Houston Texans using BFR training

In November, researchers at Brooke Army Medical Center (BAMC) shared how their use of blood flow restriction (BFR), or "tourniquet," training is helping wounded warriors return to health.

Now the technique is being implemented by one NFL team, and more could soon follow their lead.

The prospect of minimizing early muscular strength deficits while protecting healing tissue was the impetus for the Houston Texans to introduce the technique to several of their players -- including 2014 top draft pick Jadeveon Clowney -- rehabilitating post-operatively.

Dr. Walt Lowe, head team physician for the Texans, was intrigued enough by BAMC's early results to investigate how they could apply the technique in their setting. Lowe and Texans director of sports medicine Geoff Kaplan, a dual-certified physical therapist and athletic trainer, met with Johnny Owens, physical therapist and chief of human performance optimization at the Center for the Intrepid (CFI) at BAMC (who introduced the training to the facility) to learn more about his clinical research and protocols.

The scientific basis for the physiologic response to BFR training and its success within the military population gave Lowe and Kaplan the confidence to move forward.

Several Texans players are currently undergoing BFR training as a component of their rehabilitation, including Clowney, who is recovering from microfracture surgery on his right knee. (After initially undergoing surgery to address a lateral meniscus tear in September, persistent pain associated with an accompanying cartilage injury led to the second surgery in December.)

Quarterback Ryan Fitzpatrick, recovering from surgery in December to repair a tibia fracture and linebacker Brian Cushing, who has undergone several surgeries on his left knee, are also among those performing BFR training.

While it's too early in the recovery process to draw any overall conclusions, the Texans' medical staff is encouraged by what they're seeing so far.

"Players are saying they feel better and their legs are getting stronger," Kaplan said, noting that based on his own observations, the small group of players undergoing BFR training seem to be progressing more quickly than others in the past recovering from similar procedures.

For instance, one player recently shed his crutches, immediately walking with no apprehension or limp. While there are still many steps before returning to the football field, the transition to regular walking off extended use of crutches is often difficult.

"The athletes [undergoing BFR training] are exhibiting better muscle control and making progressions -- like moving from double-leg activities to single-leg -- faster than what we typically see."

When Owens first shared BAMC's clinical and research findings with the public last fall, it immediately garnered the interest of the NFL. Dr. Matthew Matava, head team physician for the St. Louis Rams and president of the NFL Team Physicians Society, said at the time that BAMC's early results were encouraging. So encouraging, in fact, that Matava extended an invitation to Owens to present his research to medical personnel gathered in Indianapolis this week for the NFL combine.

The most beneficial aspect of this technique," said Matava, "may be the ability to improve muscle strength while avoiding the stress of high-resistance exercise in the early phases of rehabilitation."

Matava notes that all involved in the care of injured NFL athletes are constantly looking for ways to improve the rehabilitation and recovery process, and BFR training appears to be an evolving, exciting area of rehab science. He says he is "cautiously optimistic" about the application within the NFL population but is eager to see further research comparing outcomes of BFR training to other standard techniques.

The Texans may be among the first to be able to provide such outcomes. Kaplan cites the advantage of working with a progressive, scientific-minded team physician such as Lowe and a supportive organization in the Texans as reasons they represent the first foray of this technique into an NFL training room. But he emphasizes it was Owens' knowledge and expertise along with the rigorous clinical research methods of BAMC that brought credibility to the process.

As Owens points out, NFL players might represent a "new" athlete population for this treatment, but the first group of elite athletes to undergo treatment was in the military.

"We have our own premier athletes, and they're the Special Forces," he said. "We consistently use this technique on our Special Forces, many of whom have been severely compromised from blast trauma. We've seen great results with no adverse events."

It might not be long until other teams follow the Texans' lead. After Owens' combine presentation, Carolina Panthers head athletic trainer and physical therapist Ryan Vermilion said he plans to investigate it further.

"This was my first exposure to this form of treatment," Vermilion said, adding, "I was very impressed by the supportive evidence, especially in the treatment of ACL reconstructions and Achilles repairs. If it will help our athletes, I'm interested in learning more."