Prehabilitation with low-load blood flow restricted resistance exercise training attenuates muscle inhibition of quadriceps femoris muscle in polytraumatized patient : a case report

Ipavec, Matej (author), Kacin, Alan (author), Tomc Žargi, Tina (author)

Background: Severe knee trauma and chronic cruciate ligament insufficiency are commonly accompanied by marked quadriceps femoris (QF) atrophy and weakness. High-load strengthening is often poorly tolerated by patients with compromised joint stability; therefore, low-load blood flow restriction resistance training (LL-BFRT) may serve as an effective alternative. Case presentation: A 38-year-old male presented 27 months after motorcycle-related polytrauma with right knee pain, instability, complete anterior and posterior cruciate ligament ruptures, and partial QF denervation after femoral nerve injury. Before surgery, he completed a supervised 5-week LL-BFRT prehabilitation program (13 sessions). Results: Lean thigh circumference increased by 5.9% proximally and 17.7% distally. Voluntary activation increased from 87.2% to 92.5%, and maximal QF EMG median frequency decreased by 7.4%. Knee extensor isometric and concentric (60°/s) peak torque increased by 52.4% and 36.9%, respectively. QF isometric endurance time increased from 48.5 to 61.8 s. Stair-climbing time decreased from 18.9 to 10.6 s, repetitions in the step-down test increased from 10 to 17, and the Y-balance test composite score increased from 77.7% to 99.4%. Conclusions: Substantial physiological and clinical improvements in QF voluntary activation, maximal strength, endurance, and lower limb function were observed following a short-term LL-BFRT program in a patient with multiple ligament injuries. Changes in lean thigh circumference were consistent with possible improvements in muscle size; however, muscle hypertrophy was not directly assessed.

• Language: English
• Keywords: ischaemic training, voluntary muscle activation, polytrauma, knee, musculoskeletal injuries
• Work type: Article
• Typology: 1.01 - Original Scientific Article
• Organization: ZF - Faculty of Health Sciences
• Publication version: Version of Record
• Publication date: 01.01.2026
• Year: 2026
• Number of pages: 13 str.
• Numbering: Vol. 16, iss. 12, art. 6079
• PID: 20.500.12556/RUL-183682
• UDC: 615.82/.84
• ISSN on article: 2076-3417
• DOI: 10.3390/app16126079
• COBISS.SI-ID: 281888259
• Publication date in RUL: 17.06.2026

Record is a part of a journal

• Title: Applied sciences
• Shortened title: Appl. sci.
• Publisher: MDPI
• ISSN: 2076-3417
• COBISS.SI-ID: 522979353

Licences

• License: CC BY 4.0, Creative Commons Attribution 4.0 International
• Link: http://creativecommons.org/licenses/by/4.0/
• Description: This is the standard Creative Commons license that gives others maximum freedom to do what they want with the work as long as they credit the author.

Projects

• Funder: ARIS - Slovenian Research and Innovation Agency
• Project number: P3-0043-2020
• Name: Molekularni mehanizmi razvoja in delovanja skeletne mišice