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Background We implemented a blood flow restriction resistance training (BFR-RT) intervention during an 8-week rehabilitation programme in anterior cruciate ligament reconstruction (ACLR) patients within a National Health Service setting. Objective To compare the effectiveness of BFR-RT and standard-care traditional heavy-load resistance training (HL-RT) at improving skeletal muscle hypertrophy and strength, physical function, pain and effusion in ACLR patients following surgery. Methods 28 patients scheduled for unilateral ACLR surgery with hamstring autograft were recruited for this parallel-group, two-arm, single-assessor blinded, randomised clinical trial following appropriate power analysis. Following surgery, a criteria-driven approach to rehabilitation was utilised and participants were block randomised to either HL-RT at 70% repetition maximum (1RM) ( n  = 14) or BFR-RT ( n  = 14) at 30% 1RM. Participants completed 8 weeks of biweekly unilateral leg press training on both limbs, totalling 16 sessions, alongside standard hospital rehabilitation. Resistance exercise protocols were designed consistent with standard recommended protocols for each type of exercise. Scaled maximal isotonic strength (10RM), muscle morphology of the vastus lateralis of the injured limb, self-reported function, Y-balance test performance and knee joint pain, effusion and range of motion (ROM) were assessed at pre-surgery, post-surgery, mid-training and post-training. Knee joint laxity and scaled maximal isokinetic knee extension and flexion strength at 60°/s, 150°/s and 300°/s were measured at pre-surgery and post-training. Results Four participants were lost, with 24 participants completing the study (12 per group). There were no adverse events or differences between groups for any baseline anthropometric variable or pre- to post-surgery change in any outcome measure. Scaled 10RM strength significantly increased in the injured limb (104 ± 30% and 106 ± 43%) and non-injured limb (33 ± 13% and 39 ± 17%) with BFR-RT and HL-RT, respectively, with no group differences. Significant increases in knee extension and flexion peak torque were observed at all speeds in the non-injured limb with no group differences. Significantly greater attenuation of knee extensor peak torque loss at 150°/s and 300°/s and knee flexor torque loss at all speeds was observed with BFR-RT. No group differences in knee extensor peak torque loss were found at 60°/s. Significant and comparable increases in muscle thickness (5.8 ± 0.2% and 6.7 ± 0.3%) and pennation angle (4.1 ± 0.3% and 3.4 ± 0.1%) were observed with BFR-RT and HL-RT, respectively, with no group differences. No significant changes in fascicle length were observed. Significantly greater and clinically important increases in several measures of self-reported function (50–218 ± 48% vs. 35–152 ± 56%), Y-balance performance (18–59 ± 22% vs. 18–33 ± 19%), ROM (78 ± 22% vs. 48 ± 13%) and reductions in knee joint pain (67 ± 15% vs. 39 ± 12%) and effusion (6 ± 2% vs. 2 ± 2%) were observed with BFR-RT compared to HL-RT, respectively. Conclusion BFR-RT can improve skeletal muscle hypertrophy and strength to a similar extent to HL-RT with a greater reduction in knee joint pain and effusion, leading to greater overall improvements in physical function. Therefore, BFR-RT may be more appropriate for early rehabilitation in ACLR patient populations within the National Health Service.

Examine the comfort and pain experienced with blow flow restriction resistance training (BFR-RT) compared to standard care heavy load resistance training (HL-RT) during anterior cruciate ligament reconstruction (ACLR) patient rehabilitation. Randomised controlled trial. United Kingdom National Health Service. Twenty eight patients undergoing unilateral ACLR surgery with hamstring autograft were recruited. Following surgery participants were block randomised to either HL-RT at 70% repetition maximum (1RM) (n = 14) or BFR-RT (n = 14) at 30% 1RM and completed 8 weeks of twice weekly unilateral leg press training on both limbs. Perceived knee pain, muscle pain and rating of perceived exertion (RPE) were assessed using Borg’s (1998) RPE and pain scales during training. Knee pain was also assessed 24 h post-training. There were no adverse events. Knee pain was lower with BFR-RT during (p < 0.05) and at 24 h post-training (p < 0.05) with BFR-RT for all sessions. Muscle pain was higher (p < 0.05) with BFR-RT compared to HL-RT during all sessions. RPE remained unchanged (p > 0.05) for both BFR-RT and HL-RT. ACLR patients experienced less knee joint pain and reported similar ratings of perceived exertion during and following leg press exercise with BFR-RT compared to traditional HL-RT. BFR-RT may be more advantageous during the early phases of post-surgery ACLR rehabilitation. •ACLR patients experienced less knee joint pain during and following leg press exercise with BFR-RT.•Similar ratings of perceived exertion were reported with BFR-RT and HL-RT.•The greater rating of muscle pain with BFR-RT did not limit adherence to training.•There were no adverse events throughout the training intervention period.

