Blood Flow Restriction Training and Ballet?!
BFR for BALLET
This month I’m inspired by a challenging but well-healing patient case. I wanted to write about some of her achievements during treatment and the benefit of using blood flow restriction training to build muscle mass. This information is shared with the consent of the patient.
Patient’s history:
Diagnosis: Left patello-femoral (knee cap) arthritis that is bone to bone in places, flattened patellar groove, loose bodies, medial meniscus tear, and a bakers cyst which would swell in the back of knee. To put it briefly a pretty messed up knee.
Her subjective report: Ballet dancer with 20 years of left knee pain located on the lateral side and underneath her patella. With both ballet class and other exercise her knee would ‘blow up like a balloon.’ She was unable to plie on one leg, ascend/ descend stairs, or jump without pain.
Past treatments: Surgical release of her IT band, stem cell therapy, arthroscopic removal of a bone spur, acupuncture, active release technique, and several other Physical Therapy treatments.
Her general medical health is good.
Some objective findings:
Hyper-mobile patellofemoral joint when patient’s knee is extended fully and significant lateral (towards the outside) shift of patella. Hypo-mobile medial glide, inferior glide, and medial tip when the knee is flexed. This means that her knee cap wiggled around way too much when her knee was extended, but moved out of place and was very stiff when she bent her knee.
Atrophy of L leg musculature including her hip, calf, and quad muscles.
Fair motor control of both ‘sides of the axis’ (With knee patients we look at both hip and quadriceps to control the movement of the knee, and in her case neither were working very well).
20 single leg heel raises (releve) on the right leg to fatigue, 15 single leg heel raises on the left (noticeably weaker on the left side).
Brief treatment outline:
One intra-articular PRP injection to improve patellofemoral cartilage healing.
Manual therapy to decrease swelling around the patella, to decrease noticeable bakers cyst, and to release overworking hip flexor muscles especially the tensor fascia latae.
Specific hands-on treatment to reduce the stiffness and improve alignment of her knee cap when her knee was flexed. These treatments included joint mobilization to the patella with her knee flexed to 20 degrees and 90 degrees.
Exercises:
Blood flow restriction training on her left lower extremity for building strength in the quadriceps, calf, and hip.
*Check out the BFR PAGE for a more thorough description of how blood flow restriction works.
Why was it so useful for this patient? When someone can’t lift weights because of pain but needs to build muscle mass this is an AWESOME option and it really was a huge part of what helped this patient get better. With the BFR machine they were able to do the prescribed exercise without pain and build muscle mass which helped to stabilize her knee in a way that improved her symptoms.
Why wouldn’t other exercises be as good? As we stated above this patient had a “pretty messed up knee.” One issue is that when you have joint arthritis you don’t really want to compress the joint with heavy weights as it could exacerbate the arthritis and cause pain. However, in order to build muscle you have to put a certain amount of load on the tissue to help signal the body to increase the muscle’s size. Using the BFR got the same results without risking the health of her knee joint.
Once she was stronger we added functional coordination and endurance training with specific ballet based exercises. *progressed over time to account for gains in strength/ stability and improvements in knee pain.
Outcomes:
Patient has returned to taking ballet class 3 times a week without knee swelling.
She has minimal pain with deeper single leg plie (squat) and this is continuing to improve over time.
30 single leg heel raises on both sides.
Noticeable hypertrophy (bigger muscles) of her quadriceps and hip complex with good control of patella during active range of motion and squatting activities.
She has returned to ascending/ descending stairs without pain and is jumping rope to start some plyometric training routine.
The snapshots below are ‘before’ and ‘after’ photos that show some change in her left quadriceps strength.
I’m so impressed by how far she’s come. Our treatments were adjusted depending on what she was working on, and it’s been really fun to come up with ballet based exercises for her. I honestly don’t think we could have made the gains we did without using the BFR and I hope it can continue to make its way into the dance - therapy world.