Golden Andrew P, Hogan Kathleen K, Morris Jamie B, Pickens Bryan B
Army-Baylor University Doctoral Fellowship in Orthopaedic Manual Physical Therapy, Fort Sam Houston, TX 78234, USA.
Special Warfare Human Performance Squadron, San Antonio, TX 78236, USA.
Int J Sports Phys Ther. 2024 Sep 1;19(9):1126-1137. doi: 10.26603/001c.122641. eCollection 2024.
Lower extremity bone stress injuries (BSI) are common injuries among athletes and military members. Typical management involves a period of restricted weightbearing which can have rapid detrimental effects upon both muscle and bone physiology. Few studies have investigated the effect of blood flow restriction (BFR) training on bone in the rehabilitative setting.
The purpose of this study was to investigate the effects of lower extremity exercise with the addition of BFR upon bone mineral density, bone mineral content, and lean body mass in military members with tibial BSIs.
Case series.
Twenty military members with MRI-confirmed tibial BSI were recruited to complete lower extremity exercise with the addition of BFR twice per week for four weeks. The BFR cuff was applied proximally to the participant's involved limb while they performed gluteal, thigh, and leg resistance exercises. Outcomes were assessed at baseline and four weeks. The primary outcomes were whole leg bone mineral density (BMD), bone mineral content (BMC), and lean body mass (LM) as measured by dual-energy x-ray absorptiometry. Secondary outcomes included thigh and leg circumference measures and patient-reported outcomes, including the Lower Extremity Functional Scale (LEFS), Patient-Reported Outcomes Measurement Information System 57 (PROMIS-57), and Global Rating of Change (GROC).
No significant differences were found in BMD (p=0.720) or BMC (p=0.749) between limbs or within limbs over time. LM was generally less in the involved limb (p=0.019), however there were no significant differences between or within limbs over time (p=0.404). For thigh circumference, significant main effects were found for time (p=0.012) and limb (p=0.015), however there was no significant interaction effect (p=0.510). No significant differences were found for leg circumference (p=0.738). Participants showed significant mean changes in LEFS (15.15 points), PROMIS physical function (8.98 points), PROMIS social participation (7.60 points), PROMIS anxiety (3.26 points), and PROMIS pain interference (8.39 points) at four weeks.
The utilization of BFR in the early rehabilitative management of tibial BSI may help mitigate decrements in both bone and muscle tissue during periods of decreased physical loading.
下肢骨应力损伤（BSI）是运动员和军人中常见的损伤。典型的治疗方法包括一段时间的负重限制，这可能会对肌肉和骨骼生理产生迅速的不利影响。很少有研究调查血流限制（BFR）训练在康复环境中对骨骼的影响。
本研究的目的是调查在患有胫骨BSI的军人中，添加BFR的下肢运动对骨矿物质密度、骨矿物质含量和瘦体重的影响。
病例系列。
招募20名经MRI确诊为胫骨BSI的军人，每周进行两次添加BFR的下肢运动，共四周。在参与者进行臀肌、大腿和腿部抗阻运动时，将BFR袖带近端应用于其受累肢体。在基线和四周时评估结果。主要结果是通过双能X线吸收法测量的全腿骨矿物质密度（BMD）、骨矿物质含量（BMC）和瘦体重（LM）。次要结果包括大腿和小腿围度测量以及患者报告的结果，包括下肢功能量表（LEFS）、患者报告结果测量信息系统57（PROMIS-57）和总体变化评分（GROC）。
随着时间的推移，各肢体之间或肢体内部的BMD（p = 0.720）或BMC（p = 0.749）均未发现显著差异。受累肢体的LM通常较低（p = 0.019），然而，随着时间的推移，各肢体之间或肢体内部均未发现显著差异（p = 0.404）。对于大腿围度，发现时间（p = 0.012）和肢体（p = 0.015）有显著的主效应，但没有显著的交互效应（p = 0.510）。小腿围度未发现显著差异（p = 0.738）。四周时，参与者的LEFS（15.15分）、PROMIS身体功能（8.98分）、PROMIS社会参与（7.60分）、PROMIS焦虑（3.26分）和PROMIS疼痛干扰（8.39分）有显著的平均变化。
在胫骨BSI的早期康复管理中使用BFR可能有助于减轻身体负荷降低期间骨骼和肌肉组织的减少。
4级。
