Buffalo Bills vs Houston Texans: J.J. Watt’s unexpected return from pectoral injury

24 September 2021

Mentioned above was the fact that Watt was in such phenomenal shape, which allowed him to reduce some of the time needed to work the surrounding muscles back into shape. It’s almost certain that he used what is known as blood-flow-restriction training to accelerate his healing process. In fact, Houston was one of the first teams to incorporate this into their rehab back in 2015.

The basis of this idea is that if blood flow is restricted to an area, this alters how muscle fibers respond. Type I muscle fibers are considered slow twitch and are used for endurance, which means they stay active as long as oxygen is fueled to them. Think of why endurance athletes are able to run or bike and can continue as long as they feed the muscles with oxygen.


Type II muscle fibers are fast twitch and used for high-intensity exercises such as jumping and sprinting. These require a different energy source, namely glycol, which allows for the energy source to be used quickly and take some time to recover compared to the aerobic Type I muscle fibers.

Getting back to blood-flow restriction, these Type II muscle fibers atrophy with inactivity and exercise needs to be slowly introduced with resistance and speed in order to slowly build them back up. If the Type I muscle fibers can be shut off through the blood-flow restriction by reducing oxygen to the area, then this forces the Type II to activate. Once again, these muscles fatigue out quickly and turn on with high-intensity exercise, which is contraindicated early in the rehab process to protect the healing tissues.

What blood-flow restriction research has found is that lower loads of resistance of a person’s 1 rep maximum (RM) can be used to increase muscle strength. Let’s say Watt can bench press and max out at 300 lbs, I’m sure he can do more, but let’s keep a rounded number. In order for him to achieve hypertrophy in the muscle, he would need to perform higher reps at a lower weight of at least 65% of his 1 RM to achieve the desired results. Simple math states that he would have to bench at least 195 lbs to activate those Type II muscles.

That healing tendon won’t allow for those loads without damaging the integrity of the muscle or surgical site. But introducing blood-flow restriction allows someone to achieve the same results with only 20-30% of the 1 rep max. So Watt would be able to bench 60-90 lbs and get the same effect. Pretty cool right?

On top of maximizing the muscle gains in the surrounding area, Watt would have to continue to work on the range of motion in the shoulder and chest region. He would not want to push the range of motion too fast as this would cause pain and stretch out the tendon at its insertion point, leading to a weakened anchor or an outright tear of the area.

By the time Watt comes to play, he will be almost ten weeks out from the surgery. Protocols state that he should have full ROM by this time and the ability to continue strengthening should be the main focus in his rehab. It has to be noted that he will be moderately limited on the left side, able to move the arm but not fully wrap up a tackle or take on a block as well as he usually does. The strength won’t be there at an NFL-caliber level despite all the work with the blood-flow-restriction equipment.