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Blood Flow Restriction Training: Understanding the Safety, Mechanisms, and Efficacy, 2nd Edition
4
4
$72.00
PTMD04BF-H
Computer Ergonomics for the Therapy Professional
3
3
$55.00
PTMD03CE-H
Introduction to Aquatic Therapy
3
3
$55.00
PTMD03AT-H
Management of Sports-Related Concussions: Staying Ahead of the Game, 2nd Edition
4
4
$72.00
PTMD04MC-H
Resistance Training for Different Populations
4
4
$72.00
PTMD04RT-H
Return to Sport: Running Injuries in Student-Athletes
2
2
$37.00
PTMD02RU-H
ACL Rehabilitation: A Review of Current Treatment Approaches
4
$72.00
PTMD04AC-H
Evaluations and Treatment of the Cervical Spine, 2nd Edition
3
$55.00
PTMD03CS-H
Exercise Prescription and Rehabilitation Considerations for Older Adults
3
$55.00
PTMD03EP-H
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Book Expiration Date: 10/9/2027
INCLUDED IN THIS BOOK
1 Blood Flow Restriction Training: Understanding the Safety, Mechanisms, and Efficacy, 2nd Edition [4 contact hours] Blood flow restriction training (BFRT) is an exercise technique that is transforming how we prescribe exercises therapy. By partially restricting blood flow to the muscles using specialized cuffs or bands, BFRT offers a range of benefits from muscle activation to advanced rehab training. Discover the benefits of blood flow restriction training with this course. From increasing muscle activation and muscle growth to enhancing strength and endurance. BFRT can even help reduce pain. BFRT is a science-based approach—over 800 articles published in the last 10 years—that can be safely prescribed to diverse populations from young to old, from patients to athletes. 9 Computer Ergonomics for the Therapy Professional [3 contact hours] The goal of this course is to provide students with the knowledge to identify ergonomic risks and make sound ergonomic recommendations to help clients prevent discomfort and injury at a computer. While we review what an ergonomist may recommend in a particular situation, our goal is to give students ergonomic analytical tools and apply this knowledge to any case at hand. 18 Introduction to Aquatic Therapy [3 contact hours] This course is for those health professionals who would like to expand their skills into aquatic therapy and rehab. Aquatic therapy and rehabilitation is a growing market and provides an excellent service to clients. As a health professional, here’s the opportunity to enhance your career with the most current essential information you need to get started. Feel confidence in the concepts including waters properties, fluid dynamics, physiological responses to immersion, precautions/contraindication to aquatic therapy. Aquatic exericse equipment as well as the basic concepts of Bad Ragaz, Halliwick, Ai Chi, Watsu, Aquastretch and the Burdenko are covered. 26 Management of Sports-Related Concussions: Staying Ahead of the Game, 2nd Edition [4 contact hours] Concussions continue to be a serious epidemic in youth and competitive sports. With approximately 1.6 million to 3.8 million sports-related concussions occurring every year, these injuries are considered among the most complex injuries in sports medicine to diagnosis, assess, and manage. The instructor will provide an overarching review of the recent literature, including the 6th International Conference on Concussion in Sport, as it pertains to concussion management from prevention techniques to reducing the risk of injury to returning to play after a concussive episode. The modules within this course include an introduction to concussions, recognition and sideline evaluation, clinical evaluation, neuropsychological testing, rehabilitation techniques, and academic modifications. As the literature and practice guidelines/recommendations are reviewed, participants will be able to assess their current practice to make appropriate modifications to their own concussion management plan. The mission of this course is to provide a concise resource on how to properly manage concussions from risk reduction techniques, acute injuries, and return to play by implementing a multimodal process and enhancing multidisciplinary communication to keep the athlete at the forefront of care.
Continued on the next page ►
INCLUDED IN THIS BOOK
34
Resistance Training for Different Populations [4 contact hours]
This course takes contemporary resistance training research for four distinct populations and shows the learner how to design safe and effective workouts for people with obesity, active aging , women over age 40, and athletes. By contrasting how resistance training is programmed for these different populations, learners are shown how to build safe and effective routines for each. 42 Return to Sport: Running Injuries in Student-Athletes [2 contact hours] This course focuses on commonly presented running injuries in student-athletes and how to effectively treat those injuries for return to sport. The course is designed for athletic trainers and allied health professionals who work in sport settings, particularly with youth and student-aged athletes. 50 ACL Rehabilitation: A Review of Current Treatment Approaches [4 contact hours] This course provides a comprehensive review of current approaches to ACL (anterior cruciate ligament) rehabilitation. It covers the latest evidence on surgical reconstruction techniques, graft choices, functional bracing, neuromuscular training, and return-to-play decision making. The course emphasizes the importance of evidence-based practice and staying current with the evolving literature in ACL rehabilitation. Participants will learn about early rehabilitation protocols, specific exercises and techniques, functional testing methods, and how to incorporate psychological readiness into return- to-sport decisions. The course includes case studies and self-assessment questions to reinforce key concepts. 57 Evaluations and Treatment of the Cervical Spine, 2nd Edition [3 contact hours] This course is intended for all healthcare professionals who care for clients who experience pain and dysfunction of the cervical spine. This course utilizes the most recent research for effective evaluation and treatment options for treating the cervical spine. Participants will learn methods for evaluating the cervical spine to classify the conditions and determine if it is safe to proceed with treatment. Participants will also learn the most effective treatment methods according to the most recent research. 71 Exercise Prescription and Rehabilitation Considerations for Older Adults [3 contact hours] This course is intended for rehabilitation professionals who participate in the care of older adults. The course explores the strength, endurance, and aerobic capacity deficits commonly seen in this population. Not only will it discuss the causes and contributing factors to these deficits, but it will also discuss assessment tools, evaluation techniques, standardized assessments, and patient interventions.
