Page 64 - Journal of Special Operations Medicine - Spring 2015

explosive device blast injury. He underwent limb salvage During the 2 weeks of BFR training, all patients were
treatment for approximately 2 years including place­ directly monitored by experienced physical therapists.
ment of a ringed external fixator and bone transport for None of the patients experienced any adverse events
significant bone loss. He was definitively treated with due to the training during this time. The only side effect
an intramedullary tibia nail following ringed fixator re­ experienced was immediate muscle soreness, which, per
moval. He was referred for BFR training 9 months after patient report, resolved by the next therapy session.
his last surgery.
Lessons Learned
Initial Biodex testing showed 49% peak torque (Table
1), 39% deficit average power (Table 2), and 40% defi­ All of the patients in this series demonstrated improve­
cit in total work (Table 3) in knee extension at 90º/sec. ments in knee extension and/or flexion testing after only
After 2 weeks of BFR therapy, he improved peak torque 2 weeks of BFR training. The average gains in peak
by 26% (Table 4), power by 33% (Table 5), and total torque, average power, and total work are summarized
work by 25% (Table 6) at the same extension speed and on Table 7 and depicted in Figure 2.
similar improvement in knee extension at 300º/sec as
well. Table 7 Mean Changes After BFR Training (%)
Extension Flexion Extension Flexion
Measurement Speed 1 Speed 1 Speed 2 Speed 2
Case Presentation 6
33.4 ± 28.8 ± 16.5 ± 21.8 ±
The patient is a 27­year­old man who 2012 sustained a 23.8 25.6 18.7 15.2
right tibia plafond fracture with associated fibula and Peak torque 2.5 to 2.3 to –15.3 to 4.3 to
calcaneus fractures from an improvised explosive de­ 65.8 73 35.8 52.4
vice. He underwent limb salvage to include placement 37.4 ± 48.7 ± 44.7 ± 75.9 ±
of an ankle­spanning ringed fixator, which was removed Average 29.0 30.9 38.9 65.8
over 1 year later, after the patient had healed. He was power 7.6 to 19.0 to –11.9 to 18.3 to
referred for BFR training 6 months after his last surgery. 76.4 102.5 108.4 212.1

Initial Biodex testing showed substantial weakness with 38.0 ± 35.6 ± 38.0 ± 47.5 ±
30.2
57.9
28.9
24.4
both knee extension and flexion with a peak torque def­ Total work
icit of 49% to 65% (Table 1), an average power deficit 7.0 to 3.9 to –13.6 to –20.1 to
69.6
77.6
159.4
77.3
of 71% to 85% (Table 2), and a total work deficit of
70% to 84% (Table 3). After 2 weeks of BFR therapy, Notes: Mean ± SD with range of torque (Nm), power (W), and work
(J) for all seven patients in case series. Speed 1 is 90º/sec. Speed 2 is
he improved his peak torque by 33% to 73% (Table 4), 300º/sec.
average power by 76% to 212% (Table 5), and total
work by 40% to 160% (Table 6). Figure 2 Mean change in peak torque (Nm), power (W),
and work (J) for all seven patients in case series after 2 weeks
(six sessions) of BFR training. Speed 1 is 90º/sec. Speed 2 is
Case Presentation 7 300º/sec.
The patient is a 48­year­old man who in May 2013 sus­
tained a comminuted left open calcaneus fracture due to
a motor vehicle collision. Two months after his injury,
he underwent staged procedures for extensive debride­
ment followed by delayed closure with local rotated flap
coverage. His calcaneus healed without hardware place­
ment due to the significant damage. He was referred for
BFR training 5 months after his last surgery.

Initial Biodex testing showed deficits in all measure­
ments; however, the largest difference extensions were at
90º/sec. At this speed, his knee extension demonstrated
a 55% deficit in peak torque (Table 1), 45% deficit in Of note, some patients improved their peak torque in knee
average power (Table 2), and 50% deficit in total work flexion more than knee extension, with the improvement
(Table 3). After 2 weeks of BFR therapy, his knee exten­ in knee extension being less consistent. All patients had
sion at 90º/sec improved peak torque 66% (Table 4), av­ improvement in their average power, which was the most
erage power 75% (Table 5), and total work 63% (Table consistent strength gain demonstrated for all measure­
6; Figure 2). ments. Total work was also improved in all cases.

54 Journal of Special Operations Medicine Volume 15, Edition 1/Spring 2015