Use of blood flow restriction for increasing the strength of the ischiocrural muscles in anterior cruciate ligament rehabilitation: A case report

Abstract

BackgroundThe hamstring muscles have a key function in the stability of the knee, limiting the anterior translation of the tibia. Therefore, to better perform rehabilitation after anterior cruciate ligament (ACL) surgery, it is important to develop a specific program based on hamstring strength recovery. It is possible to increase strength and muscle hypertrophy through high load exercises (HL); the recommended load is about 60%–80% of a maximum repetition (MR). Although low‐load resistance training (LL) is ineffective at reproducing these values, the use of Blood Flow Restriction (BFR) with LL exercises appears to allow athletes to increase strength and muscle hypertrophy. This could limit functional decline and mitigate muscle atrophy allowing to optimize the recovery path and load management in post‐operative patients. Recent scientific evidence, as far as the increasingly frequent use of BFR in rehabilitation and sports rehabilitation is concerned, suggests that these devices could represent one of the most significant innovations in the physiotherapy field. The aim of this study was to increase the strength of the hamstrings in the early phases of ACL rehabilitation with an LL‐BFR training protocol for speeding up the development of adequate muscle strength.Case descriptionsThe patient, a 25‐year‐old male professional footballer, suffered from ACL injury during a football match, and after three months, he underwent a reconstruction ACL surgery with medial Hamstring tendon autograft. The athlete engaged a pre‐operative program to restore a full active and passive knee range of motion and increase muscular strength. The first rehabilitation phase was supported by the adoption of BFR for hamstring strengthening, starting from the sixth week post‐surgery (T0). A complete assessment of posterior hamstring muscles was performed through a hand‐held dynamometer and load detection platforms. Three different types of exercises, focusing on the hamstring muscles, were chosen. Two further assessments were performed over time (T1 ant T2), highlighting different changes that occurred.ResultsInteresting results showed a significant increase between T0 and T1 for all the assessed outcomes; in this case an average increase in strength of 59.87% between the beginning and the end of 4 weeks rehabilitation protocol was obtained in the first interval (T0‐T1), while only 25.26% resulted in the second interval (T1‐T2). However, the collected data should be considered with caution due to some limitations: the single experience of a single patient can hardly be generalized. Moreover, the reliance on isometric measurement of maximal strength and the absence of a direct strength measurement of the hamstrings during squat remain questionable.ConclusionThe final results suggest the capacity of the LL‐BFR exercises to recreate a condition of a high intensity muscular effort with respect to load management, especially after surgery. This highlights the need to further investigate BFR adoption as it allows the patients to speed up their rehabilitation goals in developing adequate muscle strength.

Effectiveness of a rehabilitation protocol after anterior cruciate ligament reconstruction in returning to match rhythm: a case study of a professional soccer player

“…ACL injuries not only impact an individual's immediate ability to participate in sports but also have long-term implications for the function and health of the knee joint. Damage to the ACL can lead to instability, reduced functionality, and an increased risk of developing osteoarthritis in the affected knee over time (Ceccarelli, 2023). Therefore, understanding the mechanisms and risk factors associated with ACL injuries is crucial in developing effective prevention strategies and rehabilitation protocols to mitigate the impact of these injuries on athletes and individuals alike.…”

“…The use of blood flow restriction in strengthening the ischiocrural muscles as part of ACL rehabilitation has shown promise in improving knee stability by limiting the anterior translation of the tibia. Strengthening the hamstring muscles, which play a significant role in knee stability, can contribute to better outcomes in ACL rehabilitation and potentially reduce the risk of re-injury (Ceccarelli, 2023).…”