BalanceRehab: How To Avoid Common Active injuries

Newsletter by Balance Rehabilitation

N E W S L E T T E R

Are You Compromising Your FormDue To An Injury?

See Inside • Personalized Blood Flow Restriction • Have You Met Your Annual Insurance Deductible? • Patients Benefitting from BFR Training • Blood Flow Restricted Exercise

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N E W S L E T T E R

Personalized Blood Flow Restriction

• Decreased expression of myostatin (Myostatin impairs muscle growth) • Increase strength with only 30% loads • Increase hypertrophy with only 30% loads • Improve muscle endurance in 1/3 the time

Are you recovering from an injury? If so, you may be a candidate for blood flow restriction treatments. This may seem counterintuitive – you might ask yourself, “Why would I want to restrict my blood flow? Isn’t it good for blood to circulate?” While these are valid points, blood flow restriction treatments can actually pose several benefits, especially in athletes. Treatments are usually done during exercise, using compression to restrict circulation in the affected area(s). This is done in order to promote hypertrophy (increase in muscle mass) and prevent disuse atrophy (decrease in muscle mass). If you are interested in learning more about blood flow restriction and how it may benefit you, contact Balance Physical Therapy today! How exactly does blood flow restriction work? The compression devices used during blood flow restriction treatments are FDA approved devices that are personalized to your physiology to maximize benefits and ensure safety. The pressure created by these compression devices is high enough to occlude blood flow at 50-80% within the affected muscles. Blood flow restriction is based on the theory that the treatments lead to a “local hypoxic event,” meaning the tissues in the affected area will be temporarily deprived of oxygen. While this may sound intimidating, the local hypoxia actually helps inaccumulatingmoremetabolites, inorder toregulate thebody’sanabolic responsesystem (alsoknownas theway inwhich thebodygainsmuscleprotein) during exercise. Essentially, restricting the blood flow in the affected area helps to build more muscle protein. Restricting blood flow with low intensity exercise mimics high intensity, high load exercise and sets off a chain of events that build muscle protein and promote healing off soft tissue, ligament, tendon and bone. Physiological responses to blood flow restriction include: • Increased anabolic growth factors • Fast twitch fiber recruitment • Diminish atrophy & loss of strength from disuse and non-weight bearing after injuries

• Improve muscle protein synthesis in the elderly • Improve strength and hypertrophy after surgery • Improve muscle activation • Increase growth hormone responses

Will blood flow restriction benefit me? At your initial appointment, one of our physical therapistswillconductaphysicalevaluation,analysisofmedicalhistory, and discussion of symptoms, in order to determine if blood flow restriction will be the best course of treatment for you. Often times we will consult with your physician before moving forward with personalized BFR. Blood flow restriction has been used to treat many upper or lower body injuries and is often used as a form of rehabilitation prior to and following surgery. The compression device itself measures the amount of pressure that is recommended for each patient in order for you to successfully execute each targeted exercise and gain the desired effects. When performing the exercises, the intended goal of blood flow restriction is to fatigue the affected area, in order to stimulate the body’s natural healing and tissue-building processes. Contact Balance Physical Therapy today: If you are recovering from an injury or surgery, and you are interested in potentially participating in blood flow restriction treatments,don’thesitate tocontactourphysical therapyoffice today. Our licensed physical therapists are highly trained in performing this treatment and theywould love todiscusshow itmaybenefityoupersonally.ContactBalance Physical Therapy today to schedule a consultation and get started on the path toward pain relief, increased strength, and overall functional improvement!

Image courtesy of www.owensrecoveryscience.com

Call us today to setup an initial consultation and see just how well you can feel with physical therapy.

