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This case study involves a 35-year-old male weightlifter and strength and conditioning (S&C) coach who underwent left distal biceps repair surgery following a traumatic full biceps tendon rupture. The injury happened while spotting a client who was performing a push press exercise and the patient underwent surgery four days later. A short course of Tylenol was prescribed for the first three days post-op, the arm was immobilized in a soft cast, and the patient was advised to use a sling while at work. The surgeon recommended a lifting restriction of one pound on the left arm for three months.
The patient presented to physical therapy five days post-op and was treated 2x/week for 15 weeks. Treatment included taping, laser, manual soft tissue mobilization, and blood flow restriction training. BFR was started 3 weeks post-op using a 30, 15, 15, 15 protocol (one set of 30 reps, followed by three sets of 15 reps with a 30 sec rest period between all sets). A blood pressure cuff inflated to 80 mmHg with the arm at rest was used throughout the treatment. The exercises started with no additional external load with the forearm in neutral and were progressed to 4lbs of external load with the forearm in a supinated position.
The authors explain that, “BFR training commenced three weeks post-op in an effort to mitigate the loss in biceps strength and mass as a result of the post-op weight restriction recommended to the weightlifter. BFR has been shown to diminish strength loss and muscle atrophy absent of muscular contraction and when paired with external loads of 20-30% MVC, it has been shown to have a similar effect on muscle hypertrophy and strength that is comparable to resistance training with loads >70% MVC.”
The authors also note the possible impact that BFR training can have on the osteo-tendinous junction of the reattachment site. “Increases in interosseous pressure are thought to occur through BFR training and may influence fluid shifts through the capillary networks found in bony structures. BFR training has shown to impact bone healing properties through metabolic markers that reduce osteoclast activity.”
The authors explain that since the rehabilitation program was multimodal, it is difficult to determine how beneficial the effects of BFR training alone were for the weightlifter. “It is likely that each element of the treatment and rehabilitation had varying degrees of importance depending on each stage of the healing process.”
The results showed improvements in pain, strength, ROM, and functional outcome measures. Although arm circumference was not measured on the initial evaluation, the patient reported feeling as if his surgical arm girth was actually
larger than the non-surgical arm after only five weeks of BFR training. This prompted a measurement and the circumference of the surgical arm was actually 2cm larger than the non-surgical arm!
What do you think? Should BFR training be included in distal biceps rehabilitation protocols across the board or is more research needed at this time?
Wentzell M. (2018). Post-operative rehabilitation of a distal biceps brachii tendon reattachment in a weightlifter: a case report. The Journal of the Canadian Chiropractic Association, 62(3), 193–201.
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