Colibri Healthcare, LLC’s courses are approved by the Maryland State Board of Physical Therapy Examiners.
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License Expires
CE Hours Required
Mandatory Subjects
Every two years by March 31st: ● License numbers ending with an odd number renew in odd-numbered years ● License numbers ending with an even number renew in even-numbered years
Physical Therapists - 30 contact hours Physical Therapist Assistants - 20 contact hours period
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Are you a Maryland board-approved provider? Colibri Healthcare, LLC’s courses are approved by the Maryland State Board of Physical Therapy Examiners. Are my credit hours reported to the Maryland board? No, the Maryland Board of Physical Therapy Examiners requires licensees to certify at the time of renewal that they have complied with the continuing education requirement. The board performs audits at which time proof of continuing education must be provided. Is my information secure? Yes! We use SSL encryption, and we never share your information with third-parties. We are also rated A+ by the National Better Business Bureau. What if I still have questions? What are your business hours? We have several options for you to choose from! Online at EliteLearning.com/Physical-Therapy you will see our robust FAQ section that answers many of your questions. Simply click FAQs at the top of the page, email us at office@elitelearning.com, or call us toll-free at 1-888-857-6920, Monday - Friday 9:00 am - 6:00 pm EST, Saturday 10:00 am - 4:00 pm EST. Important information for licensees: Always check your state’s board website to determine the number of hours required for renewal, mandatory topics (as these are subject to change), and the amount that may be completed through home study. Also, make sure that you notify the board of any changes of address. It is important that your most current address is on file. Disclosures: Resolution of conflict of interest Colibri Healthcare, LLC implemented mechanisms prior to the planning and implementation of the continuing education activity, to identify and resolve conflicts of interest for all individuals in a position to control content of the course activity. Sponsorship /commercial support and non-endorsement It is the policy of Colibri Healthcare, LLC not to accept commercial support. Furthermore, commercial interests are prohibited from distributing or providing access to this activity to learners. Disclaimer: The information provided in this activity is for continuing education purposes only and is not meant to substitute for the independent medical judgment of a healthcare provider relative to diagnostic and treatment options of a specific patient’s medical condition.
©2026: All Rights Reserved. Materials may not be reproduced without the expressed written permission or consent of Colibri Healthcare, LLC. The materials presented in this course are meant to provide the consumer with general information on the topics covered. The information provided was prepared by professionals with practical knowledge of the areas covered. It is not meant to provide medical, legal, or professional advice. Colibri Healthcare, LLC recommends that you consult a medical, legal, or professional services expert licensed in your state. Colibri Healthcare, LLC has made all reasonable efforts to ensure that all content provided in this course is accurate and up to date at the time of printing, but does not represent or warrant that it will apply to your situation nor circumstances and assumes no liability from reliance on these materials. Quotes are collected from customer feedback surveys. The models are intended to be representative and not actual customers .
Blood Flow Restriction Training: Understanding the Safety, Mechanisms, and Efficacy, 2nd Edition: Summary 1
Blood Flow Restriction Training: Understanding the Safety, Mechanisms, and Efficacy,
ACCESS THE FULL VIDEO PRESENTATION Scan the QR CODE ► to start video or visit https://uqr.to/BFR_Training
2nd Edition 4 Contact Hours
Author Pieter L. de Smidt, PT, DPT, MDT, MTC
Dr. Pieter L. de Smidt has 36 years of experience as a physical therapist. He holds certifications in McKenzie Mechanical Diagnosis and Therapy (Cert. MDT), manual therapy (MTC), and sports therapy (STC). With his post-professional doctorate in physical therapy, he specialized in the management of musculoskeletal injuries of the spine and extremities. Dr. de Smidt uses an evidence-based, integrated approach of manual therapy and exercise that includes instrument assisted soft tissue mobilization (IASTM), cupping, dry needling, and joint mobilization. His main professional goal is to bridge the gap between rehab and fitness and to empower clients to embrace a healthy lifestyle.
LEARNING OUTCOMES ● Learn about the science behind BFRT ● Learn about the research that supports use of BFRT ● Learn about safety precautions for BFRT ● Learn how to determine the limb occlusion pressure (LOP) and understand why knowing the LOP is important in the use of BFRT
● Discuss the different types of BFRT ● Understand indications and contraindications for BFRT ● Understand how to program BFRT during exercise therapy
SELF-ASSESSMENT QUESTIONS
1.
What is blood flow restriction training (BFRT)? a. A technique that fully blocks blood flow to muscles during exercise b. A technique that partially restricts blood flow to muscles during exercise c. A technique that increases blood flow to muscles during exercise d. A technique that has no effect on blood flow during exercise What are some of the potential benefits of BFRT? a. Increased muscle mass and strength b. Enhanced aerobic capacity c. Reduced pain d. All of the above
3.
What percentage of 1 repetition maximum (1RM) is typically used for resistance exercises with BFRT? a. 20-40% b. 50-70% c. 80-100% d. There is no specific percentage used How long does it typically take to see benefits from BFRT? a. 1-2 weeks b. 2-4 weeks c. 8-12 weeks d. 6 months or more
4.
2.
