BFR Implicated For Hypermobility Spectrum Disorders – Part 2/2 – Shoulders

This is the follow-up to the recent post on BFR for Hypermobility Spectrum Disorders (HSD).

Confirmed shoulder HSD in athletes is strongly associated with shoulder injuries, specified as Odds Ratio = 8.23, 95% CI 3.63, 18.66; p = 0.002. For this subgroup and the general population with HSD, it seems that dynamic stability is essential to achieve patient satisfaction and to acquire this, some type of resistance training is warranted. To stabilize the shoulder during movement, emphasis should also be on neuromuscular training. Though visual and subjective measures of superior shoulder kinetics should probably be evaluated with caution.

Nevertheless, recent data seems to suggest that High-load Resistance Training (HLRT) might be superior VS Low-Load in terms of patient-reported- and objective outcomes in the treatment and management of HSDs.

For instance, a new and highly interesting study by Liaghat et. al indicates that HLRT is indeed superior. Though a likely limitation in this study is the fact that HLRT did 5 progressive exercises in full Range Of Motion (ROM), whereas the low-load group did 9 different exercises in neutral/mid-ROM to mimic “standard care”.

When peering through other relevant sources there seem to be several gaps in the body of evidence to finally determine HLRT to be superior VS Low-Load and completely absent VS BFR in HSDs.

Considering the current data in healthy individuals HLRT seems to be superior regarding 1RM, and isokinetic strength when reps are “fairly” standardized, which can be explained by the rule of specificity. So, it can easily be extrapolated and hypothesized that HLRT is indeed superior, but to our knowledge, no actual data seems to confirm this!?

Specified as no study seems to utilize homogenized protocols e.g., exercise selection with standardized exhaustion like using “Reps in Reserve” (RIR), Rate of Perceived Exertion (RPE) matched exercises, or simply applying failure protocols for all groups.

Relevant programming avenues to explore in the treatment and management of HSDs:

❓️ High-Load VS Low-Load-No-BFR VS Low-Load-BFR using the same exercise selection, ROM, method of progression considering homogenized reps, and overall dosage.

❔️ Are conventional Push-Pull workouts as effective VS traditional “shoulder stability exercises (external rotation, scaption) and/or proprioceptive type exercises (Powerball, Bodyblade, etc.)

❓️ A simple comparison of Free-weights VS Machines.

❔️ A relevant outcome measure for practical application would be to explore the difference in shoulder-specific outcomes held up against what type of resistance training is subjectively preferred or objective compliance as the rate of dropouts e.g., retention.

🗨 Please let us know your thoughts on BFR Training for HSDs in the comments below!?

📄 Primary Source: Liaghat et al. (2022) Short-term effectiveness of high-load compared with low-load strengthening exercise on self-reported function in patients with hypermobile shoulders: a randomized controlled trial

📑 Supplementary source: Liaghat et al. (2021) Joint hypermobility in athletes is associated with shoulder injuries: a systematic review and meta-analysis

Watson et al. (2017) The treatment of multidirectional instability of the shoulder with a rehabilitation program: Part 2

Burkhead et Rockwood (1992) Treatment of instability of the shoulder with an exercise program

Palmer et. Al. (2014) The effectiveness of therapeutic exercise for joint hypermobility syndrome: a systematic review ↪️

“There is some evidence that people with JHS improve with exercise but there is no convincing evidence for specific types of exercise or that exercise is better than control.”