PATIENTS BENEFITTING FROM BFR TRAINING

Tito came to see us Spring of 2019 after his second anterior cruciate ligament (ACL) reconstruction. Tito is a midfielder on the NCAA Division II Saint Anselm’s college lacrosse team. For the second time (he tore his left ACL in 2017) he had a non-contact injury and tore his right ACL. In a way, his timing was excellent, as we had just started offering Blood Flow Restriction (BFR) therapy at Balance. We were able to start utilizing the BFR tourniquet with low intensity exercise very early in the post-operative rehabilitation process. This early application of BFR can have a huge impact on the rehabilitation process. After injury, like an ACL tear, the body releases Myostatin, a chemical that promotes atrophy (muscle wasting) and fibrosis (scar tissue formation). The effect of this chemical combined with disuse creates so much atrophy, that after one year of rehabilitation, many athletes have not restored full strength or muscle girth (size) to their affected limb. By utilizing BFR, we can shut down the release of myostatin and promote the release of growth hormone and growth factors that stimulate repair and muscle protein synthesis. BFR is a very powerful tool. “BFR made a major difference in my ACL recovery. Compared to my other ACL recovery (in which I did not use BFR) I felt a major difference in my leg strength earlier on in the recovery process. The muscle mass on my leg was significantly more when using the BFR and allowed my recovery to progress at a faster rate than I could have imagined an ACL recovery to take.” Chris Pierce, Physical Therapist and Certified Strength and Conditioning Specialist worked with Tito through his early rehabilitation. “While I have rehabilitated hundreds of athletes after ACL reconstruction, I have never seen anyone restore strength and muscle mass as quickly as Tito did while using BFR and low intensity exercise. We were able to get him under the squat bar sooner than any of my previous high- level athletes after this surgery. He was pushing real weight with good form and symmetry without pain. This speaks both to Tito‘s high level of drive and the effectiveness of the BFR. Personalized BFR training is the game changer of game changers.“ BFR training is not for everyone. It requires hard work and high level of effort in combination with tolerance to significant discomfort. When you restrict bloodflow entirely out of the limb, you trap lactic acid in the muscles. Anyone who has lifted heavy weights knows what a muscle burn feels like. This burn quickly dissipates when completing an exercise. But with blood flow restriction the tourniquet is applied for 6 to 8 minutes, creating a sustained “muscle burn.“ Paul Godbout has been using BFR since his surgery to repair his quad tendon after he tore it playing in a rugby match for Amoskeag Rugby Club earlier this year. Within a week of his surgery and 2 weeks from his injury, Paul started low intensity quadricep and hip exercises with BFR. Though the road is long after this injury, BFR combined with Paul’s hard work minimized the early atrophy and allowed for him to accelerate his recovery significantly.

When asked to describe BFR, Paul Godbout explained it like this: “My knee and associated muscles feel great after the BFR treatment. It’s tough and uncomfortable while doing the BFR exercises, however the results are worth it. I’m months ahead of schedule.” Kathy Cortelyou, Physical Therapist and Sports Certified Specialist points to the very robust research supporting early use of BFR after injury and surgery to stop the body’s tendency to create scar tissue and to atrophy. “If we could get athletes old and young in our doors sooner after injury we could save themweeks and sometimes months of rehabilitation on the back end by implementing BFR.”

Call Balance Rehab at 603.890.8844 , or visit our website at balance-rehab.com to schedule your appointment today!