ANSWERS: 1: b 2 : d 3: a 4 : b
Blood Flow Restriction Training: Understanding the Safety, Mechanisms, and Efficacy, 2nd Edition: Summary 2
LEARNING TIP! Some of the key benefits that have been demonstrated through research include: • Increased muscle mass • Improved strength • Enhanced aerobic capacity • Faster recovery • Reduced pain • Potential improvements in bone health • Possible aid in weight loss • Improvements in tendon mechanical and morphological properties
INTRODUCTION
INTRODUCTION TO BLOOD FLOW RESTRICTION TRAINING
Blood flow restriction training (BFRT) is an exercise technique that is transforming how exercise therapy is prescribed in physical therapy and other fields . BFRT involves partially restricting blood flow to muscles during exercise using specialized cuffs or bands. This restriction causes muscles to experience fatigue, swelling, and oxygen depletion more quickly than during normal exercise. The body responds to this restriction by sending messages to the brain that the limbs are not getting enough oxygen, which triggers responses from the endocrine system. This temporary decrease in oxygen levels, while safe when applied properly, is essential for BFRT to produce its beneficial effects. BFRT has been shown through extensive research to be safe and effective when used appropriately. Over 800 scientific articles have been published on BFRT in the last 10 years alone, demonstrating its efficacy and safety for diverse populations ranging from young athletes to older adults. HISTORY OF BFRT BFRT has been around for decades, starting as early as the 1970s in Japan (known as KAATSU). More research started coming out in the 1990s and KAATSU started to become more widely practiced by the 2000s. It was brought to the U.S. in 2011 when the military began using it for rehabilitation of veterans. By 2018, the APTA stated BFRT was within the scope of practice for physical therapists. It was then made more popular by the body building world for its role in “muscle pumping.” Benefits of Blood Flow Restriction Training BFRT offers a wide range of potential benefits when used as an adjunct to low intensity resistance exercise (LIRE) or aerobic exercise (AE).
Benefits can be seen as quickly as 2-4 weeks. Importantly, these benefits can often be achieved using much lower loads by creating metabolic stress. Metabolic stress induces physiologic adaptations without causing any of the normal muscle damage from the mechanical stress of high intensity resistance training. Traditionally, strength gains require loading of 75-100% of 1 rep max. With BFRT, these results can be achieved with as low at 20-40% 1 rep max . This makes BFRT particularly valuable for populations that may not be able to tolerate high-load training, such as those recovering from injury or surgery. Disuse of muscles and inability to load after injury or surgery can lead to a 12% reduction in strength each week, making BFRT even more valuable in this population. THE SCIENCE BEHIND BFRT The two primary mechanisms thought to drive the benefits of BFRT are: 1. Metabolite-induced fatigue 2. Cell swelling BFRT creates an environment of low oxygen availability, causing the activation of type II muscle fibers and anaerobic metabolism. This leads to a build-up of metabolites in the muscle, which stimulates several physiological changes required for muscle and bone strengthening. LEARNING TIP!
The hypoxic (low oxygen) environment created by BFRT, combined with the accumulation of metabolites, stimulates neural afferents. This causes a significant increase in growth hormone and other anabolic factors.
Blood Flow Restriction Training: Understanding the Safety, Mechanisms, and Efficacy, 2nd Edition: Summary 3
Studies have shown dramatic increases in growth hormone levels after BFRT sessions-one study reported a 290-fold increase compared to baseline. BFRT has been shown to affect several key physiological pathways and factors: • Increased activation of the mTOR pathway, which is crucial for protein synthesis and muscle growth • Increased levels of human growth hormone (HGH) • Increased insulin-like growth factor 1 (IGF-1) • Decreased levels of myostatin, a protein that normally limits muscle growth • Increased vascular endothelial growth factor (VEGF), which promotes the growth of new blood vessels Compared to traditional high-intensity resistance training, BFRT with low-load exercise produces similar or greater increases in these anabolic factors while causing minimal tissue damage. This allows for faster recovery and the potential for more frequent training sessions. TYPES OF BLOOD FLOW RESTRICTION TRAINING There are several ways BFRT can be applied: • Passive BFRT . This involves applying blood flow restriction without exercise, primarily to promote cell swelling and potentially improve tissue healing, such as after surgery. • BFRT during aerobic exercises (BFRT-AE) . This combines blood flow restriction with low-intensity aerobic activities like walking or cycling to improve aerobic capacity and muscle strength. • BFRT during resistive exercises (BFRT-RT) . This involves using blood flow restriction during low-load resistance training to improve muscle mass and muscle strength. All types of BFRT can potentially contribute to building muscle strength and mass, though BFRT-RT is typically most effective for this purpose. • Intermittent BFRT (I-BFRT) . This approach involves alternating periods of blood flow restriction and normal blood flow, either during exercise or rest periods, commonly used for weight loss. Safety and Precautions While BFRT has been shown to be safe by many when applied correctly, including Odinesson & Finsen, 2006; Clark et al., 2011, and Poton & Polito, 2016, it is crucial to understand the proper application and potential risks.
