Recovering from an injury is a complex, but fascinating process in which the body is able to repair itself, lay down tissue quickly, and adapt. There are two primary pathways that interplay in order for the body to build itself back up after an injury: the process of laying down scar tissue, and muscle repair. Components such as heavy load strength training initiate the muscle building process. Here, the body adapts to external stimuli and stress by laying down more muscle fibers and inducing hypertrophy (Laying down more cells to induce muscle growth within the tissue). However, with an injury or strain, the body needs to initiate the healing process much quicker than simply laying down more muscle. Muscle is metabolically expensive to the body and is much slower to build back up, so the healing process post injury is a little different than your typical strength training muscle building response. This is where the formation of scar tissue comes into play.
Scar tissue formation is a process in which the body is able to quickly respond to an injury or strain by laying down connective tissue primarily composed of collagen and fibroblasts (types of cells that secrete collagen proteins). The body bypasses laying down muscle and instead induces scar tissue since an injury is a large stress on the body, and it needs to bounce back as quickly as possible. TGF-B is the main pathway that is signaled during this response. Myostatin, which is a part of this pathway responsible for shutting down muscle growth, is highly activated following an injury so that the body can reserve its energy for scar tissue formation instead. Surgeries elevate myostatin, as well as any other significant stressors to a limb that accompany an injury. Although scar tissue is a very important component of the body's healing process, and restores one’s limb quickly, it can be detrimental in terms of proper mobility, efficiency and pain free movement patterns down the road because the tissue is a quick fix, resulting in lower quality and flexibility (Owens, 2022).
So how can we minimize scar tissue formation in a rehab setting? Personalized Blood Flow Restriction training is an excellent tool to utilize for minimal scar tissue formation and increased muscle healing right off the bat following a surgery or injury. By forcing the limb into a hypoxic (oxygen deficient state), BFR suppresses Myostatin, allowing muscle proteins to begin to lay down more muscle tissue. With BFR inducing a protein synthesis response, the body will kick into muscle repairing mode, and bypass the need to lay down excessive scar tissue. BFR also initiates the proliferation of satellite cells (cells that are essential in repairing, regenerating and growing muscle), which is another reason the body will override scar tissue building and instead turn to muscle growth. Lastly, BFR is an excellent catalyst to the body’s release of beta-endorphins (the body’s natural feel-good hormone and pain reducer) and signaling neuromuscular responses so that movement patterns can come back as quickly and efficiently as possible. Not to mention, we are able to use low load resistance exercises in addition to the BFR. This allows the limb to get a positive effect without overly loading or stressing the joint, while it heals up from the injury all at the same time.
By utilizing BFR as soon as possible following a surgery, injury or muscle atrophy, we are able influence the body’s physiological processes to minimize scar tissue, induce hypertrophy and muscle growth early on. This is highly beneficial and necessary so that the body does not adapt to limited range of motion, improper movement patterns or low quality tissue within the injury site. All of our clients here at Rocky Mountain Therapros who have utilized the BFR program early on in their rehab process have been able to return to sport with improved muscle balance, lower overall pain and increased muscle activation.
Written by Caitlin Kinney, Certified Personal trainer
References:
Owens, Johnny. “Managing Muscle Strains via Personalized Blood Flow Restriction Training (PBFR),” March 24, 2022. https://owensrecoveryscience.com/blog-view/?permalink=managing-muscle-strains-via-personalized-blood-flow-restriction-pbfr