TMC PULSE

T M C » P U L S E | N O V E M B E R 2 0 1 8 34 Building Back Strength How blood flow restriction therapy has revolutionized sports medicine F our years ago, Walter Lowe, M.D., the team physician for the Houston Texans, watched as outside linebacker Jadeveon Clowney—the No. 1 NFL draft pick in 2014—injured his knee in the first game of the season. When word got out that Clowney would undergo microfrac- ture surgery to help grow new carti- lage in his torn meniscus, the sports world buzzed with speculation about whether he would ever play professional football again. After all, the highly-specialized surgery, which creates tiny punctures in the bone, requires at least six weeks of non-weight-bearing recovery. For a professional athlete, that could mean losing a lifetime of muscle memory and strength. Not long after, Lowe got a call from physical therapist Stephania Bell, a medical reporter and injury analyst for ESPN. She asked if he'd ever heard of blood flow restriction therapy or BFR. Lowe, who is also the chairman of the department of orthopedic surgery at McGovern Medical School at The University of Texas Health Science Center at Antonio Military Medical Center, many of whom had returned from deployment with missing limbs or multiple broken bones. Those types of injuries, Lowe knew, were especially challenging because without the ability to bear weight on the limb during rehabilitation, it was notoriously difficult to build back strength—particularly enough strength for a prosthesis. Could BFR work for Clowney? Bell arranged for Owens and Lowe to speak over the phone. It turned out the two actually knew each other; Owens had spent a month as a young physical therapy student under Lowe's tutelage. Owens drove to Houston, where he and Lowe met with the head trainer for the Houston Texans to discuss Owens' technology. They walked through the science and took an in-depth look at the Houston and medical director of the Memorial Hermann IRONMAN Sports Medicine Institute, was only vaguely familiar with the concept. Bell told him about a physical therapist in San Antonio named Johnny Owens who had developed the treatment for patients at the San apparatus. It didn't take long before Lowe, speaking on behalf of the Texans and Memorial Hermann, said, "We're in." The BFR device includes a tour- niquet cuff and an instrument with a digital display that self-calibrates and maintains pressure. BFR works by fitting the cuff onto the limb above the injury and then adjusting the pressure of the cuff to reduce blood flow to the limb by 80 percent. While some blood still flows into the muscle, the tourniquet completely occludes the venous drainage out of the limb and creates a high-stress environment in that extremity. This "tricks" the muscle by making basic exercises extremely difficult; patients feel as if they are lifting very heavy weights. "It creates a high-stress envi- ronment in that extremity down below where the blood pressure tourniquet is, and so under high stress, little muscle contractions can result in huge strength gains," Lowe explained. The technique worked for Clowney, who recovered and has become the Texans' leading defen- sive player. In week four of the 2018 NFL season, he was named AFC Defensive Player of the Week after returning a fumble recovery for a touchdown in a game that ended in an overtime victory. After introducing BFR to Houston via the Texans' training room, Lowe worked to get the devices into all of the Memorial Hermann IRONMAN Sports Medicine clinics. Meanwhile, Owens' star rose quickly. BFR success stories among veterans and professional athletes were B y A l e x a n d r a B e c k e r Houston Texans linebacker Jadeveon Clowney rests during an NFL football game against the Indianapolis Colts on Sept. 30, 2018 in Indianapolis. Now it's an integral part of most physical therapy programs. It's all over the country. It's used in every NFL train- ing room, every NBA training room—it really has blossomed very quickly. — WALTER LOWE, M.D. Walter Lowe, M.D., is medical director of the Memorial Hermann IRONMAN Sports Medicine Institute. Credit: Aaron Doster/AP

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