Some key safety considerations include: • Proper screening of patients for contraindications • Using the correct cuff pressure based on individual limb occlusion pressure (LOP): ○ Wider cuffs are generally safer as they require less pressure • Gradual progression of training intensity and duration • Monitoring for signs of excessive discomfort or adverse reactions Risk factors for
Developing Venous Thromboembolism
Signs and Symptoms of VTE
• Cyanosis • Edema • Erythema • Pitting edema • Superficial dilation of veins • Tenderness to palpation/warmth • Positive clinical signs such as Homan’s test
• Previous VTE • Cardiovascular disease • BMI >25 kg/m 2 • Family history of VTE • Varicose veins • >40 years old • Having multiple risk factors
Contraindications
• Pregnancy • Extremities with dialysis port • Sickle cell anemia • Open fracture/wounds and/or poor wound healing • Severe crush injury • Venous thrombo- embolism • Excessive swelling in post-surgical limb • Known clotting risk • Severe hypertension • Acidosis • Infection within extremity
• Increased intracranial pressure • Cancer • Previous revascular- ization of limb • Lymphedema • Vascular graft • History of mastectomy or axillary node dissection (avoid on affected arm) • Those in hemodialysis who have arterial or venous fistulas
Blood Flow Restriction Training: Understanding the Safety, Mechanisms, and Efficacy, 2nd Edition: Summary 4
Exercise pressures are then set as a percentage of LOP, typically:
GUIDELINE: NO BFRT IF MORE THAN 4 POINTS • History of DVT • Acute sickness or fever • Blood pressure >180/100mmHg • Early postoperative period • High class arrhythmia or coronary ischemia 5 points • Pregnancy 4 points • Varicose veins 3 points
• 30-50% of LOP for upper body exercises • 60-80% of LOP for lower body exercises • Generally, higher pressures are used with lower resistance levels Tips for Taking LOP: • Have patients relax the muscle • Do not talk
• Take in the same position in which the exercise will be performed (or least intense if in multiple positions) • A pulse ox can be used for the upper body but not the lower • This should not change much over an 8 week period of time, so there is no need to reassess every session unless there is swelling How to take LOP: • Place the cuff as proximal as possible. Find the pulse with the doppler, listening for 20 seconds. Inflate the tourniquet in 10-15 mmHg increments. Stop once the pulse cannot be located. Slowly deflate the cuff. When the pulse is heard again, this is the LOP: ○ For the upper extremity, use the radial artery ○ For the lower extremity, use the posterior tibial or dorsalis pedis Resistance training with BFRT typically uses loads of 20-40% of one repetition maximum (1RM), much lower than traditional strength training. Aerobic exercise with BFRT is usually performed at low intensities, around 40% of VO2 max or 45% of the heart rate reserve. ACSM suggests using the heart rate to estimate the percent of VO2 max as follows: • 40% VO2 max = 55% HR max • 60% VO2 max= 70% HR max • 80% VO2 max= 85% HR max • 85% VO2 max= 90% HR max Proper Intensity of BFRT Resistance Training: • Use 3-4 sets of an exercise, starting with lower reps (10) and progressing to high reps (75) • Initially use longer rest periods (90 seconds) and progress to less rest (30 seconds) • Use a total session duration of 10-20 minutes • This can be used several times per week, up to 2 times per day • Progressions:
• Prolonged inactivity • A-Fib or heart failure • Blood pressure: 160-179/95-99mmHg
• Age >60 years • BMI >30 kg/m 2 • Malignancy • Hyperlipidemia • Estrogen therapy • Age 40-58 years • Women • BMI 25-30 kg/m 2
2 points
1 point
Rhabdomyolysis Rhabdomyolysis is very rare after exercise with BFRT, but it is important to be aware of the signs and symptoms. Symptoms start 48-72 hours after exercise, reporting muscle pain, weakness, and myoglobinuria (tea colored urine) due to muscle breakdown releasing high amounts of myoglobin in the blood. Application and Programming LEARNING TIP!
Determining the appropriate cuff pressure is crucial for safe and effective BFRT. It is important to note that brands of cuffs will vary in width, number of bladders, and availability of the cuff to optimize pressure. The cuff width is a significant factor for determining safe pressure.
The pressure should be moderate in order to reduce arterial blood flow, but not occlude the vessels. This is typically done by measuring the limb occlusion pressure (LOP) - the minimum pressure required to completely occlude blood flow to a limb. This is done using a doppler.
○ Start with passive BFRT for cell swelling ○ Progress to aerobic exercises/return to sport/HIIT with BFRT
Blood Flow Restriction Training: Understanding the Safety, Mechanisms, and Efficacy, 2nd Edition: Summary 5
KEY POINTS 1. Proper cuff placement: For lower body exercises, the cuff should be placed as high on the thigh as possible, close to the hip joint. 2. Monitoring patient response: Constantly check for signs of excessive fatigue, numbness, or tingling. 3. Gradual progression: Start with easier exercises and lower volumes, progressively increasing as the patient adapts. 4. Importance of form: Maintain proper form throughout the exercises, even as fatigue sets in. 5. Individualization: Adjust the protocol based on the patient's condition, pain levels, and response to the exercises. 6. Education: Inform patients about the expected soreness and the difference between exercise-induced soreness and pain.
These practical demonstrations provided a clear illustration of how BFRT can be integrated into a rehabilitation program for various conditions, from post- surgical recovery to chronic pain management. Emphasis
on safety, proper technique, and individualization underscored the importance of thorough training and understanding of BFRT principles before implementing this technique in clinical practice.
RESEARCH EVIDENCE Numerous studies have demonstrated the efficacy of BFRT for various outcomes:
• A meta-analysis by Hughes et al. (2017) found that BFRT combined with low-load exercise was effective in augmenting changes in both muscle strength and size, with effects consistent across both resistance and aerobic exercise. • Studies have shown that BFRT can produce similar strength and hypertrophy gains as traditional high-load training, but with much lower loads (Lixandrão et al., 2018). • BFRT has been shown to be effective in populations with various conditions, including rheumatoid arthritis (Rodrigues et al., 2020) and following ACL reconstruction (Hughes et al., 2019). • Aerobic exercise with BFTR has demonstrated both improvements in aerobic capacity (VO2 max), anaerobic performance, and strength, even in highly trained athletes (Held et al., 2020; Park et al. 2010). • Although parameters have been varied, BFRT with HIIT enhances physiological improvements in aerobic, muscular, and, to some extent, anaerobic performance.
