Blood Flow Restriction Training for Subacromial Pain: Two Case Reports

BACKGROUND: Blood flow restriction training (BFRT) appears to promote the strengthening of shoulder muscles, but primary clinical applications are limited to the lower extremity. CASE PRESENTATION: Two female recreational athletes (Case A: 27 years old; Case B: 28 years old) with subacromial pain were treated with BFRT (50% occlusion) during 3 isotonic strengthening exercises of the upper extremity against 20% of the maximal isometric strength. At the beginning of each treatment week, we measured strength with a handheld dynamometer to ensure appropriate load progression. OUTCOME AND FOLLOW-UP: Case A completed 16 visits and Case B completed 22 visits of BFRT with no adverse events. At discharge, we found meaningful improvement for patient-reported function, clinical measures of shoulder flexion and external-rotation range of motion and isometric strength, supraspinatus and infraspinatus cross-sectional area, and upper extremity performance. DISCUSSION: BFRT may be a valuable adjunct to standard rehabilitation for the conservative management of subacromial pain. Despite the inherent limitations of our design, we believe these preliminary findings are compelling to warrant future investigations.