Total Hip Replacement (THR) Rehab with Blood Flow Restriction – Part 2/?

The Importance of Limb Occlusion Pressure (LOP/AOP) Assessment Post-surgery as LOP can defer substantially on contralateral limbs!

As you might already have noticed, this is the follow-up to the post published on Feb 3.

Please check below for a general explanation of LOP.

Currently, that is 2 weeks post-op. Alex has just started rehabbing with BFR. The sutures have been removed, and the cicatrice is healing as planned with no complications whatsoever, and the surgeon had approved BFR.

As displayed in the video, on the atrophied operated left hip, Alex has a substantially lower LOP at 146 mmHg, whereas 176 mmHg was detected on the contralateral leg!

Worth noting is the difference of 30 mmHg, which is probably what most healthcare professionals and trainers practicing BFR would consider of clinical relevance.

Thus, Alex’s thigh circumference differs only about 2 cm/ 0.8 Inch, probably because of minor edema, i.e., swelling surrounding the deep laceration and cicatrice. So, for Alex and potentially similar cases, limb circumference is a poor predictor of LOP.

This is particularly important when applying very low-load BFR early post-op, as higher pressures seem to be warranted. On the other hand, to avoid excessive stress on the vasculature, 80% LOP seems to be the upper limit when combined with exercise.

In this case, doing his standard rehab exercises augmented by BFR, it is advisable to keep the pressures at a maximum of ~120 mmHg, measured in a complete resting state and similar body positioning relative to the actual exercise. Whereas any BFR exercise on his unaffected right leg can definitely reach about 140 mmHg.

As no apparent discomfort at the cicatrice, even with the higher pressures, BFR is definitely expected to accelerate his recovery.

Please leave a comment for any relevant concerns in post-op BFR or general considerations in rehabbing individuals with THR!?

Concerning the LOP Device check fitcuffs.com/lop.

Limb Occlusion Pressure / Arterial Occlusion Pressure (LOP/AOP) explained:
To ensure the safety and efficacy of BFR training, it is important to determine the proper level of pressure to use, which can be determined through an assessment known as LOP.

LOP is a measurement of the minimum amount of pressure needed to completely occlude blood flow to a limb. It is often measured using a specialized cuff and a Doppler ultrasound device. Once the LOP has been determined, it is used as a guide for setting the appropriate level of pressure for BFR training.

One of the primary benefits of using LOP in BFR training is that it allows for a more personalized and accurate approach to set pressure levels. Since every individual has a unique LOP, using a standardized pressure level for all participants can result in unsafe or ineffective training. By measuring LOP, trainers and athletes can set pressure levels that are specific to the individual’s limb and ensure that the optimal amount of blood flow restriction is achieved.

Additionally, using LOP in BFR training can help to reduce the risk of injury. Overly high-pressure levels can lead to serious complications such as blood clots, nerve damage, or even limb amputation. Conversely, using pressure levels that are too low may not provide enough blood flow restriction to be effective. By measuring LOP, healthcare professionals or trainers can set pressure levels that are both safe and effective, reducing the risk of injury while maximizing the benefits of BFR training.

Another important factor to consider when using LOP in BFR training is the importance of re-evaluating the pressure level over time. LOP can change as a result of various factors such as changes in body composition, changes in blood pressure, or changes in the training environment. Therefore, it is important to regularly re-evaluate LOP to ensure that the appropriate pressure levels are being used.

Relevant souces:
Chulvi-Medrano et al. (2023) Blood Flow Restriction Training in Clinical Rehabilitation: Occlusion Pressure Methods Relative to the Limb Occlusion Pressure

Yamada et al. (2022) Potential considerations with estimating blood flow restriction pressure in the lower body using a narrower cuff

Bell et al. (2020) Limb Occlusion Pressure: A Method to Assess Changes in Systolic Blood Pressure

Mouser (2017) A tale of three cuffs the hemodynamics of blood flow restriction

El-Zein (2020) (Thesis) the use of a portable Bluetooth Device to measure blood flow restriction training pressure requirements: a validation study

Schmidt (2021) (Thesis) Validity and reliability of an oscillatory blood pressure measurement device to determine the arterial occlusion pressure in healthy adults for blood flow restriction training exercise protocols: a cross-sectional study