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How do you safely & effectively implement Leg Press & Knee Extensions in the early phase after a combined ACL and meniscus reconstruction? This is the 3. post, in the continuing series on BFR augmented rehab for ACL-R and sutured meniscus, currently 6 weeks post op.

In the video you will find that the exercise selection has been progressed by single leg press and end-range isotonic knee extension. Additionally, we’re utilizing contralateral high load resistance training for the interset rest periods. . The primary concern for the leg press is the compressive force within the knee, possibly affecting the sutured meniscus. Though, as the meniscus has a rich supply of pain receptors, monitoring any aggravation is most likely sufficient for monitorization of progression e.g., load and ROM. . In the 2. part of the video knee extension has been progressed from end range isometric contraction to limited-range isotonic contraction. . It is commonly described that Open-Kinetic-Chain (OKC) exercises like knee extension creates detrimental anterior forces within the knee. . For this reason many recommend to avoid OKC after ACL-R because of the proposed strain on the graft increasing knee laxity. . Though, when examining the vast amount of research, it seems less of importance beyond 4 weeks post op. On the other hand, it seems appropriate to limit ROM from 90-40° when using moderate or high relative load for OKC exercises at 4-12 weeks post ACL-R.

Secondly, considering the tensile force from the anterior glide of the shin bone relative to femur, it is recommended to place the shin pad more proximally. With the pad positioned mid-shin vs ankle level, the strain on the ACL is approximately 50% less.

But utilizing low-load we can probably exercise the joint in full ROM with less of a concern in regards to graft stress. And by augmenting this low-load condition by BFR we can amplify the muscular recruitment similarly to a high-load condition.

Apparently, BFR can be such a game changer especially for the early-mid phase rehab in ACL-R.

Any thoughts on this exercise prescription or concerns for laxity?

Primary Source:

Perriman et al. (2018) The Effect of Open- Versus Closed-Kinetic-Chain Exercises on Anterior Tibial Laxity, Strength, and Function Following Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis.

How do you safely & effectively implement Leg Press & Knee Extensions in the early phase after a combined ACL and meniscus reconstruction? This is the 3. post, in the continuing series on BFR augmented rehab for ACL-R and sutured meniscus, currently 6 weeks post op.

In the video you will find that the exercise selection has been progressed by single leg press and end-range isotonic knee extension. Additionally, we’re utilizing contralateral high load resistance training for the interset rest periods. . The primary concern for the leg press is the compressive force within the knee, possibly affecting the sutured meniscus. Though, as the meniscus has a rich supply of pain receptors, monitoring any aggravation is most likely sufficient for monitorization of progression e.g., load and ROM. . In the 2. part of the video knee extension has been progressed from end range isometric contraction to limited-range isotonic contraction. . It is commonly described that Open-Kinetic-Chain (OKC) exercises like knee extension creates detrimental anterior forces within the knee. . For this reason many recommend to avoid OKC after ACL-R because of the proposed strain on the graft increasing knee laxity. . Though, when examining the vast amount of research, it seems less of importance beyond 4 weeks post op. On the other hand, it seems appropriate to limit ROM from 90-40° when using moderate or high relative load for OKC exercises at 4-12 weeks post ACL-R.

Secondly, considering the tensile force from the anterior glide of the shin bone relative to femur, it is recommended to place the shin pad more proximally. With the pad positioned mid-shin vs ankle level, the strain on the ACL is approximately 50% less.

But utilizing low-load we can probably exercise the joint in full ROM with less of a concern in regards to graft stress. And by augmenting this low-load condition by BFR we can amplify the muscular recruitment similarly to a high-load condition.

Apparently, BFR can be such a game changer especially for the early-mid phase rehab in ACL-R.

Any thoughts on this exercise prescription or concerns for laxity?

Primary Source:

Perriman et al. (2018) The Effect of Open- Versus Closed-Kinetic-Chain Exercises on Anterior Tibial Laxity, Strength, and Function Following Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis.

How do you safely & effectively implement Leg Press & Knee Extensions in the early phase after a combined ACL and meniscus reconstruction? This is the 3. post, in the continuing series on BFR augmented rehab for ACL-R and sutured meniscus, currently 6 weeks post op.

In the video you will find that the exercise selection has been progressed by single leg press and end-range isotonic knee extension. Additionally, we’re utilizing contralateral high load resistance training for the interset rest periods. . The primary concern for the leg press is the compressive force within the knee, possibly affecting the sutured meniscus. Though, as the meniscus has a rich supply of pain receptors, monitoring any aggravation is most likely sufficient for monitorization of progression e.g., load and ROM. . In the 2. part of the video knee extension has been progressed from end range isometric contraction to limited-range isotonic contraction. . It is commonly described that Open-Kinetic-Chain (OKC) exercises like knee extension creates detrimental anterior forces within the knee. . For this reason many recommend to avoid OKC after ACL-R because of the proposed strain on the graft increasing knee laxity. . Though, when examining the vast amount of research, it seems less of importance beyond 4 weeks post op. On the other hand, it seems appropriate to limit ROM from 90-40° when using moderate or high relative load for OKC exercises at 4-12 weeks post ACL-R.

Secondly, considering the tensile force from the anterior glide of the shin bone relative to femur, it is recommended to place the shin pad more proximally. With the pad positioned mid-shin vs ankle level, the strain on the ACL is approximately 50% less.

