REPAIR: Rehabilitation Enhanced by Partial Arterial Inflow Restriction


Principal Investigator: Daniel J. Stinner, MD


The loss of function and disability after severe lower limb trauma in the military is well documented. One major factor that drives loss of function is the inability to regain muscle strength and endurance after these significant injuries. Guidelines from the American College of Sports Medicine recommend the use of resistance during training that approximates 80% of the individual’s 1 repetition maximum (RM) to induce a strength and hypertrophy response. Unfortunately, these loads are not well tolerated after major limb trauma.

Recently, a novel method has emerged that allows a person to restore strength using low loads, as low as 20% 1 Repetition Maximum (RM). This method of training utilizes brief and intermittent blood flow restriction via a tourniquet to restrict partial arterial inflow and venous outflow to an exercising limb. Blood flow restriction training at low loads has consistently demonstrated improved muscle strength and hypertrophy compared to the same low load training without restriction.

The purpose of this study is to test the effectiveness of the REPAIR intervention (physical therapy (PT) plus blood flow restricted (BFR) training) when compared to usual care PT alone. We hypothesize that REPAIR will lead to improved long-term functional outcomes, largely through its effect on increasing muscle strength and muscle volume.

Sponsored by: DOD PRORP/CDMRP