Korean J Sports Med.  2024 Sep;42(3):165-175. 10.5763/kjsm.2024.42.3.165.

Application of Blood Flow Restriction Exercise in Knee Patients: Current Concepts Review

• Kwon SH
• Lee JW
• Cho SI
• Kim SW
• Park BS
• Lee DW

• KMID: 2558664
• DOI: http://doi.org/10.5763/kjsm.2024.42.3.165

Abstract

n patients who have undergone knee joint surgery or suffer from osteoarthritis, weakened quadriceps muscle strength is often observed. This can lead to various pathological issues in the long term, such as abnormal gait and persistent knee pain. Due to the need to protect against pain or surgical site complications, high-intensity exercise is often restricted for most patients with muscle atrophy in the knee joint due to surgery or osteoarthritis or surgery. To overcome this challenge, various methods are being attempted, including exercise combined with neuromuscular electrical stimulation, blood flow restriction (BFR) exercise, and biofeedback exercise. Recently, BFR exercise has garnered attention in line with these strategic trends. Applying low-intensity BFR exercise to patients who have undergone anterior cruciate ligament reconstruction surgery or suffer from knee joint osteoarthritis, most studies report improvements in strength, muscle mass, and functional enhancement of the knee joint. Compared to non-BFR high-intensity exercise, it has been reported that increases in maximal strength and muscle mass are similar, but pain reduction is superior with BFR exercise. Engaging in low-intensity BFR exercise for a sufficient duration can minimize the risk of injury associated with high-intensity exercise while maximizing the exercise’s effectiveness, leading to symptom improvement and enhancement of knee joint function. Furthermore, when conducted according to specified manuals, the likelihood of cardiovascular imbalance, muscle damage, thrombosis, and embolism due to BFR is low, making it a safe rehabilitation method.

Keyword

Blood flow restriction therapy; Blood flow restriction exerciset; KAATSU training; Anterior cruciate ligament reconstruction; Knee osteoarthritis

Figure

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  Fig. 1 Blood flow restriction instruments consist of tourniquet cuff, blood pressure gauge, and pump. Tourniquet cuff is used to partially restrict arterial inflow and fully restrict venous outflow during exercise. The blood pressure gauge is used to measure the pressure within the cuff. The pump is used to inflate the tourniquet cuff to the desired pressure.

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  Fig. 2 Mechanism of blood flow restriction exercise. IGF; insulin like growth factor.

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  Fig. 3 Algorithm for blood flow restriction training (BFRT) in a similar protocol as reported in the previous review article of Scott et al.48 (Sports Med 2015;45:313-25).

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  Fig. 4 Blood flow restriction-voluntary resistance exercise.

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