- Email: [email protected]
Blood flow restriction-induced pain reduction in patients with anterior knee pain. A pilot RCT
80
Abstracts / Journal of Science and Medicine in Sport 20S (2017) 77–80
151 Blood flow restriction-induced pain reduction in patients with anterior knee pain. A pilot RCT V. Korakakis 1,2,∗ , R. Whiteley 1 1
Aspetar, Sports Medicine Hospital, Qatar Hellenic Orthopaedic Manipulative Therapy Diploma, HOMTD, Greece 2
Background: Blood flow restriction (BFR) with low-load exercise training can induce muscle morphological changes, enhance strengthening responses, attenuate muscle atrophy, and reduce pain. Exercise is an effective intervention for anterior knee pain (AKP) however pain can be a significant barrier to its application. This study evaluated if a single BFR-exercise bout would induce pain reduction compared to an exercise bout without BFR in patients with AKP. Methods: 40 patients were randomly allocated in the BFR or control group in this single-blinded trial. We assessed the effect on pain of a BFR-exercise bout compared to the same exercise-bout without BFR, immediately after application, and after a single physiotherapy session (45 min) comprising motor control and strengthening exercises. BFR pressure used was set to 80% of systolic blood flow occlusion. Both groups performed four sets of low-load open chain knee extensions with load individualized according to tolerance (max 5 kg). Outcome measures were pain (0–10) during bilateral (BLS) and single-leg squat (SLS), and step-down test (SDT). Data were analysed using two-way repeated measures ANOVA.
Results: No significant differences in baseline pain were found between groups. Significant immediate pain reductions were found in BFR group in BLS, ULS, and SDT (p < 0.001; d = 0.88, d = 1.12, d = 0.88 respectively), but no significant pain reduction was found in control group after exercise-bout in BLS, ULS, and SDT (p > 0.017; d = 0.36, d = 0.43, d = 0.41 respectively). At 45 minutes pain was reduced in BFR, (albeit lesser than immediate), and was sustained in all tests after the physiotherapy session in BLS, ULS, and SDT (p < 0.001; d = 0.84, d = 0.79, d = 0.89 respectively). No significant differences from baseline were found for the control group after the physiotherapy session in BLS, ULS, and SDT (p > 0.017, d = 0.62, d = 0.55, d = 0.47 respectively). Significant between group differences in favor of BFR group were found only in ULS post-BFR (d = 0.61), but not after physiotherapy session (d = 0.13). Discussion: A single BFR-exercise bout immediately reduced AKP with the effect sustained for at least 45 min, an effect not seen without BFR. Significant between groups interactions were found only in ULS probably due to the sample size. Further studies are needed to assess the optimum parameters of BFR-exercise and to evaluate the long-term effect in the clinical improvement of symptoms with physiotherapy. Importantly, BFR-low-load exercise can be used to reduce pain and provide a window of opportunity for clinicians to strengthen AKP patients. https://doi.org/10.1016/j.jsams.2017.09.355
Abstracts / Journal of Science and Medicine in Sport 20S (2017) 77–80
151 Blood flow restriction-induced pain reduction in patients with anterior knee pain. A pilot RCT V. Korakakis 1,2,∗ , R. Whiteley 1 1
Aspetar, Sports Medicine Hospital, Qatar Hellenic Orthopaedic Manipulative Therapy Diploma, HOMTD, Greece 2
Background: Blood flow restriction (BFR) with low-load exercise training can induce muscle morphological changes, enhance strengthening responses, attenuate muscle atrophy, and reduce pain. Exercise is an effective intervention for anterior knee pain (AKP) however pain can be a significant barrier to its application. This study evaluated if a single BFR-exercise bout would induce pain reduction compared to an exercise bout without BFR in patients with AKP. Methods: 40 patients were randomly allocated in the BFR or control group in this single-blinded trial. We assessed the effect on pain of a BFR-exercise bout compared to the same exercise-bout without BFR, immediately after application, and after a single physiotherapy session (45 min) comprising motor control and strengthening exercises. BFR pressure used was set to 80% of systolic blood flow occlusion. Both groups performed four sets of low-load open chain knee extensions with load individualized according to tolerance (max 5 kg). Outcome measures were pain (0–10) during bilateral (BLS) and single-leg squat (SLS), and step-down test (SDT). Data were analysed using two-way repeated measures ANOVA.
Results: No significant differences in baseline pain were found between groups. Significant immediate pain reductions were found in BFR group in BLS, ULS, and SDT (p < 0.001; d = 0.88, d = 1.12, d = 0.88 respectively), but no significant pain reduction was found in control group after exercise-bout in BLS, ULS, and SDT (p > 0.017; d = 0.36, d = 0.43, d = 0.41 respectively). At 45 minutes pain was reduced in BFR, (albeit lesser than immediate), and was sustained in all tests after the physiotherapy session in BLS, ULS, and SDT (p < 0.001; d = 0.84, d = 0.79, d = 0.89 respectively). No significant differences from baseline were found for the control group after the physiotherapy session in BLS, ULS, and SDT (p > 0.017, d = 0.62, d = 0.55, d = 0.47 respectively). Significant between group differences in favor of BFR group were found only in ULS post-BFR (d = 0.61), but not after physiotherapy session (d = 0.13). Discussion: A single BFR-exercise bout immediately reduced AKP with the effect sustained for at least 45 min, an effect not seen without BFR. Significant between groups interactions were found only in ULS probably due to the sample size. Further studies are needed to assess the optimum parameters of BFR-exercise and to evaluate the long-term effect in the clinical improvement of symptoms with physiotherapy. Importantly, BFR-low-load exercise can be used to reduce pain and provide a window of opportunity for clinicians to strengthen AKP patients. https://doi.org/10.1016/j.jsams.2017.09.355