Blood Flow Restrictive training and PFPS

[Michael McMurray]

This has been asked of me a few times in the past year – what do you know, what do you think?

I have reviewed the “evidence” and been underwhelmed to make recommendations.

Here is a new article from BJSM with Jill Cook as an author – so worth a read, and a discussion.

What do you know, have you used (or thought of using), or used specifically (Nic – CrossFit warrior).

Is there a place for this in the clinic?

I am a born skeptic, and have lived through many of ‘fads’ in and out of our field to change practice patterns without enough evidence, or at least basic science to attempt with patients.

Please post your thoughts

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[August Winter]

I’m less hip on PT podcasts, blogs, etc. so I don’t know very much about using blood flow restrictive training. I’m typically a believer in a “believe none of what you hear and half of what you see,” sort of mantra. I do know that the cuff that is sold through the store on Modern Manual Therapy is 130 (save $10!) and that could be put towards other things in a clinic instead. I think for this population my mind goes more quickly to NMES or any number of different patellar taping techniques, both of which are things that could also be done at home if it seemed appropriate for that particular patient. My assumption would be that those interventions are also slightly more user friendly than the restrictive training for at home use, but that could be incorrect.

As for the article, the main results are definitely interesting. Less pain with ADLs and improved quad strength are two pretty relevant outcomes, and maybe this would be a useful adjunct to care early on for more irritable PFPS. I’d be interested to hear everyone’s thoughts on the exclusion criteria…

[Kyle Feldman]

I heard about this towards the tail end of my residency year and tried in two times. One of the patients I tried it just to see if we could load the joint more with less pain. She was able to do more exercises and felt less pain (but felt the pain of the compression)
I also used it on another young girl who had only 100 degrees of knee flexion and this was a last ditch effort to avoid a manipulation. I had tried everything and tried this to see if we could reduce the pain to get her more motion. The pain was better but the ROM did not stick.

Jill Cook is a great author and I am really enjoying what she is putting out. Another great article.

I think that Eric is right about the fads and trends. There is so much talk about fascia right now that I am interested to see how long it sticks around.

I personally have become more skeptical this past year and what I have been doing is actually trying to learn more about it and trying to apply these techniques to see if they have an effect.

I think the big issue for me with these fads is that therapists tell patients what they think they are doing when in reality we do not know if it is what is going on a the anatomical level. I perfect example is the visceral manipulation. I have seen patients get better when you rub their belly. You will always have poeple who get better. But when a therapist tell them that they are moving the rotated bladder, that is not the truth. We do not have enough evidence to support this. Placebo is a powerful treatment, but as a medical profession we need to educate and treat with the best supporting research and proven ideas.

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