To compare the acute perceptual and blood pressure responses to: 1) light load blood flow restriction resistance exercise (BFR-RE) in non-injured individuals and anterior cruciate ligament reconstruction (ACLR) patients; and 2) light load BFR-RE and heavy load RE (HL-RE) in ACLR patients. Between-subjects, partially-randomised. This study comprised 3 groups: non-injured BFR-RE (NI-BFR); ACLR patients BFR-RE (ACLR-BFR); ACLR patients HL-RE (ACLR-HL). NI-BFR and ACLR-BFR performed 4 sets (30, 15, 15, 15 reps, total = 75 reps, 30s inter-set rest) of unilateral leg press exercise at 30% 1RM with continuous BFR at 80% limb occlusive pressure. ACLR-HL performed 3 × 10 reps (Total = 30 reps, 30s inter-set rest) of unilateral leg press exercise at 70% 1RM. Perceived exertion (RPE), muscle pain, knee pain and pre- and 5-min post-exercise blood pressure were measured. RPE was higher in ACLR-BFR compared to NI-BFR (p < 0.05). Muscle pain was higher in NI-BFR and ACLR-BFR compared to ACLR-HL (p < 0.05). Knee pain was lower in ACLR-BFR compared to ACLR-HL (p < 0.01). There were no differences in blood pressure. These responses to BFR exercise may not limit application and favourably influence knee pain throughout ACLR rehabilitation training programmes. These findings can help inform practitioners' decisions to utilise this tool. •Perceptual responses to BFR exercise are greater in ACLR patients than non-injured populations.•Perceptual response is similar between BFR and heavy load exercise.•BFR exercise causes less knee pain than heavy load exercise.•BFR exercise may not exacerbate post-exercise blood pressure response.•Responses to BFR exercise may not limit its application in ACLR patients.

IT was a secluded Tittle town in Russia a town within the Pale-- unpretentious undignified. Very narrow and crooked were the streets: dingy and dilapidated, the low-thatched shanties; bare and bleak, the surrounding country. And the inhabitants partook of the pervading grime. They stooped in their...

LONG, long ago there was a king who considered himself omnipotent. His body was huge, his head massive, and his chin and cheeks were covered by a growth of beard every hair of which bristled with authority. He ruled over a vast kingdom which was really made grand and glorious by his worthy grandfather. But our king liked to waive this insignificant detail, and to speak regularly three times a day of the empire he made great; and his counsellors, with the same regularity...

The cold, blank winter day breaks ghastly on the plains of northern Russia. Gloomily onward stretch the wild, snow-covered steppes of frozen Siberia; not a tree, not a bush, insight; and the winds rise, blowing with fury and whirling heaps of snow round and round in the air. On the frozen ground two men are lying huddled together trying to hide themselves from the blast...

THE cold, blank winter day breaks ghastly on the plains of northern Russia. Gloomily onward stretch the wild, snow-covered steppes of frozen Siberia; not a tree, not a bush, in sight; and the winds rise, blowing with fury and whirling heaps of snow round and round in the air.

OLD ZELIG was eyed askance. . . his brethren. No one deigned. . . call him \"Reb\" Zelig, nor to profix to his name the American equvalent-- \"Mr.\" \"The old one is barrel with a stave missing knowingly declared his neighbor \"He never spends a cent: and in...