CASE STUDIES
ACL RECONSTRUCTION
The course presented a detailed protocol for using BFRT following ACL reconstruction. The protocol begins 2 weeks post-op, provided the patient has achieved 90 degrees of flexion, can perform a single leg stance for over 5 seconds, has no quad lag with repeated straight leg raises, and shows no additional swelling after activity. The protocol progresses as follows: • Weeks 1-2 : Passive BFRT with neuromuscular electrical stimulation (NMESTIM) • Weeks 3-4 : BFRT during cycling and low-load exercises • Weeks 5-6 : Progress to long-arc quadriceps exercises, hip bridges, and single-leg leg press • Weeks 7-8 : Introduce step-ups and continue single-leg leg press • Weeks 9-12 : Progress to split squats, medial step-downs, and single-leg leg press The protocol uses 60-80% LOP, with 30/15/15/15 reps for each exercise, performed in two sessions per week.
Blood Flow Restriction Training: Understanding the Safety, Mechanisms, and Efficacy, 2nd Edition: Summary 6
ACHILLES TENDON REPAIR
The sample program for Achilles tendon repair begins 4 weeks post-op. Patients start with ambulation as tolerated with a cam walker boot and non-weight-bearing exercises. The program is divided into two phases: Phase 1 (weeks 4-8 post-op) : • BFRT-AE with cycling • BFRT-RT with non-weight bearing exercises (straight arc quads, long arc quads, straight leg raise flexion/ abduction, bridging) Phase 2 (weeks 8-12 post-op) : • BFRT-RT with weight-bearing exercises (leg press, step ups/downs, calf raises for soleus and gastrocnemius) The program emphasizes gradual progression and monitoring of patient response.
ELITE ATHLETES
Elite athletes can use BFRT for: • In-season training. BFRT allows athletes to maintain or even increase strength and muscle mass without the fatigue and muscle damage associated with heavy lifting • Recovery. Intermittent BFRT can be used post-exercise to enhance recovery. One protocol involves applying occlusion cuffs for 2 x 3-min periods with 3 min rest in between, using a pressure of 100% LOP or more • Performance enhancement. A sample program for high-intensity interval training (HIIT) with BFRT was presented. This protocol aims to enhance both aerobic capacity and muscular adaptations simultaneously. It involves: • Warm-up: ○ 4 sets of interval training on a cycle: ■ 3 min at 90% of max HR (~ 85% VO2max), without BFRT ■ 3 min rest with BFR at 40% of LOP ○ Cool-down
Conclusion Blood flow restriction training represents a powerful tool in the arsenal of physical therapists, trainers, and other health professionals. When applied correctly, it offers the potential for significant improvements in muscle strength, size, and function, as well as cardiovascular fitness, using much lower loads than traditional training methods. This makes it particularly valuable for populations that may not tolerate high-load training. However, proper application, including thorough screening, correct pressure determination, and appropriate exercise prescription, is crucial for safety and efficacy. As research continues to expand our understanding of BFRT, it is likely to play an increasingly important role in rehabilitation, fitness, and sports performance settings.
WORKS CITED
https://qr2.mobi/blood-flow
Blood Flow Restriction Training: Understanding the Safety, Mechanisms, and Efficacy, 2nd Edition: Summary 7
FINAL EXAM QUESTIONS
1.
What are the different types of BFRT? a. Passive BFRT, BFRT-AE, BFRT-RT b. Post surgery/injury BFRT, return to sport BFRT, performance BFRT c. Low intensity BFRT, moderate intensity BFRT, high intensity BFRT d. All of the above What is NOT true about the history of BFRT? a. BFRT started in Japan b. BFRT was first used for body building c. In the United States, BFRT was first used in the military d. BFRT was included in the scope of PT practice by the APTA What is TRUE about research studies regarding BFRT? a. Hundreds of studies have been done supporting the safe use of BFRT b. Studies have shown that BFRT can stimulate pain relief c. Studies on BFRT started in the 1990s d. All of the above
8.
What is TRUE about studies regarding BFRT and aerobic conditioning? a. Studies have shown increased VO2 max as a result of training with BFRT b. Study parameters for aerobic conditioning with BFRT have had great variability c. Studies have shown that BFRT with aerobic exercise can lead to strength and aerobic capacity gains at the same time d. All of the above What is NOT true about BFRT and aerobic conditioning? a. BFRT into HIIT enhances physiological improvements in aerobic, muscular, and, to some extent, anaerobic performance b. BFRT with aerobic exercise has been studied with walking and cycling programs c. Aerobic exercise with BFRT increases aerobic capacity but does not alter strength d. The intensities used during BFR-AE are
2.
9.
3.
generally low in nature (45% heart rate reserve or 40% of maximal oxygen consumption (VO2 max) 10. Which of the following authors showed that BFRT is safe to use? a. Clark b. Odinsson and Finsen a. Increase muscle size and strength b. Increase aerobic conditioning c. Increased flexibility d. Faster recovery 12. What is a typical amount of cuff pressure for BFRT? a. 20-40% 1RM b. 30-50% of LOP for the arms c. 60-80% of LOP for the arms d. 30-50% of LOP for the legs 13. What is true of the science behind BFRT? c. Poton and Polito d. All of the above 11. What is not a benefit of BFRT? a. BFRT increases growth hormone and decreases myostatin b. BFRT decreases insulin-like growth factor 1 c. BFRT decreases mTor and mTORc d. All of the above
4.
The BFRT abbreviation means: a. Blood fuel restriction training b. Blood flow resistance training c. Blood flow restriction training d. Blood flow restriction technique What is NOT an indication for BFRT? a. Weakness b. Muscle atrophy c. Poor wound healing d. In-season weight training
5.
