Back in 2017, a Texans NFL player walked into Evoker Physiotherapy to keep on top of his post operation treatment, following a pectoral tear.

It was a positive experience and one that resulted in an ongoing dialogue between head physiotherapist Adam Monteith and the sports medicine team at The Texans.

“I did speak a lot about the respect that their player showed my staff and my team, and I commended them on the culture that they were driving behind the scenes,” Monteith said.
 
“Perhaps this resonated, and within six months of that player’s visit, I was in Houston, putting a face to the name of the email signatures.”

Since then, Monteith has made annual trips to Houston to check out the latest in physiotherapy techniques, and bring them back to his team at Evoker.

“My number one priority is to connect, and build genuine relationships, with other physios in the world, that are also great at what they do - discuss, collaborate, and share ideas with people that I now call friends,” Monteith says.

“I’m there to observe and experience an authentic American Football environment, through a sports medicine lens - from ‘tissue prep’ at 6am, to strapping - the fastest that I’ve ever seen - at 8am, to activation at 10am, to practice at full speed, to running drills, to strength and conditioning in gym, and finally, ice baths.”

Monteith’s first call of action is establish how his practice compares to the world class physiotherapists of the NFL.

“My impression at each visit has always been - we are not missing a beat here in Australia.

“In fact, I’m rather pleased at how ‘good’ we Australian physiotherapists actually are.

“Our thinking, our clinical reasoning, and our no nonsense ‘roll the sleeves up’ manual therapy is second to none. 

“That said, my mind is always open to ‘how could we be doing this better?”

Which is where part two of his annual pilgrimage comes into play – finding out what’s new.

“And this mainly refers their advances in technology. What are they now using to get better, or faster, patient or player outcomes?

“They do not have a second to waste when attempting to get a player back on the field. They also have plenty of budget.”

And it’s paid off. So far, thanks to Monteith’s trips to Houston, Evoker has discovered a range of new technology, including Graston tools, the use of Alter G treadmills and their latest discovery - Blood Flow Restriction (BFR) Therapy.

“When we discover something great, we will immediately purchase the technology if we see it as a good fit.

“At the end of the day, everyone wants to get better faster, not just the highly paid players of the NFL.”

Altitude training for the lungs

Monteith describes BFR as like altitude training for the lungs.

“BFR places the limb in an oxygen deprived environment, whilst we ask it to exercise at very low loads,” he explains.

“Low loads, or very little resistance, under BFR occlusion, coupled with the specific sets and reps of 30/15/15/15 in targeted exercise, has been proven to produce greater rates of strength change than the typical heavy ‘gym based’ resistance training.

“The appeal for a physiotherapist here, which is precisely why my eyes lit up when I first saw this in Houston, is that low load training will generally also be pain free training.

“People attending physio are often in pain.

“If they likely require strength to combat said pain, then we are often trying to strengthen a limb in and around their typical pain aggravating behaviours.

“This can be difficult, or in some cases, quite limited or slow. In my mind, BFR is an absolute game changer for the entire physiotherapy profession.”

How does it work?

Blood Flow Restricted (BFR) rehabilitation is the brief occlusion of venous blood flow using a tourniquet while exercising.

“Within the body, arteries take the blood into a muscle, and veins take the blood away from the muscle.

“Partially restricting the outward flow of blood from the muscle, causes the muscle to swell with blood, consisting of metabolites and lactic acid.”

The metabolites stimulate muscle growth and the lactic acid increases protein synthesis. This build-up of blood to the muscle fibres stimulates a metabolic response which forces the fibres to adapt, thus creating an increase in muscle strength, size and function.

“The result of blood flow occlusion is that the muscle improves in strength, size and functional aerobic capacity in shorter amounts of time with less stress on the body than in ‘normal gym’ training.”

Who does it benefit?

According to Monteith BFR benefits anyone who is trying to build strength, fast, but experiences pain in doing so.

“Someone who is trying to build quad muscle, but gets pain when they squat. Their knee pain kicks in before they feel any real fatigue in the quad.

“If this person were to apply BFR, they would be doing rather simple quad exercises, at very low loads, so no knee pain, and they would feel genuine fatigue in the quad, and they would also be building quad muscle strength much faster than if they were able to squat heavy resistance in the gym.

“It’s a win/win. No knee pain and faster strength gain.”

Other conditions it can be used for are:

1. Shoulders – unstable or dislocated shoulders.
2. Elbows – tennis elbow.
3. Hips – OA and glut tendon pathologies.
4. Knees – OA, Patella tendinopathy, meniscal pains, ACL reconstruction, PCL/MCL/LCL ligament sprains.
5. Ankles - sprains, Achilles tendinopathies.
6. Running tendon problems.
7. Muscle tears – hamstring and calf.

“We use BPR for all these conditions, but ACL reconstructions is where we truly see it shine.

The patient must be able to tolerate some discomfort in the limb, when the pressure to occlude is on, and hard work.

“Even though the load is light, and there is no joint pain, the patient must still push through muscle fatigue, whilst holding perfect form, to get the greater strength gains.

“Provided our motivated patient can do this, then we would consider them a good candidate for BFR.

“BFR does require a willingness for hard work, and there is some slight discomfort under occlusion, so it is not for everyone. But, for those people that are a good fit for BFR, they do very, very well.”