but had a knee surgery over 15 years ago and still had a significant side-to-side difference in leg size. However, there’s a revolutionary piece of equipment that is taking the world of physical therapy by storm, on that’s allowing healthcare professionals to prevent this initial 30% loss of muscle mass from even happening in the first place, Personalized Blood Flow Restriction Training. I go more into detail about what exactly Personalized Blood Flow Restriction Training (PBFRT) is in my previous article, but in a nutshell PBFRT is the use a modified surgical tourniquet to occlude a percentage of the arterial flow into a limb to trick your body into thinking it’s doing something much harder than it actually is. So why is personalized blood flow restriction training so revolutionizing when it comes to surgery? It prevents the significant muscle atrophy from even happening in the first place. In normal circumstances it takes 8-12 weeks of high intensity strength training (>65% of your one rep max) to get improved strength and muscle size from, you can see how this would be an issue for someone recovering from a surgery. When you have a surgery, you’re going to go through a period of time where it simply isn’t feasible, nor safe, to lift the weight required to increase muscle size. This is where PBFRT comes in. Say you’ve torn your ACL. With an ACL reconstruction, for the first few weeks the “strengthening” component of your rehabilitation will include simple exercises like seated knee extensions, mini squats, and heel raises. None of these exercises are going to make you a stronger functioning human, because none of these are at a high enough intensity level to cause the biological responses needed to increase muscle size and strength. However, if we put on a blood flow restriction device, and do these exact same exercises, we cause the following:
There are about 200 published research articles in 15 different countries that have demonstrate the benefits of personalized blood flow restriction training and we are seeing those benefits every day here in the clinic. Whether it’s helping someone who has years of atrophy as a result of surgery or we’re preventing the atrophy from even happening in the first place, the results we’re seeing are simply incredible. If you’re living in Atlanta, and you’ve had surgery or are struggling to get your strength back after a surgery, we’d love to help you. Give us a call at 470-355-2106 or fill out the contact request form and we’ll contact you.
Thanks for reading, -Dr. Jake, PT, DPT  To put it bluntly, being strong makes life easier. Humans don’t have the ability to create more muscle fibers (hyperplasia), so in order to get stronger we have to work tediously to increase the size of our existing muscle fibers (hypertrophy). According to the American Academy of Sports Medicine, gaining strength through hypertrophy takes 8-12 weeks of moderate to high intensity resistance training (>65% of your one rep max) utilizing 8-10 upper and lower body exercises at a rate 2-3 times per week. A relatively easy formula to follow; right? Well, what happens when you are recovering from an injury and can’t safely use loads heavy enough to improve strength and size? Or when you’re an athlete who is in-season and can’t tolerate the drop in performance associated with the muscle soreness that follows heavy lifting? Up until now those have been troubling questions for medical professionals and strength coaches alike. However, there is a new tool with over 160 peer reviewed research studies and documented success across the military, college, and professional sports arenas; something that is creating increased size and strength in as little as two weeks and is completely changing the game of how professionals approach rehab and sports performance…Personalized Blood Flow Restriction Training (PBFRT). What is Personalized Blood Flow Restriction Training and How Does it Work?  PBFRT is the brief and intermittent use of a tourniquet in order to restrict the amount of blood flow from coming into your limb (arterial flow) while performing low-load resistance training. There are numerous types of blood flow restriction devices available, but the gold standard occlusion device is the Delphi Personal Occlusion Tourniquet. The Delphi Personal Occlusion Tourniquet the only device have FDA approval to be safely used for medical use and is essentially a modified surgical tourniquet that contains a doppler system. This doppler system allows so you read a person’s arterial flow in live time, so you know exactly how much blood you are occluding, and it will adjust its pressure automatically throughout an exercise to maintain a designated percentage of occlusion that is personalized to each individual person. The way PBFRT works is it reduces the amount of oxygenated blood reaching a working muscle in order to trick your body into thinking it’s working at a higher intensity than it actually is. By using this form of engineered suffering you’re able to use extremely light resistance and still get the same increases in size and strength as lifting at higher intensities with heavy weight! Exactly how this happens is laid out below:
So who exactly would benefit from Personalized Blood Flow Restriction Training? Prehabilitation
Rehabilitation
Sports Performance
Personalized blood flow restriction training has been one of the largest advancements for injury rehabilitation and sports performance and we are so excited to offer it at our clinic in Decatur, GA. Whether you are training through a nagging injury or preparing for your next triathlon, we would love to help you achieve your performance goals. Give us a call at 470-355-2106 or fill out the contact request form below and we will be happy to contact you. Thanks for reading, -Dr. Jake, PT, DPT  Before graduating with my Doctoral degree in Physical Therapy, I had the distinct privilege of completing an internship with one of the highest performing populations out there, the United States Air Force. With patients ranging from active duty fighter pilots to military retirees, I was constantly in awe of the pain and physical punishment these individuals would put themselves through to be able to perform on a daily basis. Injuries were just another part of life. Some of these patients had been dealing with weeks of shoulder pain, months of hip pain, or years of low back pain; but there was a common ground nearly all of them all shared: pain relief and improved performance from dry needling. What Is Dry Needling? Dry needling is a treatment approach that involves the strategic placement of a thin needle into spots known as trigger points to alleviate myofasical pain. When describing dry needling to my patients, my go-to analogy is a sniper. Using a needle to go directly into a trigger point versus my hands or instrument assisted soft tissue mobilization is like a gunman using the extreme skill and precision of a sniper to pinpoint the problem area. Several studies have demonstrated the ability of dry needling to cause immediate improvements in musculoskeletal pain by targeting these trigger points and eliciting a local twitch response. The proposed mechanisms of pain relief supported by research include:
These effects of dry needling have been demonstrated across orthopedic, neurologic, sports, and post-surgical populations to improve range of motion, pain, performance, and increase local blood flow and oxygenation to surrounding tissues. So It's Like Acupuncture; Right? Wrong! Well, for the most part. Both dry needling and acupuncture use a similar instrument (a needle) to perform a treatment, but the philosophies and reasoning behind why the treatment is being performed couldn’t be more different. This is similar to how both chiropractors and physical therapists perform manipulations, but the chiropractor is attempting to correct “subluxations” while the physical therapist is attempting to unlock facet joints. Some of the key differences you should know between dry needling and acupuncture are:
What Exactly Is A Trigger Point? This is a great question, and one that I answer on a daily basis with my patients. Trigger points are characterized as the presence of nodules (or knots) in tight bands of muscle that are overly sensitive or painful to the touch. Trigger points are divided into two main groups, active or latent. An active trigger point is described as a palpable nodule that can cause local or referred pain without being touched or pressed on, and a latent trigger point is essentially the same thing only it does not cause any symptoms without being stimulated or pressed.  Several theories exist in the scientific community regarding how trigger points form and what exactly their role is in the development of pain. Some of these theories include:
If you’re experiencing pain, regardless of your fitness goals, lifestyle, or injury history, I highly recommend seeking out a physical therapist in your area who performs dry needling for an evaluation. Let me be clear though: dry needling is not a magic bullet. It is a great tool in the hands of a skilled therapist to alleviate pain that would otherwise prevent patients from performing certain movements or exercises, but it is only a part of the picture. Education on areas like strength, mobility, and posture are vital to sustain a pain-free lifestyle and to perform at an optimal level. f you’re living in Atlanta, and you’re struggling with back pain, we’d love to help you. Give us a call at 470-355-2106 or fill out the contact request form and we’ll contact you. Thanks for reading, -Dr. Jake, PT, DPT, CSCS |
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