BLOOD FLOW RESTRICTED EXERCISE Blood flow restricted (BFR) rehabilitation is the brief and intermittent occlusion of venous (veins) blood flow using a tourniquet while exercising. Using this technique you can exercise with significantly lighter weight while still creating a hypertrophy (growth) and strength response. Traditionally to get a hypertrophy and strength response in your muscles you would need to lift a heavy load. Application. The goal is to reduce just enough blood flow to create positive changes. However, the amount of pressure used varies between individuals. The sizeofyour limb,densityof thesoft tissue inyour limb,bloodpressure,placement of the tourniquet cuff and width of the tourniquet cuff all must be taken into account when determining your personalized pressure. Your healthcare provider will utilize a specialized tourniquet system with built in monitor to account for these variables. Additionally, your healthcare provider will discuss potential contraindications to this treatment with you to determine if you are a candidate. Training. Once your personalized pressure is determined you will begin specific exercises based on your rehabilitation plan. Even though you are lifting a light weight your muscle will begin to feel like it is working very hard. This feeling in yourmuscle is thebuildupof lactateand is thedesiredresponseof this training. It is important thatyoucomplete the totalnumberofsetsandrepetitionsprescribed by your healthcare provider in order to maximize this response. You may also begin to sweat and feel your heart rate rise similar to a heavy workout. This is common and expected. Effects. After you have completed your exercise session and you have built up sufficient lactate many positive effects can occur. These include an increase in growth hormone and other anabolic (positive) muscle growth factors. There will also be an increase in muscle protein synthesis, your muscles ability to grow. You should discuss proper nutrition guidelines with your healthcare provider to maximize these effects. Side Effects. Adverse side effects are rare. The most common effects after this training are residual swelling in the limb, a fatigued muscle and possibly some mild soreness. These are transient and usually resolve within 24 hours. If you have prolonged swelling, fatigue or soreness discuss this with your healthcare provider along with any other concerns you may have. Source: “From Owen’s Recovery Science”

HAVE YOU MET YOUR ANNUAL INSURANCE DEDUCTIBLE?

An insurance deductible is the amount of money that you must pay before your insurance company pays for your medical services. If your deductible is met, your Physical Therapy may not cost you anything. Patients with family plans or those who have had major surgeries or have a chronic illness are especially likely to have a $0 balance remaining on their out-of-pocket expenses. This means that the cost of physical therapy could be minimal or completely covered by the patient’s insurance plan. If you are close to or have met your insurance deductible for the year, then now is the time to come in for Physical Therapy! Are you feeling aches and pains? Need to work on your core? Let us help you get a head start for 2020. Contact us today to schedule your appointment.

REFUELING YOUR BODY WITH CHOCOLATE MILK AFTER A HARD WORKOUT

We all know that working out is good for our muscles, but did you know that what you eat and drink AFTER a workout can have a huge impact on how those muscles recover and get ready for the next round at the gym? There have been a multitude of studies suggesting that drinking chocolate milk after a hard workout can help the body retain, replenish and rebuild muscles to help in the recovery process. Carbohydrates and Protein. Chocolate Milk has a 3:1 carbohydrate to protein ratio.This is theperfectbalanceofcarbs toprotein tohelpre-fuel tiredmuscles. During exercise our muscles rely on both stored and dietary carbohydrates for energy. Since carbohydrates are burned quickly, they are used up quickly and chocolate milk is an easily digestible and delicious way to re-fuel tired muscle glycogen (stored carbs) at a time when a person may not feel like eating solid foods. Chocolate milk provides a natural source of high quality protein to speed alongmusclerecoveryanddiminish the likelihoodofsoremuscles thenextday. Milk protein consists of whey and casein, both of which help muscle rebuilding but in different ways. The whey is fast acting, and the casein is slow acting. If that was not enough, milk also contains the amino acid leucine, which acts as a “light switch” for turning on muscle recovery after a workout. Hydration. Chocolate milk is 90% water, which means its is an excellent choice for re-hydrating after a workout. Studies have indicated that both fat free and whole milk rank higher than some sports drinks for re-hydration due to their sodium and potassium content. What About Sugar? Yes, chocolate milk does contain sugar, but we need to remember thatweare talkingaboutathletes thathavebeenworkingouthard for over an hour. Sugar is what the body needs to replace depleted carbohydrates

after a hard workout. Along with this additional sugar, chocolate milk provides a myriad of nutrients such as bone building calcium, magnesium and Vitamin D, electrolytes and B vitamins that help convert food to energy. If you are lactose intolerant or have a milk allergy, there are several options of chocolate milk that may work for you. Lactaid milk works well if you have difficulty digesting the milk sugar lactose and A2 milk is another brand that may work for someone with a casein allergy. So the next time you push yourself hard at the gym or go for a long run, grab chocolate milk because it is good for you and it tastes great!

Noreen Gallo MSRD, LD Your Forever Nutrition Counseling

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