The discussion points for this paper are several, some broad and some specific, but to touch on a few…
All of these questions have come from reading of the abstract alone. Let’s explore.
1. BFR fundamentally challenges assumptions around load magnitude and tendon rehab.
The mechanism of exercises effect is nowhere near as well understood we feel it could/should or would like it to be. Working at lower load magnitudes being effective challenges the assumption that higher load magnitudes is needed for improvements in tendon symptoms. More studies evaluating these mechanisms, not just improvements in pain/PROMs is needed.
2. With a sample size of 46, have they achieved sufficient power?
Page 805 does a good job of satisfying this concern.
3. How have they defined/arrived at the diagnosis of LE tendinopathy?
Page 804 ‘Participants’ almost sorts this for me, but given that a neural driver for LE pain is common, I could argue that there is a lack of transparency about how this was evaluated/excluded. But the inc. criteria is well defined and reproducible in our clinics.
4. In what population was this conducted – what is the external validity of these findings – i.e. how readily could they be applied to our patient group?
Greek private practice. Sure UK PP would be more applicable, but certainly useful.
5. How well was BFR tolerated?
Page 807 ‘Results’ first section addresses this concern explicitly.
6. How was it applied, have the methods been described in sufficient detail that any practitioner could deliver their protocol tomorrow?
In conclusion, a good and insightful paper, but there are gaps. When establishing 1RM, they describe pain as a cut off for stopping – this sparks the questions, how much pain, if any? With the intervention itself, sets and reps are there, but not time under tension. There are progression markers of no pain with the exercises to progress to stage two.
An interesting read and certainly food for thought.
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