Feasibility of Blood Flow Restriction Exercise in Adults with a Non-surgically Treated Achilles Tendon Rupture; a Case Series

Abstract

Blood flow restriction exercise (BFRE) appears to provide a unique opportunity to preserve lower limb muscle and function in patients with an Achilles tendon rupture. The purpose of this study was to investigate the feasibility of BFRE in patients with an Achilles tendon rupture. Additionally, to evaluate muscle volume and patient-reported ankle function, symptoms, complications, and physical activity following 12 weeks of BFRE. Feasibility was measured by adherence to training sessions, drop-out rate, intervention acceptability, ankle pain exacerbation (NRS), and adverse events. At baseline and 12-weeks follow-up, patients completed the Achilles Tendon Total Rupture Score questionnaire and had their thigh and calf circumference measured. At follow-up, patients' ability to perform a single-leg heel rise was tested. Sixteen of 18 patients completed the intervention and for those, adherence to training sessions was 88% ±16%. The mean NRS following BFRE sessions was 1.1 (95%CI: 1; 1.2). Three adverse events occurred during the 12 weeks. Two re-ruptures after completion of the BFRE program and one deep venous thrombosis following cast removal. BFRE was found to be feasible in a subset of patients with an Achilles tendon rupture. However, with three adverse events in a population of 18 patients, the effectiveness and safety of BFRE warrants further investigation.

Keywords: Achilles tendon rupture; blood flow restriction exercise; case series; non-surgical treatment; rehabilitation.

Figure 1

Flowchart of patient enrollment. DVT: Deep venous thrombosis * Two patients identified at their initial visit in the emergency department were later excluded because they did not have an Achilles tendon rupture.

Figure 2

The three intervention phases in relation to time post injury for patients at the two hospitals. Brackets indicate the standard deviation of the time point for intervention initiation and follow-up testing.

Figure 3

Demonstration of Seated knee extension in a patient post immobilization restrictions. 3A shows the starting position, with the bucket hanging from the foot wrist and the cuff properly placed on the thigh of the affected leg. 3B shows end-range position with the knee of the affected leg extended.

Figure 4

Mean NRS ankle pain, rate of perceived exhaustion and mean external load used for each training session (n=16). NRS: Numerical rating scale, kg: Kilogram(s), Mean ankle pain post exercise and mean rate of perceived exertion post exercise is read on the y-axis on the left, Mean external load used is read on the y-axis on the right, Brackets represents 95% confidence intervals, Generally, occlusion pressure was increased from 40% LOP to 80% LOP at ‘Training session 6’ (Gødstrup Regional Hospital) or ‘Training session 12’ (Aarhus University Hospital).