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Examine the comfort and pain experienced with blow flow restriction resistance training (BFR-RT) compared to standard care heavy load resistance training (HL-RT) during anterior cruciate ligament reconstruction (ACLR) patient rehabilitation. Randomised controlled trial. United Kingdom National Health Service. Twenty eight patients undergoing unilateral ACLR surgery with hamstring autograft were recruited. Following surgery participants were block randomised to either HL-RT at 70% repetition maximum (1RM) (n = 14) or BFR-RT (n = 14) at 30% 1RM and completed 8 weeks of twice weekly unilateral leg press training on both limbs. Perceived knee pain, muscle pain and rating of perceived exertion (RPE) were assessed using Borg's (1998) RPE and pain scales during training. Knee pain was also assessed 24 h post-training. There were no adverse events. Knee pain was lower with BFR-RT during (p 0.05) for both BFR-RT and HL-RT. ACLR patients experienced less knee joint pain and reported similar ratings of perceived exertion during and following leg press exercise with BFR-RT compared to traditional HL-RT. BFR-RT may be more advantageous during the early phases of post-surgery ACLR rehabilitation. [Abstract copyright: Copyright © 2019. Published by Elsevier Ltd.]

Purpose: Recovery from lower limb fracture, surgery or injury often requires a period of immobilisation, which leads to significant declines in muscular strength and size, ranging from 0.3–4.2% per day. A common technique used to attenuate muscle atrophy during immobilisation is neuromuscular electrical stimulation (NMES). However, a more recently utilised intervention is blood flow restriction (BFR). During immobilisation, isolated NMES and BFR have both been shown to reduce muscular atrophy, but not strength declines. Recently, NMES combined with BFR has been investigated and led to increased muscular strength and size in healthy participants and those with spinal cord injuries, compared with NMES and BFR alone. The mechanisms and safety of NMES combined with BFR is currently unknown. The aim of the present study was to discover the acute effects of NMES combined with varying degrees of BFR on muscular, cardiovascular and perceptual variables.

Protein and amino acid supplementation is often observed in conjunction with different exercise modes to augment adaptations of improve acute exercise performance. Acute supplementation with branched-chain amino acids (BCAAs) may offset fatigue during prolonged endurance exercise. When adequate carbohydrate is delivered, adding protein to carbohydrate does not appear to improve acute endurance performance. A training stimulus of 6+ weeks may be necessary to observe adaptations to skeletal muscle hypertrophy and muscle strength following protein supplementation with resistance training. Resistance exercise-induced adaptations may not be augmented when protein intake is adequate. Whole proteins, such as milk-based beverages, can help to attenuate symptoms of muscle damage. Supplementing either mixed BCAA solutions or leucine in doses ranging between 5 and 20 g/day, typically multiplied across two to three feedings, accelerates recovery from muscle damaging exercise. These improvements are characterized by improved perception of muscle soreness, increased muscle function, and decreased leakage of intracellular proteins into the blood.