6.
What mechanisms do we think explain the benefits of BFRT? a. Increased human growth hormone b. Decreased insulin-like growth factor 1 c. Increased myostatin d. All of the above What is NOT true about strength training? a. Exercise for 3-8 weeks, 3x/week, with 50-75% 1RM will result in increased strength b. Exercise for 3-8 weeks, 3x/week, with 75-100% of 1RM results in increased strength c. HIRT causes muscle damage, which initiates the body’s response that leads to increased strength d. Exercises with BFRT, with 20-40% 1RM, are sufficient to increase strength
7.
Blood Flow Restriction Training: Understanding the Safety, Mechanisms, and Efficacy, 2nd Edition: Summary 8
14. All of the following are precautions or contra- indications for BFRT, except: a. Pregnancy b. Sickle cell anemia c. Acidosis d. General weakness 15. What types of BFRT can be used to build muscle strength and muscle mass? a. BFRT-AE b. I-BFRT c. Passive BFRT d. All of the above 16. The ACSM suggests that: a. 40% VO2 max corresponds to 70% HR max b. 30% VO2 max corresponds to 70% HR max c. 80% VO2 max corresponds to 85% HR max d. 85% VO2 max corresponds to 100% HR max a. Increased muscle mass and strength b. Faster recovery c. Decreased pain d. All of the above 18. Why do you need to know the patient's limb occlusion pressure (LOP)? a. It is used for dosing the treatment, as it relates to pressure used in the cuff b. We obtain LOP using an MRI machine c. You do not need to LOP d. Most protocols use 60-80% of LOP for upper body exercise and 30-50% of LOP for lower body exercises 19. What is TRUE regarding different brands or products of BFRT devices? a. Some brands have narrow bands and others have wider bands b. Some brands have a single bladder c. Some brands have built-in mechanisms to optimize pressure in the cuff d. All of the above 20. What is TRUE for patients who have been immobilized or have been inactive? a. Disuse of muscles leads to atrophy and loss of muscle strength at about 12% per week b. Limb immobilization for 3 days can lead to 44- 47% atrophy 17. What is a benefit of BFRT? c. Atrophy can be reversed by isometric exercises d. Dirks showed no decline in cross-sectional area (CSA) with 1 week of bed rest
21. What is NOT true about studies regarding BFRT with aerobic exercises? a. Park showed improvement of VO2 max with a walking program b. All studies used around 40% of resting heart rate for intensity c. Studies have been done with cycling and walking d. Many studies showed improvement in aerobic capacity, but results varied 22. What is TRUE about benefits of BFRT? a. This exercise therapy can increase muscle mass, muscle strength, and balance b. Some studies suggest the possibility of weight loss and improved bone health c. Participants in studies had either improved aerobic capacity or improved strength d. Pain relief with BFRT has not been studied 23. What is true about high and low pressure BFRT? a. Lixandrão showed that with low resistance levels we should use high-pressure BFRT to increase strength b. Both low and high pressure have similar results c. All BFRT has been studied with low pressure d. Low-pressure BFRT has been shown to reduce pain better than high-pressure BFRT 24. What is TRUE about the amount of pressure used for BFRT? a. Studies have used the same levels of pressure b. Most commonly in recent studies we have seen 30-50% LOP pressure for the upper body and 60-80% LOP in the lower body c. The amount of pressure does not affect the results of BFRT d. All of the above 25. What is true about the use of BFRT? a. BFRT is safe when done with individual parameters in the absence of contraindications b. BFRT can be effective for the trained and untrained patient c. BFRT can help to improve muscle strength, reduce atrophy, and improve aerobic conditioning d. All of the above
To Complete this Course: Scan the QR code Proceed to exam Log into your account
Course content code: PTMD04BF-H
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Computer Ergonomics for the Therapy Professional: Summary
Computer Ergonomics for the Therapy Professional 3 Contact Hours
ACCESS THE FULL VIDEO PRESENTATION Scan the QR CODE ► to start video or visit https://uqr.to/Ergonomics-Therapy
Author Shaul Lent OTR/L, MA, CEAS
Shaul Lent has been a practicing occupational therapist for the past nine years. Over seven years ago, Shaul founded Ergonomics Advance, an ergonomic consulting company helping clients return to work after injury and preventing those working at their computer from experiencing pain.
LEARNING OUTCOMES
• Identify common ergonomic obstacles facing clients working at their computer • Recognize the purpose, benefits, and/or concerns for recommending specific ergonomic products to improve occupational performance
• Choose customized computer-based ergonomic recommendations, whether they be product, environmental, body mechanic, or stretching suggestions to improve occupational performance
SELF-ASSESSMENT QUESTIONS
1.
What is the correct recommendation for employees reporting lower back discomfort? a. Back rest and monitor arm
2.
