Speaker 2: Hey, everybody what's going on? Welcome to BFR Tuesday. Today is Tuesday, December 7th, almost here to the holidays. Crazy how fast this year has gone by. So my name is Ed Le Cara. I host this every Tuesday to answer questions regarding blood flow restriction training, whether for rehab or prefer performance or best case usage or research or whatever you'd like. So all you have to do is just put in a question into the upper corner. You'll see the right corner. You'll see a chat section, just so like I'll put Hello from Dallas and you can put a question in there and I'm happy to answer it. 

Speaker 2: Any questions regarding BFR 

Speaker 2: All right. If no specific questions, then I will, talk about something. I got a question, about via email this morning from a provider. and what he asked me was regarding total knee replacement. What protocols are, are best used to prepare the individual for the, surgery or surgical intervention. and so what we teach before really any type of surgery is the preparation for the surgical tourniquet. see when we put the tourniquet on a limb and we keep it there for, it can be up to a couple hours. A lot of times for surgery, you can create what's called a ischemia, meaning, lack of blood flow due to the tourniquet reprofusion. So after you opened the tourniquet up again, the flush of blood that goes into the limb, stimulates some bad cells for the body called reactive oxygen species. 

Speaker 2: Not always bad, but in this case, it's an over flood of them. And so you'll see acute, very acute, atrophy. if you've ever seen somebody with an intro cruciate ligament repair, my personal one, you know, I went in, feeling like my leg was, ready to go. And I had done prehab and ready to ready to get the surgery done. And then the next day was like a thing of jelly and it's, it's a lot of times due to this ischemia reprofusion. So if you can prepare the land prior to surgery, then you won't have as much of this, tourniquet induced damage, after the surgery, it's not really the tourniquet that's causing the damage. It's the  it's the lack of oxygen and blood into the limb. So we do something called ischemic, preconditioning and ischemic preconditioning, or some people will call it cellular swelling. 

Speaker 2: It can, it just depends on how much pressure you're using. in this case, I'm going to take it back. I, I recommended styler swelling protocol, which is 60 to 80% limb occlusion pressure. For the total knee, it would be in the lower extremity for five rounds of five minutes with a three minute rest in between. So 60 to 80% LOP four or five by five minutes with 30 second rest in, three minutes, sorry, three minute inter-set rest. And what we try to combine that with is, electric stimulation, to cause muscular contraction. And then also if they can tolerate it without it being too painful, 10, second isometric holds. And so what you're doing is you're contracting the muscle tissue, you're, creating a cellular swelling effect, which helps to stimulate a muscle protein synthesis. And then the electric stem is helping to, recruit more motor units. 

Speaker 2: So those, those muscles are getting stressed. And if we remember, muscle protein synthesis is, is really part of the equation to keep and maintain muscle mass. So, we want to have a positive net protein balance, positive net protein balance. We get from ingesting protein, but also creating a mechanical stress. and, so that mechanical stress that contraction of the muscle helps us to maintain muscle mass. And so we don't get the nearly the amount of disuse atrophy we would normally get prior to the surgery. And then we get used to the tourniquet and get used to, the limb gets used to the ischemic effect of the tourniquets. We don't have as much muscle loss post-surgical then we have less hypertrophy that we need to do so we can accelerate rehab that way. 

Speaker 2: Hello labs is it, hopefully that's occur. I, I pronounced that correctly, physiotherapist from Algeria. So thank you for joining us today. So any questions about that We can use ischemic preconditioning or what I was talking about really cellular swelling. we can use that cell swell protocol anytime that we're in a, in a time of disuse. So if I don't have full range of motion of a joint, I'm in a brace, I'm in a cast, I can use cellular swelling protocol in order to maintain muscle mass. And, of course maintaining that muscle mass helps for metabolism and it helps, so that way you don't lose as much, strength and, and then it just accelerates the rehab process after the surgery. So any questions about, cellular swelling That's a, you're welcome. My pleasure. 

Speaker 2: And of course we talk about cellular swelling in our level one course, the BFR introduction. and then we talk a lot about ischemic preconditioning, which is just higher, higher LOP. It's a hundred percent LOP, for four to five rounds of five minutes. we just don't use any muscle contraction with it just cause it's, it's very high intensity and we use that prior to activity to prevent, muscle damage. And we also use it, to improve performance. And so we talk about that in our level two, performance BFR course, both of those can be found, full courses can be found, online at smarttoolsplus.com. Any questions regarding cellular swelling, presurgical treatments, All right. Looks like I have a patient here. So if I don't have any other questions I am going to, sign off. So, thank you so much for joining. I will be back next week. and we'll see what we talk about. Usually it comes up from questions, what I get during the week or during the webinar. So thanks so much and I will see you next week. Bye for now.