Blog

Managing ACLs with PBFR


ACL tears are one of the most common injuries in athletics that lead to surgical intervention. The rate at which ACL reconstructions (ACLR) are performed has risen 22% from 2002 to 2014; with the highest rates occurring in adolescents.1 Unfortunately, far fewer return to their prior level of sport participation vs. anticipated (~65%2 vs ~84%3). During the immediate post-injury and post-op periods, and due to a number of factors, the quadriceps can atrophy quite rapidly. Accompanying this loss of muscle is an associated decrease in strength. Addressing this loss of size and strength is an important target for us in rehab, and one we need a deeper understanding of to help us intervene more effectively. 

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The Hallmark of Aging


Sarcopenia is the hallmark of aging responsible for significant muscle mass loss seen with advancing chronological age. It is associated with decreases in functional ability due to its impact on strength; most notable are losses in mobility and increases in fall risk. This loss of muscle can begin as early as the 3rd decade of life, and results in the loss of 5-10% of one’s vastus lateralis mass by the 5th decade.1 Upon reaching age 50, the sarcopenic rate accelerates causing the loss of as much as 30-40% of the vastus lateralis by age 80.1Collectively, these factors contribute to a decreased quality of life, frailty, and increased mortality. A recent meta-analysis of studies comprised of approximately 2 million men and women demonstrated that strength loss was a strong predictor of mortality across the life span, regardless of comorbidities.2 When broken down by body region, increased grip strength had a 31% reduction in all-cause mortality risk compared to those with decreased strength.2 In the lower extremity, increased knee extensor strength had a 14% reduction in all-cause mortality.2 In addition to the physical and medical burden imposed upon aged persons, the financial burden of sarcopenia in the United States is substantial as well. Annually, treatment of ailments associated with the condition amount to $40.4 billion.10 To combat sarcopenia, the American College of Sports Medicine recommends older adults perform a combination of resistance training at 70-80% 1RM at least two times per week, and participate in 150-300 minutes of moderate intensity aerobic training weekly.3 However, less than 10% of those >65 years old met both guidelines and only 14% met the resistance training guideline.4 More recently, resistance training has taken on an increasingly important target given its superior ability to impact physical functioning via strength translation.11

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Ischemic Preconditioning for Improved Cycling Performance


Ischemic Preconditioning for Improved Cycling Performance

"The major finding of the current study was that performing IPC immediately prior to incremental cycling exercise improved time-to-exhaustion (TTE) in comparison to both a traditional control and deceptive sham, despite participants’ performance expectations anticipating the contrary."

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