Employees at your office report back discomfort. Should you ... a. Recommend different back rests for each employee b. Purchase the same new chair for every employee c. Purchase a different chair for each employee d. Assess how each employee interacts with their workstation and recommend products based on their unique physical characteristics and work routine
b. Stretching and footrest c. Stretching and new chair d. Depends on the person
ANSWERS: 1: d 2 : d
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Computer Ergonomics for the Therapy Professional: Summary
Poor Posture Example (Jack)
INTRODUCTION
SECTION 1: INTRODUCTION TO ERGONOMICS
What is Ergonomics? Ergonomics is the science of designing the job to the worker (rather than the worker to the job). It involves adjusting the setting to the individual. Ergo = Work Nomos = Natural Law The Importance of Ergonomic Assessment Good ergonomics lowers risk of injury amongst workers. Companies who successfully implemented ergonomics are able to reduce disability days by 10- 35% and improve return to work rates by 6%. Turnover rates have also declined for those companies who have implemented a successful ergonomic program. SECTION 2: ERGONOMIC POSTURES Ergonomic risk factors at the computers include: • Contact stress • Eyestrain: ○ Positioning: keep an arm’s length away ○ Glare: i.e., light from outside can contribute to eyestrain, not just the computer screen ○ Screen brightness ○ Word size ○ Computer breaks • Repetitive movement: repeating the same motion every few seconds for 2 consecutive hours can cause ergonomic strain
• Neck is bent down looking at the monitor • Shoulders are hiked • Glare on screen • R wrist in bent Musculoskeletal Disorders (MSDs)
MSDs are defined as injuries of the muscles, nerves, and tendons. For example, awkwardly and repetitively moving your wrist and thumb can cause tendonitis by the thumb side of the wrist. Using a neutral posture can help prevent MSDs. Neutral Posture • Feet/Knees: ○ Keep feet placed flat on the ground or on a footrest ○ Knees should be between perpendicular (90 degrees) to 110 degrees • Thighs: ○ Thighs should be about parallel to the floor ○ Ensure about a 2-inch space between the chair and the back of knees • Back: ○ The back should be in contact with the backrest of the chair ○ While in contact with the chair, the back should in a perpendicular to a slightly reclined position, between 90 and 110 degrees ○ The backrest of the chair should provide support for the lower back ○ The back should not be bent forward or bent excessively backward (beyond 110 degrees) • Arms/Hands: ○ Elbows should be between a 9- and 110-degree angle ○ Hands should be equal to or lower than the elbow ○ Upper arms and elbows should be close to the body (not extending outward) ○ Keep your wrist aligned with your forearm ○ Wrist, forearm, and fingers should be parallel to the floor
• Postures that are awkward or static: ○ What does poor posture look like?
■ Bending at neck and/or back, due to monitors/laptop being too low/high ■ Neck rotation ■ Hiking shoulders ■ Bending at the wrist ■ Feet not resting on the floor ■ Sitting > 6 hours a day at a time
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Computer Ergonomics for the Therapy Professional: Summary
Appropriate Observations to Consider • Chair • Monitor/computer level • Keyboard Measurements to Consider • Height/depth of desk • Neutral postures • Mouse/keyboard height (sitting and standing) • Monitor height (sitting and standing) • Seat height • Bins in the way • Thickness of desk (i.e., keyboard trays) • Occasional occurrences SECTION 4: DECISION MAKING PROCESS How to Make Recommendations • Recognize Ergonomic Problems : Consider all ergonomic risk factors • Determine Range of Possible Solutions : Consider options to improve ergonomic positioning • Choose Best Recommendations : Make decisions based on the best options for the individual client Clinicians must recognize that user preference is the priority. Employees should sample various products to determine which ones best fit their needs. Adjustable furniture alone will not lower MSD risk. However, adjustable products with proper training were shown to significantly lower MSDs. Product Recommendations Chair SECTION 5: ENVIRONMENTAL/ PRODUCT RECOMMENDATIONS • Allows User to : Support back and legs and adjust to contribute to neutral posture; adjusting body so eyes are level with the monitor • Consider : ○ Adjustability: helps decrease shoulder/wrist/hand discomfort ○ Arm rests ○ Often the most important item Lumbar Supports • Allows User to : Increase lumbar support • Consider : ○ Density ○ Type (mesh, memory foam) ○ Sampling Keyboard Trays • Allows User to : Position elbow in a neutral posture and place forearm and wrist/palm at the same level • Consider : ○ Fit of mouse/keyboards ○ Installation underneath desk ○ Adjustability ○ Wrist position without deviation ○ Keyboard height/legs
○ Wrist and fingers should be pointed straight ahead (not turning to the pinky or the thumb) • Neck/Shoulders: ○ Shoulders should be relaxed (not raised) and perpendicular to the floor ○ Neck, head, and shoulders should be directly opposite the computer, not twisted or rotated ○ Head and neck should not be excessively bent forward or backward: ■ Adjust the monitor higher or lower depending on posture • Back/Thighs/Elbow: ○ Back and thighs should be upright ○ Not bending forward to see the monitor ○ Wrist, forearm, and fingers should be parallel to the floor Other Considerations for Good Posture • The monitor should be a little more than an arms’ length away from the user • The monitor should be directly in front of the user to avoid rotating the neck and head • The top of the monitor should be about eye level or slightly below • Do not tuck the phone between the neck and shoulder • Ensure clearance under the desk so that the user can get close enough to type and use the mouse without having to reach • Avoiding sharp edges on the desk and wrist rest • Continue to use a preferred hand for the mouse to get stronger if the client does not wish to change mouses or try alternating sides SECTION 3: ASSESSMENTS The Onsite Assessment An onsite assessment involves the therapist being at the work site during the actual assessment. The workspace does not always need a new product and many times adjustments can be made to currently used products. Clinicians should bring the following to an onsite assessment: an onsite assessment template or OSHA E-tool, pen/clipboard, sample products (such as an ergonomic mouse/keyboard), and a measuring tape. Home Office vs Office Space Home Office considerations • Flexibility in workspace • Less pain on average reported: ○ Greater control over work environment less pain perception Office Space considerations • Just a workstation • More pain on average: ○ Less control more pain at work