But utilizing low-load we can probably exercise the joint in full ROM with less of a concern in regards to graft stress. And by augmenting this low-load condition by BFR we can amplify the muscular recruitment similarly to a high-load condition.

Apparently, BFR can be such a game changer especially for the early-mid phase rehab in ACL-R.

Any thoughts on this exercise prescription or concerns for laxity?

Primary Source:

Perriman et al. (2018) The Effect of Open- Versus Closed-Kinetic-Chain Exercises on Anterior Tibial Laxity, Strength, and Function Following Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis.

February 07, 2021

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How do you safely & effectively implement Leg Press & Knee Extensions in the early phase after a combined ACL and meniscus reconstruction?

January 27, 2021

Fit cuffs, fitcuffs, okklusionstræning occlusion training, blood flow restriction exercise, oclusao vascular, vascular occlusion vascular occlusion training bfrtraining kaatsu, bfr, bfrt, blood flow restriction therapy, bfr exercise, okklusjonstrening, Okklusionstraining, ocklusionsträning, bfrcuffs, bfrtool, bfrequipment, bfr cuffs

In display we have the new Wireless edition of the pressure gauge assessing Limb Occlusion Pressure (LOP) by the Bluetooth Device and app, which can be imperative for safe applications of blood flow restriction (BFR).


This is the 3. post, in the continuing series on BFR augmented rehab for ACL-R and sutured meniscus, currently 6 weeks post op.

In the video you will find that the exercise selection has been progressed by single leg press and end-range isotonic knee extension. Additionally, we’re utilizing contralateral high load resistance training for the interset rest periods.

The primary concern for the leg press is the compressive force within the knee, possibly affecting the sutured meniscus. Though, as the meniscus has a rich supply of pain receptors, monitoring any aggravation is most likely sufficient for monitorization of progression e.g., load and ROM.

In the 2. part of the video knee extension has been progressed from end range isometric contraction to limited-range isotonic contraction.

It is commonly described that Open-Kinetic-Chain (OKC) exercises like knee extension creates detrimental anterior forces within the knee.

For this reason many recommend to avoid OKC after ACL-R because of the proposed strain on the graft increasing knee laxity.

Though, when examining the vast amount of research, it seems less of importance beyond 4 weeks post op. On the other hand, it seems appropriate to limit ROM from 90-40° when using moderate or high relative load for OKC exercises at 4-12 weeks post ACL-R.

Secondly, considering the tensile force from the anterior glide of the shin bone relative to femur, it is recommended to place the shin pad more proximally. With the pad positioned mid-shin vs ankle level, the strain on the ACL is approximately 50% less.

But utilizing low-load we can probably exercise the joint in full ROM with less of a concern in regards to graft stress. And by augmenting this low-load condition by BFR we can amplify the muscular recruitment similarly to a high-load condition.

Apparently, BFR can be such a game changer especially for the early-mid phase rehab in ACL-R.

Any thoughts on this exercise prescription or concerns for laxity?

Primary Source:

Perriman et al. (2018) The Effect of Open- Versus Closed-Kinetic-Chain Exercises on Anterior Tibial Laxity, Strength, and Function Following Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis.
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Limb Occlusion Pressure or LOP is the minimum pressure needed to fully block both arterial & venous blood flow. In display 160 mmHg is LOP for this particular person, for that limb, in this position with this exact cuff (Arm Cuff V3).

When preparing for BFR training just set the pressure relative to 100% LOP, but without the Bluetooth Device attached, as this will automatically deflate the cuff.

We recommend to measure LOP in a seated position with the following recommendations for setting the pressure during upper body exercise:

Lying exercise: 40-70% of LOP & seated or standing exercise: 40-80% of LOP. For swift conversions of % to mmHg by our app check the LOP module at training.fitcuffs.com.

“Based on the results of our study, we recommend using the Fit Cuffs® portable Bluetooth Device for objective and personalized BFR practice. This device is a valid, reliable and low-cost replacement for other measurement devices, which are substantially more expensive and require considerable usage skills. Thus, using the Bluetooth Device would offer BFR practitioners the ability to provide high-quality services for their clients or patients, ensuring minimal risks and optimal results regardless of location.” El-Zein (2020).

Nerd Alert – The Bluetooth Device works by oscillometrics i.e, analyzing pulse waves and the absence of pulse waves. This is fundamentally the same as ultra sound by handheld dopplers that detects the absence of blood flow.

– The correct terminology is probably “Arterial Occlusion Pressure” (AOP), but LOP and AOP can for practical applications and explanations be used interchangeably. Total Limb Occlusion (TOP) is another term used in BFR research, this method resolves the problem with hemodynamics i.e., blood pressure variability in relation to external stimuli. So please mind, when doing repeated and continues measurements of LOP on the same limb, readings will vary because of the hemodynamic response to BFR.

Source:

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

Morais et al. (2016) Upper limbs total occlusion pressure assessment; Doppler ultrasound reproducibility and determination of predictive variables.

Loenneke et al. (2014) Blood flow restriction in the upper and lower limbs is predicted by limb circumference and systolic blood pressure.

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

Disclaimer: When assessing conventional blood pressure, you should always use a calibrated cuff, i.e., width of the cuff relative to the circumference of the limb you are assessing. That is why you can not use Fit Cuffs product selection to measure “blood pressure” and this combined unit is only valid for assessment of LOP.
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