Get Back in the Game

Get Back in the Game

For elite athletes and weekend warriors alike, getting sidelined by a sports injury is agonizing. Rehab can be lengthy and getting back into action too soon can cause more damage.

“We often see sports injuries to knees and shoulders that are caused by heavy contact or cut-and-pivot motions,” says orthopedic surgeon Scott Doroshow, DO of St. Luke’s Orthopedic Care.

Common knee injuries include torn meniscus, dislocated kneecap, and damage to a variety of ligaments that connect the bones of the upper and lower leg known as the ACL, LCL and MCL.

“The most common shoulder injury involves the rotator cuff, which allows you to move your arm,” Dr. Doroshow says. When it’s damaged, your range of motion is often severely limited. Also, a ring of cartilage called the glenoid labrum helps to keep the base of the shoulder stable. Tearing it can result in pain, instability, even dislocation.

Physical therapy—whether following surgery or on its own—can help to rebuild strength and movement after an injury.

St. Luke’s is helping athletes get back in the game faster by using an atypical PT procedure: Blood-flow restriction (BFR). The technique was originated in Japan by Yoshiaki Sato, MD, PhD, who experimented on himself after a skiing accident. He limited blood flow in his injured leg by using belts, while continuing to exercise the limb, and maintained his strength.

“Blood flow restriction has been used by the military to help injured soldiers get back to their active lifestyle and potentially even return to service,” says Gregory Colvin, PT, DPT, CMP. “St. Luke’s is one of the only medical facilities in the region to use the technique; it’s more commonly found in larger market areas.”

Muscles break down and gain strength as a result of working with heavy loads to the point of near-exhaustiona process that stimulates protein synthesis, thus, building muscle growth.

But because BFR limits venous blood flow, “lactic acid builds up quicker, and has a cascade effect that stimulates natural growth hormones, myostatin, and other biochemical substances that promote muscle formation,” Colvin says. And, it’s accomplished with much lighter weights, reducing strain on already-damaged tissues.

The emphasis is on blood flow restriction and is reduced by about 50% for upper limb work and about 80% for lower. “We take plenty of safety precautions and walk our clients through the process before we start,” he added. “When the cuff is in place, they perform their prescribed exercises. Most of them hate it while they’re using it, but they love the results they get!”

Moravian College athletes Salvatore Pagano and Kaela Kane are solidly in that camp.

Sal, a fullback and the captain of the college football team, tore his ACL on two occasions. Several months into his current rehab program he began using BFR. With the cuff on his leg, he exercises in time intervals—for example, three one-minute rounds of squats followed by a minute of rest. “Even with lighter weight loads, the exercises are harder with the cuff on,” he says, “and I still reach a high level of muscle fatigue.”

The procedure has paid off for him. “My strength and endurance have improved, and I’ve started all 10 games this past season,” he says. “I had to sit out parts of the previous two seasons.”

Kaela’s trouble began with an on-field collision in 2016 when she tore her front and back shoulder tendons. To compensate, the softball player moved from shortstop to second base, and her shoulder was surgically repaired later. After a re-injury in early 2018 and hitting a plateau in her recovery, Kaela turned to BFR.

“I hadn’t heard of it before, but I was willing to try anything,” Kaela recalls. With the cuff on her right arm, she worked intensively on strengthening and stabilizing both sides of her body. Within just two weeks, she felt stronger and more confident in throwing—so much so that she hopes to return to shortstop for the coming season.

“My recovery would have taken much longer without the restriction therapy,” she says. “we got a lot accomplished in a little time.”

Of course, it’s best to avoid injury in the first place, and Dr. Doroshow offers some common sense advice. “Work to stay active and flexible with stretching to maintain a good range-of-motion,” he says. “Even a few minutes each day, every day, can make significant contributions.”


St. Luke’s uses the Delfi personalized tourniquet system, the same device used by elite athletes across the country. “The National Football League (NFL), the National Basketball Association (NBA), and Major League Baseball (MLB) have all used this system to help injured players recover more quickly,” Colvin says. One of the first to use the technique was Jadeveon Clowney of the Houston Texans, back in 2015.

“It’s a very safe system,” Colvin adds. “The restrictive band is wider than others, for less pressure per square inch, and the device provides automatic Doppler and blood pressure readings.” It also features numerous monitors and controls for added patient safety.

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