Nov 30, 20183 takes on blood flow restriction (part 2)
Before founding Owens Recovery Science in 2014, Johnny Owens first experienced the power of BFR therapy firsthand as the Chief of Performance Optimization at the Center for the Intrepid in San Antonio, Texas. Owens faced difficulty reaching ideal muscle quantity and quality changes in injured soldiers, so he and a team of scientists and surgeons began applying BFR treatments to them, and the results did not disappoint. “A lot of those involved delayed amputations from service members who were trying to salvage their limbs, but we also were seeing lost muscle due to blast injury. And in a 10 year window, we had over 50,000 ACL injuries from the war,” says Owens.
Finding positive results with those three populations, Owens began to apply his decade of experience working with the military to his new venture with Owens Recovery Science. “We published some early papers and went after large grants to start randomized clinical trials,” says Owens. “We eventually received some exposure on ESPN, and then all of a sudden, NFL teams started asking me to come out and teach BFR to them. Before we knew it, we were presenting at the NFL Combine, and we now work with a number of NBA, MLB, and NHL teams, as well.”
With any form of exercise comes safety concerns, but Owens urges clinicians to use extra precautions when it comes to BFR training. “If you’re an athlete or patient looking to do this, find a certified provider and use a device you can trust will be non-harmful and give you the best effect,” he says.
For the past three years, Owens Recovery Science has been providing medical professionals with the necessary education and training to safely practice BFR therapy. The courses include teaching the proper way to apply tourniquets, how to use the devices, and the clinical and sports performance protocols behind BFR.
According to Owens, the company offers two paths to BFR certification. “We have open courses where clinicians can just sign up and attend to get certified. Those are typically on a weekend, and we pick a fairly large location, like a university,” he says. “We also do private trainings. That’s when a team will call and ask us to train their entire athletic department or sports medicine staff, and our trainers around the country will go train them on-site.”
In both cases, the certification course is a daylong process with half of the time being spent in the lab. “It’s pretty intense on the physiology and science side, and once our clients receive their certification, we provide a lot of backend support,” says Owens. “We have a private advisory board that only certified BFR providers have access to, and they are able to ask questions between each other. Our board includes a cardiothoracic surgeon, sports medicine doctor, and dietitian, who all answer questions and keep everyone updated on any changes they should be aware of as the research continues to advance.”
However, not just anybody can become certified in BFR through Owens Recovery Science. “You have to have a medical license to be able to purchase our BFR device or get certified,” he says. “If a team wants to purchase it, they must take all the regulatory steps and show us they have a medical license that would pertain to the rehab of injuries — MD, PT, ATC, DC, and OT.”
The PBFR system that Owens Recovery Science distributes is developed by Delfi Medical Innovations, based in Canada. Owens’ relationship with Delfi began during his tenure at the Center for the Intrepid, where he first witnessed how well the technology worked. “They have modern microprocessor tourniquets that stay tethered, allowing the machine to constantly ensure that the numbers displayed on the device represent the exact pressure that’s coming out of the cuff,” Owens explains. “It also regulates the changes that need to take place to adapt the cuff to the limb.”
When the tourniquet is placed on the limb, the machine measures the limb occlusion pressure and the artery’s wave flow pattern until it stops completely. “Once that reading is complete, that’s how we know how much pressure it took to make all the blood stop in the limb. At that point, the clinician can decide what percentage to use,” says Owens. “We include protocols of what we think is the best evidence, but if the clinician fears an older patient may not tolerate BFR well, they can take the pressure down and choose which exercise to accompany it.”
With any form of exercise comes safety concerns, but Owens urges clinicians to use extra precautions when it comes to BFR training. “If you’re an athlete or patient looking to do this, find a certified provider and use a device you can trust will be non-harmful and give you the best effect,” he says. “Two recent commentaries in the Journal of Arthroscopy recommends the same thing and specifically listed the Delfi device as meeting safety standards.
“We often rely on this premise: if you can’t put a tourniquet on to have a surgery, then you shouldn’t put one on to do rehab,” Owens continues. “But as you can imagine, most people can have a tourniquet on for surgery, so we feel really comfortable for most types.”
One of the most frequently asked questions Owens’ clients have is the age at which it is safe to begin BFR training or therapy. “The youngest that we’ve had reported from one of our providers was a seven-years-old, who was post-op and tolerated it well,” says Owens. “Unfortunately, there is currently no research that suggests BFR helps younger kids recover any faster, but we’re really pushing for more as the gap in literature involves the younger individual. We are working with some large pediatric institutes, including one that is doing neurologic research, to look at safety and tolerance of BFR.”
Over the years, Owens has seen a shift in the culture of clinicians practicing BFR. “I think years ago, if you said that we’re going to put tourniquets on people after they break a bone, surgeons would have looked at you like you said you were going to barbeque a kitten,” says Owens. “That’s evolved big time and has become a huge part of clinical practice. Clinicians are now understanding the way to maximize a tourniquet by using good tourniquet technology, using Dopplers to understand blood flow, and really dialing this treatment in to a laser level.”