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Computer Ergonomics for the Therapy Professional: Summary
Footrest • Allows the User to : Support dangling feet and keep the back flush against the backrest of the chair • Consider : Standing Desks • Allows the User to : Limit static sitting posture (limit 20 mins of standing/hour), adjust to achieve neutral posture, minimize hip discomfort • Consider : ○ Depth/width of desk ○ Overhead bins ○ Fit within cubicle ○ Sit-stand converters (increased height) Eyestrain ○ Floor obstacle ○ Static posture Eyestrain can be prevented by addressing the glare. This can be done by removing one of the bulbs, adding curtains/shades, readjusting monitor positions, adjusting screen brightness, cleaning the monitor every few weeks, and installing light diffusers. Eye stretches The ‘20-20-20 Rule’ can help alleviate eyestrain. However, if the ergonomist knows that the client will not integrate this as part of their daily routine it is best for them to do it as often as possible, even if it is only once every 1-2 hours. Desk Set Up For the most ideal desk set up, commonly used items should be at arms reach with least commonly used items further away. SECTION 6. DEVELOPING A STRETCH PROGRAM Behavioral/Stretching Recommendations – Increase Movement by: • Regular stretching • Telephone usage in standing • Alternating sedentary and active activities • Walking during breaks Examples of Alternating Positions • Right hand and left hand for the mouse • Taking hands off the keyboard/mouse • Regularly readjusting the chair • Breaks with colleagues • Aerobic breaks (i.e., walk) or stretch breaks
Adjustable Monitor Arms • Allows the User to : Maintain upright neck/head/back posture and keep the monitor at eye level • Consider : ○ VESA compatible: Ensure that monitors and mounts can be brand-interchangeable as long as the mount sizing is the same ○ Weight of monitor ○ Clamp/grommet mounts Monitor Risers/Laptop Stands • Allows the User to : Raise the monitor and keep the monitor at eye level • Consider : ○ User’s daily habits Vertical Mouse • Allows the User to : Maintain neutral wrist posture and minimize contact stress
• Consider : ○ Size
○ Right-handed or left-handed ○ Difficulty getting used to
Roller Mouse • Allows the User to : Minimize awkward wrist posture and alternate between the right and left hand • Consider : ○ Wrist deviation ○ Practice Wrist Rests • Allows the User to : Limit contact stress & keep forearm, wrist, and palm level • Consider : ○ Height of support Desks • Allows the User to : Hold items at a certain height and help encourage neutral position/decrease discomfort at shoulders/wrist/hands • Consider : ○ Height of desk ○ Depth/width (enough room) ○ Fit within cubicle • Options : ○ Marabel Desk: 29.25 inches from the floor ○ Hamrick Desk: 31 inches in height
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Computer Ergonomics for the Therapy Professional: Summary
• Back Roll : Lean to your left side and place you left elbow on your left hip. Bring your right hand overhead and look up at the ceiling. Repeat on the other side • Light Lower Back Stretch : Place your hands on your hips and gently lean your head and upper back backwards, holding for 5-10 seconds • Wrist Stretch 1 : Keep wrist aligned with forearm. Look at your palm and slowly extend the wrist and then gently bring the thumb back • Wrist Stretch 2 : Straighten your elbow with the palm facing the floor and bend your wrist down and make a gentle fist. With the other hand, gently pull down on the back of your hand while slowly rotating the hand away from your body. Hold for 5-10 seconds. Repeat 5 times • Wrist Stretch 3 : Bend your elbow and have your palm and fingers pointed toward your face. Bend your palm away from your face. Use your other hand to gently pull palm and fingers away from your face. Hold for 5-10 seconds. Repeat 5 times • Hamstring Stretch : Place your heel on the ground in front of you with your knee kept straight. Bend forward at your hips and look upward. Hold for 5-10 seconds. Repeat 5 times Schedule Breaks ○ After daily activity (i.e., lunch, daily meeting) ○ At a set time (i.e., at 10 am and 3 pm) daily
Benefits : Taking short breaks to stretch and walking during work activities have been shown to reduce MSD related pain. Considerations for Stretching • Don’t give a stretch or exercise if the user reports pain or recently had surgery • Instruct the employee to stop the stretch or exercise if they experience any pain • If you have had surgery recently, have a recent injury, or any of these stretches causes you pain, stop the exercise and consult with your ergonomic specialist Stretches • Neck Rotation : Look straight ahead and rotate the neck to the right and hold the position for 5 seconds; repeat on the left • Neck Tilt : Look straight ahead and keep the left hand behind the back while tilting the neck to the right. Repeat on the other side • The Bird : Place your hands in front of your forehead with your palms facing out. Take a deep breath in as you pull your elbows and hands outward (palms should be rotating outward). Slowly exhale and look up as your hands move back and hold for 5-10 seconds. Repeat 5 times • Shoulder Blade Stretch : Bend both elbows so they are in front of you and pull both shoulders back; try bringing the shoulder blades together and hold the position Try the stretch differently in the hitchhike position. Rotate thumbs back and hold
CASE STUDIES
Case Study 1 Case Study 1: Alex has been working as an office manager for the past 20 years. She sits at her computer for 4 hours at a time and reports lower back discomfort at the end of the day. She knows you are an OT and wants to get an ergonomic assessment. Please watch the video and write down what problems you noticed about Alex’s workstation. • Because the desk was too high, Alex needed to bring her shoulders and upper arms forward to reach the keyboard and mouse. • Because the desk was too high, Alex’s upper arms and elbows were not close to her body. • Because the desk was too high, Alex’s forearm was not parallel to the floor. • Seat depth appears to be too large for Alex, and she therefore needs to sit away from the backrest. • There appears to be some glare on her monitor. • Alex was not able to adjust the height and depth of her keyboard, monitor, or mouse, allowing her to make occasional changes during the day. • You may use the OSHA checklist to help ID problems.
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