Training Triggers Strength Gains for Wounded Troops

By Elaine Sanchez

Brooke Army Medical Center

JOINT BASE SAN ANTONIO-FORT SAM HOUSTON, Texas, Nov. 20, 2014 – Wounded and injured service members are getting pumped up about a cutting-edge strength training program at Brooke Army Medical Center here.

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Johnny Owens, chief of the Human Performance Optimization Program, adjusts a setting on a tourniquet worn by Marine Corps Staff Sgt. Brandon Kothman during blood flow restriction training at the Center for the Intrepid’s outpatient rehabilitation center, Brooke Army Medical Center, Texas. Owens implemented the groundbreaking program to help wounded service members build muscle strength and function. U.S. Army photo by Robert D’Angelo 

(Click photo for screen-resolution image);high-resolution image available.

This groundbreaking program, called blood flow restriction training, or BFR, offers warriors huge gains from low-resistance exercise.

“I’ve seen some very dramatic results,” said Johnny Owens, chief of the Human Performance Optimization Program at BAMC’s Center for the Intrepid. “The training is proving a game-changer for our warriors.”

Specialized Surgical Tourniquet

In BFR, a physical therapist applies a specialized surgical tourniquet to an injured limb to partially restrict blood flow during low-weight strength training. This signals the body to use fast-twitch muscle fibers typically set aside for high-resistance exercise such as heavy weight lifting, Owens explained.

As a result, the brain triggers an “anabolic cascade,” he said, meaning substances such as human growth hormone are released at a higher-than-normal rate.

Results have been “very dramatic,” Owens said, citing 30 percent to more than 300 percent strength gains.

“The best part is the results seem to happen very quickly -- within two to four weeks,” he said.

Marine Corps Staff Sgt. Brandon Kothman started BFR three months prior to knee surgery to build muscle strength and function, then resumed training immediately after. His surgeons told him he should be back running in nine months to a year, but thanks to the BFR, “I was running after three months and released back to full duty in six,” he said during a recent ESPN interview.

This day at the Center for the Intrepid, he’s lifting a 10-pound weight on a leg extension machine while wearing a tourniquet.

“It feels like I’m lifting 40 or 50 pounds,” he said, slightly out of breath.

Building Strength Without Pain, Further Injury

Owens first learned of the training about three years ago when researching ways to help his patients with lower extremity injuries. He wanted to help them build strength quickly and effectively without the pain or risk of further injury to an already compromised limb.

“To get strong, you need to lift heavy weight, but warriors with severely damaged limbs often can’t do that,” he explained. “I wanted to find a solution that would prevent my patients from a frustrating recovery or even, in some cases, opting to amputate their leg due to a lack of strength gain over time.”

Owens’ enthusiasm for the training was tempered by a lack of research. It’s been used sparsely in Europe and Japan, but he’s yet to hear of a practical clinical application in the United States.

However, when some well-respected journals began publishing literature on its effectiveness, he pitched it to his bosses and decided to try it on himself. After six months of positive results and the green light from leadership, he implemented the program at the Center for the Intrepid. He’s since used it to aid patients with upper and lower extremity injuries, as well as amputees.

Owens cited a recent case in which a patient showed a 372 percent increase in calf strength nine months after Achilles tendon surgery.

Potential to Benefit More People

Moving forward, Owens said, he and a team of Center for the Intrepid researchers are looking to see how BFR can benefit a variety of populations, such as those who have had knee surgery.

“Injuries can be just as devastating to a service member’s military career as to a pro athlete’s,” Owens told an ESPN reporter. “If you can’t carry a pack or run, you can’t do your job. Tourniquet training has the potential to make a remarkable impact for recovering warriors.”

On a wider scale, Owens said, he sees a tremendous benefit for civilian trauma patients, the elderly or anyone, including athletes, seeking a swift recovery from an injury. There’s also a potential for home use, he said, but that would require a smaller portable unit.

Owens stressed the importance of proper application. His tourniquet system automatically monitors and maintains pressure, he explained, and is applied and monitored by a physical therapist. In other words, at this point, “don’t try this at home,” he said.

After using BFR successfully on more than 200 warriors in the past two years, Owens said, he’s blown away by the results.

“The training has tremendous potential,” he said.